Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis

Designing for the post-pandemic era: Trends, focuses, and strategies learned from architectural competitions based on a text analysis

The COVID-19 pandemic has made the built environment an important source of prevention and control, architects and scholars have thus been seeking countermeasures since the beginning of the outbreak. As design and construction cycles are long, only a few completed cases and evidence-based studies are available for reference. However, massive architectural competition works have emerged, which always been the soil for discussion and practice of cutting-edge design issues. These contain a vast number of ideas for solutions from various design dimensions-including cities, buildings, and facilities-and provide a great deal of materials worth analyzing and summarizing. Therefore, the exploration of competitions will provide us with public health intervention directions, strategies and a rethinking of the built environment. Using a text-mining approach, we analyzed 558 winning entries in architectural competitions related to the pandemic response, exploring specific issues, populations involved, coping strategies, and trends that emerged as the pandemic evolved. Our results show that the strategies proposed can be grouped into 17 keywords, with modularization being the most frequent strategy and related strategies like rapid assembly, flexible space, etc. are also took a significant percentage of the use. Further, we explored the technical orientation, year, territory, target groups, and target problems of the works which lead to a series of cross-comparison relationships. The results indicate that indirect impacts caused by the pandemic gained more attention and flexible Solutions were used more often highlighted the consensus when adapting to the uncertainties. The focus on the spiritual dimension is increasing year by year reflected the spiritual influences were gaining traction and the indirect impacts gradually showed up over time. The research will provide a strategy reference for the design response to the pandemic, as well as help understand the influence and significance of social factors behind the divergence of issue focuses and strategic tendency in different regions and times.

WASH, nutrition and health-seeking behavior during COVID-19 lockdowns: Evidence from rural Bangladesh

A general lockdown to minimize to slow transmission of COVID-19 in Bangladesh came into effect on March 26th and lasted until May 30th. The lockdown had far-reaching economic implications for the population, with many facing economic hardship due to loss of income. Despite the attempt of the government to ease economic hardship by means of social safety net packages, people suffered from poor access to health services, and financial and food insecurity. This is likely to have disastrous consequences for the nutritional status of young children. This cross-sectional study measured the impact of the first general lockdown on food consumption of young children, access to water, handwashing and health seeking behavior, and the ability to maintain livelihood among households with children under the age of 5, in rural Bangladesh. The result of the analysis suggest that loss of income was reported by almost all respondents across all socio-economic groups. However, the poorest households were less likely to provide for sufficient food for their families and had to reduce consumption of food. Diet diversity and food intake-particularly animal protein sources-for young children were severely affected. On the other, increased awareness of handwashing and access to soap were also reported. The pandemic is likely to be detrimental to the nutritional status of children in Bangladesh and can exacerbate existing health inequities. Strong social safety net programs are needed to protect vulnerable populations to consequences of restrictive measures, supported in design and implementation by non-governmental organizations.

Time-series comparison of COVID-19 case fatality rates across 21 countries with adjustment for multiple covariates

OBJECTIVES

Although it is widely used as a measure for mortality, the case fatality rate (CFR) ofcoronavirus disease 2019 (COVID-19) can vary over time and fluctuate for many reasons otherthan viral characteristics. To compare the CFRs of different countries in equal measure, weestimated comparable CFRs after adjusting for multiple covariates and examined the mainfactors that contributed to variability in the CFRs among 21 countries.

METHODS

For statistical analysis, time-series cross-sectional data were collected from OurWorld in Data, CoVariants.org, and GISAID. Biweekly CFRs of COVID-19 were estimated bypooled generalized linear squares regression models for the panel data. Covariates includedthe predominant virus variant, reproduction rate, vaccination, national economic status,hospital beds, diabetes prevalence, and population share of individuals older than age 65. Intotal, 21 countries were eligible for analysis.

RESULTS

Adjustment for covariates reduced variation in the CFRs of COVID-19 across countriesand over time. Regression results showed that the dominant spread of the Omicron variant,reproduction rate, and vaccination were associated with lower country-level CFRs, whereasage, the extreme poverty rate, and diabetes prevalence were associated with higher countrylevel CFRs.

CONCLUSION

A direct comparison of crude CFRs among countries may be fallacious, especiallyin a cross-sectional analysis. Our study presents an adjusted comparison of CFRs over timefor a more proper comparison. In addition, our findings suggest that comparing CFRs amongdifferent countries without considering their context, such as the epidemic phase, medicalcapacity, surveillance strategy, and socio-demographic traits, should be avoided.

Release of phthalate esters (PAEs) and microplastics (MPs) from face masks and gloves during the COVID-19 pandemic

Marine pollution with personal protective equipment (PPE) has recently gained major attention. Multiple studies reported the release of microplastics (MPs) and chemical contaminants from face masks, the most used PPE type. However, not much is known concerning the release of phthalate esters (PAEs) in aquatic media, as well as the hazard posed by other types of PPE. In the present study, we investigated the release of MPs and PAEs from face masks and gloves recovered from the environment. The results indicated that both PPEs release MPs comparable to the literature, but higher concentrations were presented by face masks. In turn, the total concentration of six PAEs was higher in gloves than in face masks. The release of these contaminants is exacerbated over time. The present study allows researchers to understand the contribution of PPE to marine pollution while accounting for gloves, a generally overlooked source of contaminants.

Randomized trials on non-pharmaceutical interventions for COVID-19: a scoping review

OBJECTIVE

We aimed at providing a systematic overview of randomised trials assessing non-pharmaceutical interventions (NPIs) to prevent COVID-19.

DESIGN

Scoping review.

METHODS

We included all randomised trials assessing NPIs to prevent COVID-19 in any country and setting registered in ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform using the COVID-evidence platform (until 17 August 2021). We searched for corresponding publications in MEDLINE/PubMed, Google Scholar, the Living Overview of Evidence platform, and the Cochrane COVID-19 registry as well as for results posted in registries (until 14 November 2021). Descriptive statistics using numbers and percentages were used in the narrative synthesis of the results.

RESULTS

We identified 41 randomised trials. Of them, 12 were completed (29.3%) including 9 with published results. The 41 trials planned to recruit a median of 1700 participants (IQR 588-9500, range 30-35 256 399) with a median planned duration of 8 months (IQR 3-14, range 1-24). Most came from the USA (n=11, 26.8%). The trials mostly assessed protective equipment (n=11, 26.8%), COVID-19-related information and education programmes (n=9, 22.0%), access to mass events under specific safety measures (n=5, 12.2%), testing and screening strategies (n=5, 12.2%) and hygiene management (n=5, 12.2%).

CONCLUSIONS

Worldwide, 41 randomised trials assessing NPIs have been initiated with published results available to inform policy decisions for only 9 of them. A long-term research agenda including behavioural, environmental, social and systems level interventions is urgently needed to guide policies and practices in the current and future public health emergencies.

Maternal and infant outcomes in women with and without gestational diabetes mellitus in the COVID-19 era in China: Lessons learned

Aims

The global COVID-19 pandemic has required a drastic transformation of prenatal care services. Whether the reformulation of the antenatal care systems affects maternal and infant outcomes remains unknown. Particularly, women with gestational diabetes mellitus (GDM) are among those who bear the greatest brunt. Thus, this study aimed to evaluate the impact of COVID-19 lockdown during late pregnancy on maternal and infant outcomes in women stratified by the GDM status in China.

Study design

The participants were women who experienced the COVID-19 lockdown during late pregnancy (3185 in the 2020 cohort) or not (2540 in the 2019 cohort) that were derived from the Beijing Birth Cohort Study. Maternal metabolic indicators, neonatal outcomes, and infant anthropometrics at 12 months of age were compared between the two cohorts, stratified by the GDM status.

Results

Participants who experienced COVID-19 lockdown in late pregnancy showed lower gestational weight gain than those in the control cohort. Nevertheless, they displayed a worse metabolic profile. COVID-19 lockdown during pregnancy was associated with higher glycosylated hemoglobin (HbA1c) (β= 0.11, 95% CI = 0.05-0.16, q-value = 0.002) and lower high density lipoprotein cholesterol level (HDL-C) level (β=-0.09, 95% CI = -0.14 to -0.04, q-value = 0.004) in women with GDM, adjusted for potential confounders. In normoglycemic women, COVID-19 lockdown in late pregnancy was associated with higher fasting glucose level (β= 0.10, 95% CI = 0.08-0.12, q-value <0.0001), lower HDL-C level (β=-0.07, 95% CI = -0.08 to -0.04, q-value <0.0001), and increased risk of pregnancy-induced hypertension (adjusted OR=1.80, 95%CI=1.30-2.50, q-value=0.001). The fasting glucose level decreased less from early to late pregnancy in women who experienced COVID-19 lockdown than in the controls, regardless of the GDM status. The HDL-C has risen less with COVID-19 lockdown in the normoglycemic subgroup. In contrast, no significant differences regarding neonatal outcomes or infant weight were found between the two cohorts.

Conclusion

Experiencing the COVID-19 lockdown in pregnancy was associated with worse maternal metabolic status but similar neonatal outcomes and infant weight.

Narrative Review of the COVID-19 Pandemic's First Two Years in Italy

Italy was the first country in the western world to be affected by the COVID-19 pandemic, arguably among the worst-affected ones, counting 12 million cases and 150 thousand deaths two years since the first case. Facing new challenges, Italy has enacted different strategies and policies to limit the spread of the SARS-CoV-2 virus and treat those affected by COVID-19. This narrative review provided an overview of factors, measures, and actions that shaped Italy's first two years of the COVID-19 pandemic by investigating epidemiological data and using a mixed-method approach. This narrative review aimed to summarize the most relevant aspects and measures and analyze available data to provide policymakers and healthcare providers with the instruments to learn from this pandemic and improve their preparedness for future pandemic events. The first two years of the pandemic differ in that, during the first year, significant necessary changes to the way health systems were organized were implemented, increasing healthcare spending and adopting social and physical distancing measures that were stricter than the ones adopted in the second year. However, as the pandemic progressed, increased knowledge of the virus and related variants, as well as the introduction of highly effective vaccines, which were not equally available to the whole population, resulted in a stratification of COVID-19 infections and deaths based on factors such as age, vaccination status, and individual susceptibility to the virus.

Persisting Vaccine Hesitancy in Africa: The Whys, Global Public Health Consequences and Ways-Out-COVID-19 Vaccination Acceptance Rates as Case-in-Point

Vaccine hesitancy (VH) is the seventh among the WHO's top 10 threats to global public health, which has continued to perpetuate the transmission of vaccine preventable diseases (VPDs) in Africa. Consequently, this paper systematically reviewed COVID-19 vaccine acceptance rates (VARs)-including the vaccine uptake and vaccination intention-in Africa from 2020 to 2022, compared the rates within the five African regions and determined the context-specific causes of VH in Africa. Generally, COVID-19 VARs ranged from 21.0% to 97.9% and 8.2% to 92.0% with mean rates of 59.8 ± 3.8% and 58.0 ± 2.4% in 2021 and 2022, respectively. Southern and eastern African regions had the top two VARs of 83.5 ± 6.3% and 68.9 ± 6.6% in 2021, and 64.2 ± 4.6% and 61.2 ± 5.1% in 2022, respectively. Based on population types, healthcare workers had a marginal increase in their mean COVID-19 VARs from 55.5 ± 5.6% in 2021 to 60.8 ± 5.3% in 2022. In other populations, the mean VARs decreased from 62.7 ± 5.2% in 2021 to 54.5 ± 4% in 2022. As of 25 October 2022, Africa lags behind the world with only 24% full COVID-19 vaccinations compared to 84%, 79% and 63% reported, respectively, in the Australian continent, upper-middle-income countries and globally. Apart from the problems of confidence, complacency, convenience, communications and context, the context-specific factors driving COVID-19 VH in Africa are global COVID-19 vaccine inequality, lack of vaccine production/maintenance facilities, insecurity, high illiteracy level, endemic corruption, mistrust in some political leaders, the spreading of unconfirmed anti-vaccination rumors and political instability. With an overall mean COVID-19 acceptance rate of 58%, VH still subsists in Africa. The low VARs in Africa have detrimental global public health implications, as it could facilitate the emergence of immune invading SARS-CoV-2 variants of concern, which may spread globally. Consequently, there is a need to confront these challenges frontally and engage traditional and religious leaders in the fight against VH in Africa, to restore public trust in the safety and efficacy of vaccines generally. As the availability of COVID-19 vaccines improves, the vaccination of pets and zoo-animals from which reverse zoonotic transmission of SARS-CoV-2 have been reported is recommended, to limit the evolution and spread of new variants of concern and avert possible SARS-CoV-2 epizootic or panzootic diseases in susceptible animal species.

SARS-CoV-2-specific humoral and cellular immune responses to BNT162b2 vaccine in Fibrodysplasia ossificans progressiva patients

Introduction

Fibrodysplasia ossificans progressiva (FOP) is characterized by progressive heterotopic ossification triggered by various conditions, such as trauma, infection, including COVID-19 infection, and vaccination. Although SARS-CoV-2 vaccinations prevent poor outcomes in the general population, there is limited evidence on safety, immunogenicity, and efficacy of SARS-CoV-2 vaccines for inpatients with FOP.

Methods

A case series of two patients with FOP focused on humoral, cellular post-vaccination response, and the incidence of adverse events after administration of the BNT162b2 vaccine (Comirnaty).

Results

Injection site reactions, fever, myalgia, and fatigue were the most common adverse events (AE). Neither severe AE (SAE), nor disease flare-ups were observed. No differences between patients with FOP and healthy controls were observed in humoral and cellular responses.

Conclusions

The BNT162b2 vaccine induced high humoral and cellular response levels in patients with FOP. Vaccination was not associated with SAE or disease relapse. The AEs spectrum was comparable to that of the general population.

Exposure to images showing (non)adherence to physical distancing rules: Effect on adherence behavior and perceived social norms

Introduction

Adherence to behavioral measures such as physical distancing are key to mitigating the effects of viral pandemics such as the COVID-19 pandemic. Adherence depends in part on people’s perception of what others do (descriptive norms) or approve of (injunctive norms). This study examines the effects that exposure to images depicting people following or breaking physical distancing rules have on perceptions of descriptive and injunctive norms and subsequent adherence behavior.

Methods

An online between-subjects experiment (n = 315) was conducted, in which participants were exposed to a set of five photographs of different public spaces in which people either did or did not adhere to physical distancing rules (pre-registration: https://www.osf.io/uek2p). Participants’ adherence behavior was measured using a triangulation of measures (incentivized online behavioral task, vignettes, intention measure). Perceptions of relevant social norms were also measured.

Results

Mann-Whitney tests showed no effects of condition on perceptions of descriptive and injunctive norms or on adherence behavior. Linear regressions showed that both component paths of the indirect effect (condition on norm perceptions, and norm perceptions on adherence behavior) were non-significant, hence mediation analyses were not conducted.

Conclusions

Exposure to images of people following (compared to breaking) physical distancing rules did not affect adherence to such rules or perceived norms. We surmise that a single exposure to such images, especially in the context of COVID-19, is insufficient to affect behavior. We therefore recommend performing a comparable experiment in which participants are exposed repeatedly to images showing people (non)adhering to a specific behavior in a particular context for a longer period.

Acute Respiratory Distress Syndrome and the Use of Inhaled Pulmonary Vasodilators in the COVID-19 Era: A Narrative Review

The Coronavirus disease (COVID-19) pandemic of 2019 has resulted in significant morbidity and mortality, especially from severe acute respiratory distress syndrome (ARDS). As of September 2022, more than 6.5 million patients have died globally, and up to 5% required intensive care unit treatment. COVID-19-associated ARDS (CARDS) differs from the typical ARDS due to distinct pathology involving the pulmonary vasculature endothelium, resulting in diffuse thrombi in the pulmonary circulation and impaired gas exchange. The National Institute of Health and the Society of Critical Care Medicine recommend lung-protective ventilation, prone ventilation, and neuromuscular blockade as needed. Further, a trial of pulmonary vasodilators is suggested for those who develop refractory hypoxemia. A review of the prior literature on inhaled pulmonary vasodilators in ARDS suggests only a transient improvement in oxygenation, with no mortality benefit. This narrative review aims to highlight the fundamental principles in ARDS management, delineate the fundamental differences between CARDS and ARDS, and describe the comprehensive use of inhaled pulmonary vasodilators. In addition, with the differing pathophysiology of CARDS from the typical ARDS, we sought to evaluate the current evidence regarding the use of inhaled pulmonary vasodilators in CARDS.

Global SARS-CoV-2 seroprevalence from January 2020 to April 2022: A systematic review and meta-analysis of standardized population-based studies

BACKGROUND

Our understanding of the global scale of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains incomplete: Routine surveillance data underestimate infection and cannot infer on population immunity; there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS-CoV-2 seroprevalence studies, standardized to those described in the World Health Organization's Unity protocol (WHO Unity) for general population seroepidemiological studies, to estimate the extent of population infection and seropositivity to the virus 2 years into the pandemic.

METHODS AND FINDINGS

We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between January 1, 2020 and May 20, 2022. The review protocol is registered with PROSPERO (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies-those aligned with the WHO Unity protocol-were extracted and critically appraised in duplicate, with risk of bias evaluated using a modified Joanna Briggs Institute checklist. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate underascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% low- and middle-income countries [LMICs]) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/subnational scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vaccination was 59.2%, 95% CI [56.1% to 62.2%]. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% [24.6 to 28.8] to 86.7% [84.6% to 88.5%] in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% [8.3% to 11.0%] in June 2020 to 95.9% [92.6% to 97.8%] in December 2021, in European high-income countries [HICs]). After the emergence of Omicron in March 2022, infection-induced seroprevalence rose to 47.9% [41.0% to 54.9%] in Europe HIC and 33.7% [31.6% to 36.0%] in Americas HIC. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0 to 9 years and adults 60+ were at lower risk of seropositivity than adults 20 to 29 (p < 0.001 and p = 0.005, respectively). In a multivariable model using prevaccination data, stringent public health and social measures were associated with lower seroprevalence (p = 0.02). The main limitations of our methodology include that some estimates were driven by certain countries or populations being overrepresented.

CONCLUSIONS

In this study, we observed that global seroprevalence has risen considerably over time and with regional variation; however, over one-third of the global population are seronegative to the SARS-CoV-2 virus. Our estimates of infections based on seroprevalence far exceed reported Coronavirus Disease 2019 (COVID-19) cases. Quality and standardized seroprevalence studies are essential to inform COVID-19 response, particularly in resource-limited regions.

COVID-19 public health and social measures: a comprehensive picture of six Asian countries

The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.

Understanding the impact of lockdowns on short-term excess mortality in Australia

During 2020 and 2021, Australia implemented relatively stringent government restrictions yet had few COVID-19 deaths. This provides an opportunity to understand the effects of lockdowns and quarantining restrictions on short-term mortality and to help provide evidence in understanding how such public health policies can impact on health. Our analysis is based on preliminary mortality data collected by the Australian Bureau of Statistics. Rates were estimated by disease and over time and compared with mortality statistics in the period 2015-2019. Comparing deaths in 2020-2021 with 2015-2019 show the annual mortality rate (per 100 000 people) fell by 5.9% from 528.4 in 2015-2019 to 497.0 in 2020-2021. Declines in mortality are across many disease categories including respiratory diseases (down 9.4 deaths per 100 000), cancer (down 7.5 deaths per 100 000) and heart disease (down 8.4 deaths per 100 000). During 2020 and 2021, Australian age-standardised mortality rates fell by 6%. This drop was similar for men and women, and was driven by a reduction in both communicable and non-communicable causes of death. Such evidence can help inform public health policies designed to both control COVID-19 and other infectious diseases.

Effect of Lockdowns on Hospital Staff in a COVID Center: A Retrospective Observational Study

At the onset of the SARS-CoV-2 pandemic, individual and social measures were strengthened through restrictive non-pharmaceutical interventions, labelled with the term “lockdown”. In Italy, there were two lockdowns (9 March 2020−3 May 2020 and 3 November 2020−27 March 2021). As part of preventive measures, healthcare workers and the administrative staff population of Policlinico A. Gemelli underwent nasopharyngeal swab tests from 1 March 2020 to 9 February 2022, a long time interval that includes the two aforementioned lockdowns. The population included 8958 people from 1 March 2020 to 31 December 2020; 8981 people from 1 January 2021 to 31 December 2021; and 8981 people from 1 January 2022 to 9 February 2022. We then analysed pseudo-anonymized data, using a retrospective observational approach to evaluate the impact of the lockdown on the incidence of SARS-CoV-2 infections within the population. Given the 14 day contagious period, the swab positivity rate (SPR) among the staff decreased significantly at the end of the first lockdown, every day prior to 18 May 2020, by 0.093 (p < 0.0001, CI = (−0.138−−0.047)). After the fourteenth day post the end of the first lockdown (18 May 2020), the SPR increased daily at a rate of 0.024 (p < 0.0001, 95% CI = (0.013−0.034)). In addition, the SPR appeared to increase significantly every day prior to 17 November 2020 by 0.024 (p < 0.0001, CI = (0.013−0.034)). After the fourteenth day post the start of the second lockdown (17 November 2020), the SPR decreased daily at a rate of 0.039 (p < 0.0001, 95% CI = (−0.050−−0.027)). These data demonstrate that, in our Institution, the lockdowns helped to both protect healthcare workers and maintain adequate standards of care for COVID and non-COVID patients for the duration of the state of emergency in Italy.

Leisure Time Physical Activity and SARS-CoV-2 Infection among ELSA-Brasil Participants

The regular practice of physical activity (PA) can reduce the chance of aggravation of the disease and lower rates of hospitalization and mortality from COVID-19, but few studies have analyzed the association of PA with the risk of infection by SARS-CoV-2. The aim of the study was to analyze the association between PA and self-reported SARS-CoV-2 infection. A longitudinal study was conducted with data from 4476 ELSA-Brasil participants who had their PA analyzed twice, once in 2016-2018 and again in 2020. PA was identified using the IPAQ at both follow-up moments and categorized into four groups: (a) remained physically inactive (reference); (b) remained physically active; (c) became physically active in the second moment; and (d) became physically inactive in the second moment. The variables of age, sex, obesity, hypertension, diabetes and specific protective practices against COVID-19 were tested as possible confounders. Data were analyzed by logistic regression. A 95% confidence interval (CI) was used. Remaining physically active was associated with a 43% reduction in the risk of SARS-CoV-2 infection only among those who used specific practices to protect against COVID-19, OR = 0.57 and CI = 0.32-0.99. The results suggested that regular practice of PA can reduce the risk of SARS-CoV-2 infection, especially among those who have used specific practices to protect against COVID-19 during the pandemic.

Nanotechnology Transition Roadmap toward Multifunctional Stimuli-Responsive Face Masks

In recent times, the use of personal protective equipment, such as face masks or respirators, is becoming more and more critically important because of common pollution; furthermore, face masks have become a necessary element in the global fight against the COVID-19 pandemic. For this reason, the main mission of scientists has become the development of face masks with exceptional properties that will enhance their performance. The versatility of electrospun polymer nanofibers has determined their suitability as a material for constructing "smart" filter media. This paper provides an overview of the research carried out on nanofibrous filters obtained by electrospinning. The progressive development of the next generation of face masks whose unique properties can be activated in response to a specific external stimulus is highlighted. Thanks to additional components incorporated into the fiber structure, filters can, for example, acquire antibacterial or antiviral properties, self-sterilize the structure, and store the energy generated by users. Despite the discovery of several fascinating possibilities, some of them remain unexplored. Stimuli-responsive filters have the potential to become products of large-scale availability and great importance to society as a whole.

Materials analysis and image-based modelling of transmissibility and strain behaviour in approved face mask microstructures

Comparisons are made between six different approved face masks concerning their particle transmissibility allied to mechanical properties. The latter involves material testing and stretch or strain behaviour under load. SEM and X-ray elemental analyses showed contrasting structures between random and ordered fibre orientations. These constitute the mask designs where transmissibility is to be minimised. Airflow velocity measurement enabled filtration to be measured between the different mask designs, from two to six layers of different fabrics in combination. SEM provided the fibre diameter and pore size of each mask layer, up to a maximum of six. Stretching each complete mask showed its elasticity and recovery behaviour on an energy basis. The energy conversion involved in mask straining involves areas enclosed within steady and cyclic load-extension plots. Thus, the work done in extending a mask and the energy recovered from its release identified a hysteresis associated with an irrecoverable permanent stretch to the mask fabric. Failure of individual layers, which occurred successively in extended stretch tests, appeared as a drop in a load-extension response. That change is associated with permanent damage to each mask and friction contact within the rearrangement of loose fibre weaves. Masks with the greatest number of layers reduced particle transmissibility. However, woven or ordered mask fabrics in two layers with different orientations provided comparable performance. Simulation of each mechanical response, velocity streamlining and fibre distribution within the mask layers are also presented.

Actitudes y opiniones de la población adolescente sobre las recomendaciones de protección de la salud frente a la COVID-19

Objetivo: determinar las opiniones y actitudes de los estudiantes de enseñanza secundaria sobre las medidas de prevención frente al virus SARS-CoV-2, así como analizar los factores asociados a una mejor actitud hacia ellas. Diseño: estudio descriptivo transversal. Emplazamiento: centros de enseñanza secundaria. Participantes: 1.886 adolescentes que cursaban enseñanza secundaria de quince institutos de cinco comunidades autónomas. Mediciones principales: mediante encuesta anónima autocumplimentada, se valoraron aspectos sociodemográficos, hábitos de salud (actividad física, consumo de alcohol y tabaco) y opiniones, percepciones y actitudes sobre las recomendaciones preventivas durante la pandemia de la COVID-19. Resultados: edad media: 13,8 años (desviación estándar [DE]:1,3). El 88,6% (intervalo de confianza [IC] 95%: 87,1-90,1) conocía las recomendaciones. El 43,4% (IC 95%: 41,2-45,7) cumplió todas las medidas durante el confinamiento y el 31,3% (IC 95%: 29,2-33,5) cumplió todas las medidas durante el resto de pandemia. La medida peor considerada fue el adelanto del cierre de establecimientos (36,1%), seguida del cierre entre ciudades (35%) y de evitar reuniones (26,6%). Mediante regresión logística, fueron variables asociadas de forma independiente a una mejor actitud hacia las medidas durante la pandemia: menor edad (odds ratio [OR]: 1,14), no consumir alcohol (OR: 2,11), conocer las recomendaciones (OR: 2,11) y creer que existirán consecuencias negativas para el país (OR: 1,48). Conclusiones: los jóvenes y las jóvenes mostraron una actitud positiva hacia las medidas frente a la COVID-19 y una mayoría las conocía. Cumplieron en gran medida las recomendaciones preventivas, aunque no en su totalidad, siendo superior su cumplimiento durante el confinamiento. La opinión sobre las medidas se relaciona con la edad, la actitud con el alcohol, el conocimiento de las medidas y las posibles consecuencias de la pandemia. Palabras clave: promoción de la salud, prevención de enfermedades, salud del adolescente, COVID-19.

Stay-at-home and face mask policy intentions inconsistent with incidence and fatality during the US COVID-19 pandemic

During the COVID-19 pandemic, many states imposed stay-at-home (SAH) and mandatory face mask (MFM) orders to supplement the United States CDC recommendations. The purpose of this study was to characterize the relationship between SAH and MFM approaches with the incidence and fatality of COVID-19 during the pandemic period until 23 August 2020 (about 171 days), the period with no vaccines or specific drugs that had passed the phase III clinical trials yet. States with SAH orders showed a potential 50-60% decrease in infection and fatality during the SAH period (about 45 days). After normalization to population density, there was a 44% significant increase in the fatality rate in no-SAH + no-MFM states when compared to SAH + MFM. However, many results in this study were inconsistent with the intent of public health strategies of SAH and MFM. There were similar incidence rates (1.41, 1.81, and 1.36%) and significant differences in fatality rates (3.40, 2.12, and 1.25%; p < 0.05) and mortality rates (51.43, 34.50, and 17.42 per 100,000 residents; p < 0.05) among SAH + MFM, SAH + no-MFM, and no-SAH + no-MFM states, respectively. There were no significant differences in total positive cases, average daily new cases, and average daily fatality when normalized with population density among the three groups. This study suggested potential decreases in infection and fatality with short-term SAH order. However, SAH and MFM orders from some states' policies probably had limited effects in lowering transmission and fatality among the general population. At the policy-making level, if contagious patients would not likely be placed in strict isolation and massive contact tracing would not be effective to implement, we presume that following the CDC's recommendations with close monitoring of healthcare capacity could be appropriate in helping mitigate the COVID-19 disaster while limiting collateral socioeconomic damages.

A systematic survey of adults' health-protective behavior use during early COVID-19 pandemic in Canada, Germany, United Kingdom, and the United States, and vaccination hesitancy and status eight months later

Adoption of health-protective behaviors, including social distancing measures, are a mainstay of mitigating pandemics, so it is important to understand the characteristics associated with those who use them or not. We aimed to delineate local and personal factors associated with self-reported use of health-protective behaviors (HPB) in response to COVID-19, among adults across 4 economically developed countries. We conducted an exploratory, cross-sectional, representative, on-line survey of adults in Canada, Germany, U.K., or the U.S. during the COVID-19 pandemic (June-July, 2020) with two and eight month follow-ups. All countries were experiencing the initial waves of the COVID-19 pandemic. We obtained N=6,990 participants, who reported 20 specific health-protective behaviors (dependent measure), along with locally mandated health measures, individual characteristics and psychological scales. Using health-protective behaviors (HPB-Quartile score) was significantly associated with 28 of 35 variables studied. In stepwise logistic regression, 21 variables predicted 23.51% of the variance in HPB-Q scores (p <.000). The strongest predictors were locally mandated protective measures, immature defense mechanisms, COVID-fears, age, moving due to COVID-19, domestic violence, and perceived emotional support from significant others. HPB-Q predicted vaccination hesitancy/willingness (OR=4.61, CI-95%: 2.66-8.00) and adoption 8 months later. During the early pandemic, HPB use was most strongly associated with locally mandated measures, followed by psychiatric, demographic, and other personal factors. Considering these empirically derived characteristics may improve public health approaches to optimize HPB and vaccination adoption, mitigating SAR-CoV-2 transmission. Findings may also inform public health responses to future epidemics/pandemics.

An Exploration of Nanoparticle-Based Diagnostic Approaches for Coronaviruses: SARS-CoV-2, SARS-CoV and MERS-CoV

The wildfire-like spread of COVID-19, caused by severe acute respiratory syndrome-associated coronavirus-2, has resulted in a pandemic that has put unprecedented stress on the world's healthcare systems and caused varying severities of socio-economic damage. As there are no specific treatments to combat the virus, current approaches to overcome the crisis have mainly revolved around vaccination efforts, preventing human-to-human transmission through enforcement of lockdowns and repurposing of drugs. To efficiently facilitate the measures implemented by governments, rapid and accurate diagnosis of the disease is vital. Reverse-transcription polymerase chain reaction and computed tomography have been the standard procedures to diagnose and evaluate COVID-19. However, disadvantages, including the necessity of specialized equipment and trained personnel, the high financial cost of operation and the emergence of false negatives, have hindered their application in high-demand and resource-limited sites. Nanoparticle-based methods of diagnosis have been previously reported to provide precise results within short periods of time. Such methods have been studied in previous outbreaks of coronaviruses, including severe acute respiratory syndrome-associated coronavirus and middle east respiratory syndrome coronavirus. Given the need for rapid diagnostic techniques, this review discusses nanoparticle use in detecting the aforementioned coronaviruses and the recent severe acute respiratory syndrome-associated coronavirus-2 to highlight approaches that could potentially be used during the COVID-19 pandemic.

Real-Time Analysis of Predictors of COVID-19 Infection Spread in Countries in the European Union Through a New Tool

Objectives: Real-time data analysis during a pandemic is crucial. This paper aims to introduce a novel interactive tool called Covid-Predictor-Tracker using several sources of COVID-19 data, which allows examining developments over time and across countries. Exemplified here by investigating relative effects of vaccination to non-pharmaceutical interventions on COVID-19 spread.

Methods: We combine >100 indicators from the Global COVID-19 Trends and Impact Survey, Johns Hopkins University, Our World in Data, European Centre for Disease Prevention and Control, National Centers for Environmental Information, and Eurostat using random forests, hierarchical clustering, and rank correlation to predict COVID-19 cases.

Results: Between 2/2020 and 1/2022, we found among the non-pharmaceutical interventions “mask usage” to have strong effects after the percentage of people vaccinated at least once, followed by country-specific measures such as lock-downs. Countries with similar characteristics share ranks of infection predictors. Gender and age distribution, healthcare expenditures and cultural participation interact with restriction measures.

Conclusion: Including time-aware machine learning models in COVID-19 infection dashboards allows to disentangle and rank predictors of COVID-19 cases per country to support policy evaluation. Our open-source tool can be updated daily with continuous data streams, and expanded as the pandemic evolves.

Estimating SARS-CoV-2 variant fitness and the impact of interventions in England using statistical and geo-spatial agent-based models

The SARS-CoV-2 epidemic has been extended by the evolution of more transmissible viral variants. In autumn 2020, the B.1.177 lineage became the dominant variant in England, before being replaced by the B.1.1.7 (Alpha) lineage in late 2020, with the sweep occurring at different times in each region. This period coincided with a large number of non-pharmaceutical interventions (e.g. lockdowns) to control the epidemic, making it difficult to estimate the relative transmissibility of variants. In this paper, we model the spatial spread of these variants in England using a meta-population agent-based model which correctly characterizes the regional variation in cases and distribution of variants. As a test of robustness, we additionally estimated the relative transmissibility of multiple variants using a statistical model based on the renewal equation, which simultaneously estimates the effective reproduction number R. Relative to earlier variants, the transmissibility of B.1.177 is estimated to have increased by 1.14 (1.12-1.16) and that of Alpha by 1.71 (1.65-1.77). The vaccination programme starting in December 2020 is also modelled. Counterfactual simulations demonstrate that the vaccination programme was essential for reopening in March 2021, and that if the January lockdown had started one month earlier, up to 30 k (24 k-38 k) deaths could have been prevented. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

Estimating SARS-CoV-2 variant fitness and the impact of interventions in England using statistical and geo-spatial agent-based models

The SARS-CoV-2 epidemic has been extended by the evolution of more transmissible viral variants. In autumn 2020, the B.1.177 lineage became the dominant variant in England, before being replaced by the B.1.1.7 (Alpha) lineage in late 2020, with the sweep occurring at different times in each region. This period coincided with a large number of non-pharmaceutical interventions (e.g. lockdowns) to control the epidemic, making it difficult to estimate the relative transmissibility of variants. In this paper, we model the spatial spread of these variants in England using a meta-population agent-based model which correctly characterizes the regional variation in cases and distribution of variants. As a test of robustness, we additionally estimated the relative transmissibility of multiple variants using a statistical model based on the renewal equation, which simultaneously estimates the effective reproduction number R. Relative to earlier variants, the transmissibility of B.1.177 is estimated to have increased by 1.14 (1.12-1.16) and that of Alpha by 1.71 (1.65-1.77). The vaccination programme starting in December 2020 is also modelled. Counterfactual simulations demonstrate that the vaccination programme was essential for reopening in March 2021, and that if the January lockdown had started one month earlier, up to 30 k (24 k-38 k) deaths could have been prevented. This article is part of the theme issue 'Technical challenges of modelling real-life epidemics and examples of overcoming these'.

A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19

BACKGROUND

This article investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviours and disease outcomes in Sweden during the first wave of the coronavirus disease 2019 (COVID-19) pandemic (March to July 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household.

METHODS

We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96 053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21 804) and confirmed cases (n = 48 984)-to estimate the effects of the policy.

RESULTS

Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year threshold. These results imply that the age-specific recommendations prevented approximately 1800-2700 severe COVID-19 cases, depending on model specification.

CONCLUSIONS

It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.

The methodologies to assess the effectiveness of non-pharmaceutical interventions during COVID-19: a systematic review

Non-pharmaceutical interventions, such as school closures and stay-at-home orders, have been implemented around the world to control the spread of SARS-CoV-2. Their effectiveness in improving health-related outcomes has been the subject of numerous empirical studies. However, these studies show fairly large variation among methodologies in use, reflecting the absence of an established methodological framework. On the one hand, variation in methodologies may be desirable to assess the robustness of results; on the other hand, a lack of common standards can impede comparability among studies. To establish a comprehensive overview over the methodologies in use, we conducted a systematic review of studies assessing the effectiveness of non-pharmaceutical interventions between January 1, 2020 and January 12, 2021 (n = 248). We identified substantial variation in methodologies with respect to study setting, outcome, intervention, methodological approach, and effectiveness assessment. On this basis, we point to shortcomings of existing studies and make recommendations for the design of future studies.

Transmission of SARS-CoV-2 in a primary school setting with and without public health measures using real-world contact data: A modelling study

Background

Stringent public health measures have been shown to influence the transmission of SARS-CoV-2 within school environments. We investigated the potential transmission of SARS-CoV-2 in a primary school setting with and without public health measures, using fine-grained physical positioning traces captured before the COVID-19 pandemic.

Methods

Approximately 172.63 million position data from 98 students and six teachers from an open-plan primary school were used to predict a potential transmission of SARS-CoV-2 in primary school settings. We first estimated the daily average number of contacts of students and teachers with an infected individual during the incubation period. We then used the Reed-Frost model to estimate the probability of transmission per contact for the SARS-CoV-2 Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron variant (B.1.1.529). Finally, we built a binomial distribution model to estimate the probability of onward transmission in schools with and without public health measures, including face masks and physical distancing.

Results

An infectious student would have 49.1 (95% confidence interval (CI) = 46.1-52.1) contacts with their peers and 2.00 (95% CI = 1.82-2.18) contacts with teachers per day. An infectious teacher would have 47.6 (95% CI = 45.1-50.0) contacts with students and 1.70 (95% CI = 1.48-1.92) contacts with their colleague teachers per day. While the probability of onward SARS-CoV-2 transmission was relatively low for the Alpha and Delta variants, the risk increased for the Omicron variant, especially in the absence of public health measures. Onward teacher-to-student transmission (88.9%, 95% CI = 88.6%-89.1%) and teacher-to-teacher SARS-CoV-2 transmission (98.4%, 95% CI = 98.5%-98.6%) were significantly higher for the Omicron variant without public health measures in place.

Conclusions

Our findings illustrate that, despite a lower frequency of close contacts, teacher-to-teacher close contacts demonstrated a higher risk of transmission per contact of SARS-CoV-2 compared to student-to-student close contacts. This was especially significant with the Omicron variant, with onward transmission more likely occurring from teacher index cases than student index cases. Public health measures (eg, face masks and physical distance) seem essential in reducing the risk of onward transmission within school environments.

Opportunities in Health Education in the Post-COVID-19 Era: Transforming Viral to Vital

Although the current pandemic is associated with many difficulties and social challenges, in parallel, it has been linked with new opportunities. The field of education and, in particular, health education, represent a highlighted example. According to the United Nations Educational, Scientific and Cultural Organization (UNESCO) statistics, the education of more than 1.5 billion students in 188 countries around the globe was affected due to the closure of educational institutions following the coronavirus outbreak. In the present study, we examine the development of possibilities, prospects, and opportunities in the post-COVID-19 era in the field of health education. Using reflective observations on what we have gained as knowledge during this pandemic, we summarize five VITAL aspects of health education: the emerging value in health; the power of preventive interventions in health education; the transmission of health messages by students in the context of communication between school, family, and community; the exploitation of contemporary e-learning applications as a mixed hybrid learning mode; and the life examples as projected from the theoretical principles of health education to real scenarios. In conclusion, the global pandemic crisis, serving as a "violent teacher," presents us with hidden potential, promising new prospects in the field of health education that we need to exploit.

Low baseline IFN-γ response could predict hospitalization in COVID-19 patients

The SARS-CoV-2 infection has spread rapidly around the world causing millions of deaths. Several treatments can reduce mortality and hospitalization. However, their efficacy depends on the choice of the molecule and the precise timing of its administration to ensure viral clearance and avoid a deleterious inflammatory response. Here, we investigated IFN-γ, assessed by a functional immunoassay, as a predictive biomarker for the risk of hospitalization at an early stage of infection or within one month prior to infection. Individuals with IFN-γ levels below 15 IU/mL were 6.57-times more likely to be hospitalized than those with higher values (p<0.001). As confirmed by multivariable analysis, low IFN-γ levels, age >65 years, and no vaccination were independently associated with hospitalization. In addition, we found a significant inverse correlation between low IFN-γ response and high level of IL-6 in plasma (Spearman’s rho=-0.38, p=0.003). Early analysis of the IFN-γ response in a contact or recently infected subject with SARS-CoV-2 could predict hospitalization and thus help the clinician to choose the appropriate treatment avoiding severe forms of infection and hospitalization.

COVID-19 and U.S. Disputes Over Authority, 2020-2021: Implications for the Constructionist Analysis of Social Problems

COVID-19 is very different from the cases typically studied by constructionist analysts of social problems: it emerged quickly, spread widely, and affected many aspects of social life. As such, it offers important opportunities to reconsider the constructionist model. We focus on three issues-metrics, masks, and vaccines-where COVID-19 disputes about authority led to different alliances among several categories of claimsmakers. Our point is that COVID-19 discourse seems far messier than most of the narratives presented by constructionist analysts, and we identify several lessons from this unusual contemporary case that might help us strengthen existing social problems theory.

Immunogenicity and safety of the booster BNT162b2 vaccine in patients with axial spondyloarthritis treated with biological disease-modifying drugs

Background

Vaccination confers relatively short-term protection against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), indicating the need for booster doses. Immunocompromised individuals, including those with immune-mediated inflammatory diseases (IMIDs), may have pronounced immune response waning. Vaccine-boosted humoral and T-cell responses minimize poor coronavirus disease 19 (COVID-19) outcome without increasing adverse events (AE). There is limited evidence of third-dose vaccination in axial spondyloarthritis (AxSpA) patients. We investigated immune-response persistence after primary vaccination and immunogenicity and safety after the BNT162b2 booster vaccination.

Methods

This prospective observational study enrolled an AxSpA cohort treated with interleukin-17 (IL-17) and tumor necrosis factor-alpha (TNFα) inhibitors. Serum SARS-CoV-2-specific and virus-neutralizing antibodies for humoral response and flow cytometric detection of intracellular cytokines following SARS-CoV-2-specific peptide-based stimulation for T-cell immune responses were assessed, and safety was evaluated via a clinical questionnaire.

Results

Fifteen male AxSpA patients treated with TNFα (73·3%) or IL-17 (26·7%) inhibitors were enrolled and had humoral response persistence at 6 months: 905·6 ( ± 186·1 SD) and 409·1 ( ± 335·7) U/mL. Specific antibody concentrations further increased after booster vaccination to 989·7 ( ± 12·62) and 1000 U/mL and T-cell responders from 53·3% to 80%, with no differences between AxSpA (including “vaccination only” and “hybrid immunity” subgroups) and healthy control (HC) cohorts. No severe AE occurred; the AE spectrum was comparable to that of the general population.

Conclusion

Immune-response persistence after primary vaccination and immunogenicity after booster vaccination were unaffected by anti-IL17 or anti-TNFα therapy with similar AE as in the general population.

Immunogenicity and Safety of COVID-19 Vaccines among People Living with HIV: A Systematic Review and Meta-Analysis

BACKGROUND

The immunogenicity and safety of COVID-19 vaccines among people living with human immunodeficiency virus (PLWH) are unclear. We aimed to evaluate the immunogenicity and safety of COVID-19 vaccines among PLWH.

METHODS

We systematically searched PubMed, EMBASE, and Web of Science from 1 January 2020 to 28 April 2022 and included observational studies, randomized clinical trials, and non-randomized clinical trials reporting extractable data about the immunogenicity and safety of COVID-19 vaccines among PLWH.

RESULTS

A total of 34 eligible studies covering 4517 PLWH were included. The pooled seroconversion rates among PLWH after the first and second doses were 67.51% (95% confident interval (CI) 49.09-85.93%) and 96.65% (95%CI 95.56-97.75%), respectively. The seroconversion was similar between PLWH and healthy controls after the first (risk ratio (RR) = 0.89, 95%CI 0.76-1.04) and the second (RR = 0.97, 95%CI 0.93-1.00) dose. Moreover, the geometric mean titer (GMT) showed no significant difference between PLWH and healthy controls after the first dose (standardized mean difference (SMD) = 0.30, 95%CI -1.11, 1.70) and the second dose (SMD = -0.06, 95%CI -0.18, 0.05). Additionally, the pooled incidence rates of total adverse events among PLWH after the first and the second dose were 46.55% (95%CI 28.29-64.82%) and 30.96% (95%CI 13.23-48.70%), respectively. There was no significant difference in risks of total adverse events between PLWH and healthy controls after the first (RR = 0.86, 95%CI 0.67-1.10) and the second (RR = 0.88, 95%CI 0.68-1.14) dose.

CONCLUSIONS

The available evidence suggested that the immunogenicity and safety of COVID-19 vaccines among PLWH were acceptable. There was no significant difference in the seroconversion rates and incidence rates of adverse events of COVID-19 vaccines between PLWH and healthy controls.

Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future

The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.

EVALUATION OF PHYSICAL ACTIVITY LEVELS, SLEEP QUALITY AND NUTRITIONAL HABITS OF PARAATHLETES DURING THE PANDEMIC PROCESS

Background: Cancellation or postponement of sports organizations due to the Covid 19 pandemic has caused great stress for athletes. There are limited studies on how physical activity levels, nutritional habits and sleep quality are affected, especially in physically disabled athletes(paraathletes) during the pandemic process. Purpose: the aim of the research is to examine the physical activity, nutritional habits and sleep quality levels of paraathletes during the pandemic process. Method: Eighty- seven male paraathletes were included in the study. The personal data form required to determine the characteristics within the study subject International Physical Activity Questionnaire Short Form (IPAQ Short Form), the Pittsburg Sleep Quality Index Questionnaire were used in a way consistent with the study. In addition to these sections, changes in participants' nutritional habits were questioned. Results: Total MET values of paraathletes were determined as 3233 ± 1421. The sleep quality index total score averages of the participants were 5.83 ± 0.80 points, indicating the level of 'poor sleep quality'. Food consumption of the participants It was found that 56% of them increased their food consumption, 28% did not change, and 18% decreased. Conclusion: The results of the study showed that physical activity, nutrition and sleep processes, which have an important place in the life cycle of paraathletes, were adversely affected during the pandemic process.

A cross-country comparison of Covid-19 containment measures and their effects on the epidemic curves

BACKGROUND

European countries are still searching to eliminate or contain the Covid-19 pandemic. A variety of approaches have achieved different levels of success in limiting the spread of the disease early and preventing avoidable deaths. Governmental policy responses may explain these differences and this study aims to describe evidence about the effectiveness of containment measures throughout the course of the pandemic in five European countries (France, Germany, Italy, Spain and the UK).

METHODS

The research approach adopted consisted of three steps: 1) Build a Containment Index (C.I.) that considers nine parameters to make an assessment on the strength of measures; 2) Develop dynamic epidemiological models for forecasting purposes; 3) Predict case numbers by assuming containment measures remain constant for a period of 30 days.

RESULTS

Our analysis revealed that in the five European countries we compared, the use of different approaches definitively affected the effectiveness of containment measures for the Covid-19 pandemic.

CONCLUSION

The evidence found in our research can be useful to inform policy makers' decisions when deciding to introduce or relax containment measures and their timing, both during the current pandemic or in addressing possible future health crises.

A cross-national and longitudinal analysis of handwashing and its predictors during the COVID-19 pandemic in France and Belgium

BACKGROUND

Using a longitudinal design, we investigate how the adherence to handwashing and its underlying socio-psychological predictors evolved over time during the COVID-19 pandemic and under distinct circumstances (e.g. when the crisis was more acute or chronic).

METHOD

We collected data (N = 753) in Belgium and France at the onset of the COVID-19 pandemic when the crisis was at its peak (April 2020), and almost a year later (February 2021), when the outbreak was more manageable.

RESULTS

Regression models suggest that the compliance with handwashing and its pattern of underlying predictors remained remarkably stable over time despite the variations in contextual factors such as the severity of the health crisis and the stringency of health measures. As such, the findings also highlight the robustness of the models that predict it, namely the Theory of Planned Behavior. The intentions to perform the behavior, the perceived control over it, and being part of the (para)medical field were among the strongest predictors.

CONCLUSIONS

In practice, the stability of the underlying factors suggests a set of action levers that can be used in communication campaigns aimed at fostering its adherence throughout the pandemic.

Compliance with Barrier Gestures during COVID-19 Pandemic as a Function of the Context: A Longitudinal Observational Survey at the University of Liège

During the COVID-19 pandemic, barrier gestures such as mask wearing, physical distancing, greetings without contact, one-way circulation flow, and hand sanitization were major strategies to prevent the spread of SARS-CoV-2, but they were only useful if consistently applied. This survey was a follow-up of the first survey performed in 2020 at the University of Liège. We aim to evaluate the compliance with these gestures on campuses and examine differences in the extent of the compliance observed in different educational activities and contexts. During 3.5 months, the counting of compliant and non-compliant behaviors was performed each week in randomly selected rooms. Using data collected during both surveys (2020 and 2021), binomial negative regression models of compliance depending on periods (teaching periods and exam sessions), type of rooms, and campuses were conducted to evaluate prevalence ratios of compliance. The percentage of compliance in this second survey was the highest for mask wearing and physical distancing during educational activities (90% and 88%, respectively) and lowest for physical distancing outside educational activities and hand sanitization (45% and 52%, respectively). Multivariate analyses revealed that the compliance with most gestures was significantly higher in teaching rooms than in hallways and restaurants and during exam sessions. The compliance with physical distancing was significantly higher (from 66%) in auditoriums, where students had to remain seated, than during practical works that allowed or required free movement. Therefore, the compliance with barrier gestures was associated with contextual settings, which should be considered when communicating and managing barrier gestures. Further studies should specify and confirm the determining contextual characteristics regarding the compliance with barrier gestures in times of pandemic.

SARS-CoV-2 rapid antigen screening of asymptomatic employees: a pilot project

SETTING

Rapid antigen screening can be effective in identifying infectious individuals in occupational settings to reduce transmission and outbreaks. We report results from a pilot project at the Greater Toronto Airports Authority (GTAA) and describe the operationalization. Toronto Pearson is a large international airport encompassing over 400 employers and, pre-pandemic, with approximately 50,000 employees.

INTERVENTION

An employee screening program was piloted between March 8 and May 28, 2021, to implement rapid antigen testing for asymptomatic employees. Recruitment targeted enrolment of 400 employees and yielded participation of 717 from 58 companies. Employees were recommended to book three times per week for nasal swabs on site, and were tested on the Abbot Panbio^TM rapid antigen test. No action was taken from a negative result, and if positive, the employee was told to isolate at home and obtain a confirmatory polymerase chain reaction test.

OUTCOMES

A total of 5117 tests were performed on 717 individuals over 12 weeks; 5091 tests were negative (99.5%), and 22 individuals tested positive (3.1% positivity rate). One hundred twenty-four (17%) completed the post-participation survey. All respondents reported that testing did not change their behaviour at work with respect to public health recommendations, and only 1 (1%) reported behaviour change outside of work (socializing with family) as a result of the program.

IMPLICATIONS

This pilot program identified 22 (3.1%) potentially infectious employees. Onsite testing was feasible and highly accepted by this group of employees who completed the survey. Education resulted in reasonable uptake and no substantial change in behaviour, although the survey response rate may limit generalizability. Home-based testing may facilitate larger recruitment.

The impact of face-mask mandates on all-cause mortality in Switzerland: a quasi-experimental study

Background

Whereas there is strong evidence that wearing a face mask is effective in reducing the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), evidence on the impact of mandating the wearing of face masks on deaths from coronavirus disease 2019 (COVID-19) and all-cause mortality is more sparse and likely to vary by context. Focusing on a quasi-experimental setting in Switzerland, we aimed to determine (i) the effect of face-mask mandates for indoor public spaces on all-cause mortality; and (ii) how the effect has varied over time, and by age and sex.

Methods

Our analysis exploited the fact that between July and October 2020, nine cantons in Switzerland extended a face-mask mandate at different time points from being restricted to public transportation only to applying to all public indoor places. We used both a Difference-in-Differences approach with fixed-effects for canton and week and an event-study approach.

Results

In our main Difference-in-Differences model, the face-mask mandate was associated with a 0.3% reduction in all-cause mortality [95% confidence interval (CI): −3.4% to 2.7%; P = 0.818]. This null effect was confirmed in the event-study approach and a variety of robustness checks. Combining the face-mask mandate with social distancing rules led to an estimated 5.1% (95% CI: −7.9% to −2.4%; P = 0.001) reduction in all-cause mortality.

Conclusions

Mandating face-mask use in public indoor spaces in Switzerland in mid-to-late 2020 does not appear to have resulted in large reductions in all-cause mortality in the short term. There is some suggestion that combining face-mask mandates with social distancing rules reduced all-cause mortality.

Effect of Lockdown and Mass Testing for the SARS-CoV-2 Omicron Epidemic on Reducing New Infections in Shenzhen, China

On 14 March 2022, China’s tech hub Shenzhen, a mega-city with more than 18 million inhabitants, imposed a one-week citywide lockdown immediately after it observed a surge in infections. We assessed the effect of this one-week lockdown, coupled with mass testing, on reducing the daily number of new confirmed cases and asymptomatic cases during the Omicron wave, using an interrupted time series analysis approach. Our analysis suggests that the one-week citywide lockdown in Shenzhen was effective at lowering both daily new confirmed cases and asymptomatic cases during the Omicron wave. Early detection ensures timely isolation and treatment of infected patients in designated hospitals, and therefore helps lower the prevalence of confirmed cases and asymptomatic cases. Our findings of the immediate increase in asymptomatic cases after lockdown warrant further verifications in other city epidemic scenarios.

Assessment of the Importance of COVID-19 Prevention Measures and Their Applicability in the Daily Life of Pregnant Women and Mothers of Infants

Abstract. The COVID-19 pandemic has posed significant challenges to (expectant) mothers of infants in terms of family health protection. To meet these challenges in a health literate manner, COVID-19 protective measures must be considered important and must also be implemented appropriately in everyday life. To this end, N = 343 (expectant) mothers of infants indicated (a) how important they considered 21 COVID-19 infection prevention measures, and (b) how well they succeeded in implementing them in their daily life (20 measures). We performed data analysis using exploratory factor analysis for ordinal data and latent class analysis. One- and two-dimensional models (CFI = .960 / .978; SRMR = .053 / .039) proved to appropriately explain maternal importance ratings. The items on successfully applying COVID-19 measures in daily life can be modeled by the 5 factors hygiene measures, contact with other people, public transportation, staying at home, and checking infection status (CFI = 0.977; SRMR = .036). Six latent classes can be distinguished. Despite the largest class (39 %), classes are characterized by selective or general applicability problems. Classes reporting problems in the applicability of the measures rated them as generally less important (η = .582). Assessing and modelling importance and applicability of COVID-19 prevention measures allows for a psychometrically sound description of subjective perceptions and behaviors that are crucial for health literate practice in maternal daily life.

Associative evidence for the potential of humidification as a non-pharmaceutical intervention for influenza and SARS-CoV-2 transmission

BACKGROUND

Both influenza and SARS-CoV-2 viruses show a strong seasonal spreading in temperate regions. Several studies indicated that changes in indoor humidity could be one of the key factors explaining this.

OBJECTIVE

The purpose of this study is to quantify the association between relevant epidemiological metrics and humidity in both influenza and SARS-CoV-2 epidemic periods.

METHODS

The atmospheric dew point temperature serves as a proxy for indoor relative humidity. This study considered the weekly mortality rate in the Netherlands between 1995 and 2019 to determine the correlation between the dew point and the spread of influenza. During influenza epidemic periods in the Netherlands, governmental restrictions were absent; therefore, there is no need to control this confounder. During the SARS-CoV-2 pandemic, governmental restrictions strongly varied over time. To control this effect, periods with a relatively constant governmental intervention level were selected to analyze the reproduction rate. We also examine SARS-CoV-2 deaths in the nursing home setting, where health policy and social factors were less variable. Viral transmissibility was measured by computing the ratio between the estimated daily number of infectious persons in the Netherlands and the lagged mortality figures in the nursing homes.

RESULTS

For both influenza and SARS-CoV-2, a significant correlation was found between the dew point temperature and the aforementioned epidemiological metrics. The findings are consistent with the anticipated mechanisms related to droplet evaporation, stability of virus in the indoor environment, and impairment of the natural defenses of the respiratory tract in dry air.

SIGNIFICANCE

This information is helpful to understand the seasonal pattern of respiratory viruses and motivate further study to what extent it is possible to alter the seasonal pattern by actively intervening in the adverse role of low humidity during fall and winter in temperate regions.

IMPACT

A solid understanding and quantification of the role of humidity on the transmission of respiratory viruses is imperative for epidemiological modeling and the installation of non-pharmaceutical interventions. The results of this study indicate that improving the indoor humidity by humidifiers could be a promising technology for reducing the spread of both influenza and SARS-CoV-2 during winter and fall in the temperate zone. The identification of this potential should be seen as a strong motivation to invest in further prospective testing of this non-pharmaceutical intervention.

The prevalence of insomnia in different COVID-19 policy phases: Longitudinal evidence from ITA.LI - Italian Lives

BACKGROUND

This study investigated changes in the prevalence of insomnia in Italy during COVID-19, starting from the first lockdown period (8 March 2020). We hypothesized that lockdown precipitated increased prevalence of insomnia symptoms relative to the pre-pandemic period; b) the gradual relaxation of containment measures - post-lockdown period (Phase 2 and Phase 3) - reduced insomnia severity, leading to a relative recovery of pre-pandemic levels; and c) we tested age-related heterogeneity in sleep responses, with an expected higher increase in insomnia in younger and middle-age groups.

METHODS

Analyses drew on a subsample (N = 883) of respondents to ITA.LI - Italian Lives, a recently established panel study on a probability sample of individuals aged 16 + living in Italy. To estimate patterns of change in insomnia, we first fitted a random-effects ordered logistic model on the whole sample. We then added an interaction term between policy phases and the respondent age to test whether the relationship between insomnia and policy phases differed across age groups. Analyses accounted for survey non-response weights.

RESULTS

The fraction of respondents reporting moderate ("somewhat" + 0.159, S.E. 0.017) or severe ("very much" + 0.142, S.E. 0.030) sleep disturbances significantly increased during Phase 1. The prevalence of insomnia followed an inverted U-shaped curve across policy phases, with further increases from baseline levels ("somewhat" + 0.168, S.E. 0.015; "very much" + 0.187, S.E. 0.030) during Phase 2, followed by a relative reduction in Phase 3, although it remained significantly higher than in the pre-pandemic period ("somewhat", + 0.084, S.E. 0.016; "very much", + 0.045, S.E. 0.010). There were significant age-related differences in insomnia patterns, as the discrete change from pre-pandemic levels in the probability of not suffering from insomnia was negative and significant for the younger age group (- 0.269, S.E. 0.060) and for respondents aged 35-54 (- 0.163, S.E. 0.039).

CONCLUSION

There is reason to believe that the emergency policy response to the COVID-19 crisis may have had unintended and possibly scarring effects in terms of increased prevalence of insomnia. The hardest hit were young adults and, to a lesser extent, the middle-aged; however, older respondents (55 +) remained resilient, and their insomnia trajectory bounced back to pre-pandemic levels.

Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages

Background

Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance.

Objective

In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media.

Methods

A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother–daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages.

Results

Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=–0.10, 95% CI –0.12 to –0.08, P<.001) and daughters (b=–0.10, 95% CI –0.18 to –0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=–0.04, 95% CI –0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers’ intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=–0.50, 95% CI –0.99 to –0.01, P=.05).

Conclusions

Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general.

Trial Registration

ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807

Serologic response and safety of COVID-19 vaccination in HSCT or CAR T-cell recipients: a systematic review and meta-analysis

Background

Patients receiving hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T cell (CAR T-cell) therapy are immunocompromised and at high risk of viral infection, including SAR2-CoV-2 infection. However, the effectiveness and safety of COVID-19 vaccines in these recipients is not well characterized. The present meta-analysis evaluated the serologic response and safety of COVID-19 vaccines in these population.

Methods

Literature databases (MEDLINE, EMBASE, Web of Science, MedRvix and BioRvix) were searched for original studies with serologic response post COVID-19 vaccination in HSCT or CAR T-cell recipients published until July 14, 2022. The analysis included 27 observational studies with a total of 2899 patients receiving allogeneic HSCT (2506), autologous HSCT (286) or CAR T-cell therapy (107), and 683 healthy participants with serologic response data. Random effects models were used to pool the rate of serologic response to COVID-19 vaccination in HSCT or CAR T-cell recipients and odds ratio comparing with healthy controls.

Results

The pooled seropositivity rates in HSCT and CAR T-cell recipients were 0.624 [0.506–0.729] for one dose, 0.745 [0.712–0.776] for two doses. The rates were significantly lower than those in healthy controls (nearly 100%). In subgroup analysis, CAR T-cell recipients exhibited an even lower seroconversion rate (one dose: 0.204 [0.094–0.386]; two doses: 0.277 [0.190–0.386]) than HSCT counterparts (one dose: 0.779 [0.666–0.862]; two doses: 0.793 [0.762–0.821]). The rates were comparable between autologous and allogeneic HSCT recipients. Other possible impact factors related to seropositivity were time interval between therapy and vaccination, use of immunosuppressive drugs and immune cell counts. Most vaccine-related adverse effects were mild and resolvable, comparable to general population.

Conclusions

This analysis revealed a diminished response to COVID-19 vaccines in HSCT or CAR T-cell recipients. Our findings may inform regular COVID-19 vaccination at appropriate intervals after HSCT or CAR T-cell therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40164-022-00299-6.