Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China

Medical Resource Management in Emergency Hierarchical Diagnosis and Treatment Systems: A Research Framework

The occurrence of major public health crises, like the COVID-19 epidemic, present significant challenges to healthcare systems and the management of emergency medical resources worldwide. This study, by examining the practices of emergency medical resource management in select countries during the COVID-19 epidemic, and reviewing the relevant literature, finds that emergency hierarchical diagnosis and treatment systems (EHDTSs) play a crucial role in managing emergency resources effectively. To address key issues of emergency resource management in EHDTSs, we examine the features of EHDTSs and develop a research framework for emergency resource management in EHDTSs, especially focusing on the management of emergency medical personnel and medical supplies during evolving epidemics. The research framework identifies key issues of emergency medical resource management in EHDTSs, including the sharing and scheduling of emergency medical supplies, the establishment and sharing of emergency medical supply warehouses, and the integrated dispatch of emergency medical personnel. The proposed framework not only offers insights for future research but also can facilitate better emergency medical resource management in EHDTSs during major public health emergencies.

Reduction in ACE2 expression in peripheral blood mononuclear cells during COVID-19 - implications for post COVID-19 conditions

BACKGROUND

Severe COVID-19 is uncommon, restricted to 19% of the total population. In response to the first virus wave (alpha variant of SARS-CoV-2), we investigated whether a biomarker indicated severity of disease and, in particular, if variable expression of angiotensin converting enzyme 2 (ACE2) in blood might clarify this difference in risk and of post COVID -19 conditions (PCC).

METHODS

The IRB-approved study compared patients hospitalized with severe COVID-19 to healthy controls. Severe infection was defined requiring oxygen or increased oxygen need from baseline at admission with positive COVID-19 PCR. A single blood sample was obtained from patients within a day of admission. ACE2 RNA expression in blood cells was measured by an RT-PCR assay. Plasma ACE1 and ACE2 enzyme activities were quantified by fluorescent peptides. Plasma TIMP-1, PIIINP and MMP-9 antigens were quantified by ELISA. Data were entered into REDCap and analyzed using STATA v 14 and GraphPad Prism v 10.

RESULTS

Forty-eight patients and 72 healthy controls were recruited during the pandemic. ACE2 RNA expression in peripheral blood mononuclear cells (PBMC) was rarely detected acutely during severe COVID-19 but common in controls (OR for undetected ACE2: 12.4 [95% CI: 2.62-76.1]). ACE2 RNA expression in PBMC did not determine plasma ACE1 and ACE2 activity, suggesting alternative cell-signaling pathways. Markers of fibrosis (TIMP-1 and PIIINP) and vasculopathy (MMP-9) were additionally elevated. ACE2 RNA expression during severe COVID-19 often responded within hours to convalescent plasma. Analogous to oncogenesis, we speculate that potent, persistent, cryptic processes following COVID-19 (the renin-angiotensin system (RAS), fibrosis and vasculopathy) initiate or promote post-COVID-19 conditions (PCC) in susceptible individuals.

CONCLUSIONS

This work elucidates biological and temporal plausibility for ACE2, TIMP1, PIIINP and MMP-9 in the pathogenesis of PCC. Intersection of these independent systems is uncommon and may in part explain the rarity of PCC.

Molecular Epidemiology of Human Parainfluenza Virus Type 3 in Children With Acute Respiratory Tract Infection in Hangzhou

BACKGROUND

Since the outbreak of COVID-19, China has undertaken a variety of preventative and control measures, effectively reducing the incidence of numerous infectious diseases among the pediatric population in Hangzhou. We aim to investigate the genetic and epidemiological characteristics of Human parainfluenza virus-3 (HPIV-3) in pediatric patients during this period.

METHODS

A total of 1442 pharyngeal swab samples were collected from outpatients and inpatients with a diagnosis of acute respiratory tract infections (ARTIs) from November 2020 to March 2021. HPIV-3 was detected by quantitative real time polymerase chain reaction (qRT-PCR). The L gene of HPIV-3 positive samples was amplified and sequenced.

RESULTS

Among 1442 children with ARTI, the positive rate of HPIV-3 was 7.07% (102/1442). The positive detection rate was the highest in the 6-month to 1-year age group. Coinfection was observed in 36 HPIV-3-positive samples (35.29%, 36/102), and adenovirus (ADV) was the most common coinfecting virus (63.89%, 23/36). The L gene of 48 HPIV-3 positive samples was sequenced. The nucleotide sequence analysis showed high consistency (92.10%-99.40%), and all strains belonged to C3a.

CONCLUSIONS

During study periods, the positive detection rate of HPIV-3 among children is high, and the highest proportion of coinfection was observed in HPIV-3 mixed ADV infection. Phylogenetic analysis revealed that the nucleotide sequence of the L gene of HPIV-3 was highly consistent, and the main epidemic strain in this area was the C3a subtype.

Adherence to COVID-19 protocols: A comparative study of public and private hospitals in Ghana

Objective

This study aimed to comparatively examine how public and private hospitals adhered to the COVID-19 safety protocols, and the factors associated with, and barriers to adherence in Ghana.

Study design

A case study design drawing on quantitative and qualitative methods to determine adherence to, and barrier of adherence to the COVID-19 protocols.

Method

A sample of 283 staff participated in the quantitative study, while in-depth interviews were conducted among management staff across the public and private hospitals. Data were analyzed using descriptive statistics, independent t-test to compare differences in adherence and logistic regression model to identify the factors associated with adherence to the COVID-19 protocols.

Results

The regression results showed that adherence to the COVID-19 protocols in public and private hospitals were significantly associated with staff training on adherence in public (OR = 2.08; p < 0.01) and private (OR = 1.44; p < 0.05), and knowledge on adherence in public (OR = 3.12; p < 0.01) and private (OR = 11.45; p < 0.01) hospitals. Adherence to the protocol varied significantly between public and private hospitals (0.001 > p < 0.05), with an effect size ranging from small to large. Clients' behavioural factors and poor stocking of PPEs due to financial challenges were reported as barriers to adherence in both hospital types.

Conclusion

Adherence to the COVID-19 protocols was more pronounced in public hospitals than private hospitals suggesting the need for interventions targeting the latter to promote client and staff safety.

Trajectories and determinants of acute stress disorder during the COVID-19 centralized quarantine: A latent class growth analysis

COVID-19 centralized quarantine may cause acute stress disorder (ASD). However, it is unknown how individuals present heterogeneous ASD trajectories during the COVID-19 centralized quarantine and what factors contribute to these patterns. This study aimed to identify the ASD trajectories and their determinants during the centralized quarantine period, and the mediating effects of resilience on these associations. A longitudinal survey with three waves was conducted in a randomly selected quarantine hotel in Shenzhen, China from October to November 2020. A total of 273 participants completed online measures assessing ASD symptoms, Eysenck's personality constructs of extraversion (E), neuroticism (N), psychoticism (P), and resilience on Day 1, and reported ASD symptoms on Days 7 and 14 during their 14-day centralized quarantine periods. Latent class growth analysis identified three trajectories: constantly high symptoms (CHS, 4.76%), decreasing symptoms (DS, 11.72%), and constantly low symptoms (CLS, 83.52%). The CHS and DS subgroups both reported lower E and higher N scores, but not P, compared with the CLS subgroup. Resilience mediated the effects of three personality constructs on ASD trajectories, except for the association between N and DS membership. Our study highlights the heterogeneity in stress responses to the COVID-19 centralized quarantine. The high-risk subgroup with persistent ASD symptoms was characterized by lower E and higher N. The resilience process accounted for the effects of personality in shaping distinct ASD trajectories. Our findings have implications to detect the populations vulnerable to ASD and provide insights for developing timely resilience enhancement intervention programs.

Bayesian inference for the onset time and epidemiological characteristics of emerging infectious diseases

Background

Emerging infectious diseases pose a significant threat to global public health. Timely detection and response are crucial in mitigating the spread of such epidemics. Inferring the onset time and epidemiological characteristics is vital for accelerating early interventions, but accurately predicting these parameters in the early stages remains challenging.

Methods

We introduce a Bayesian inference method to fit epidemic models to time series data based on state-space modeling, employing a stochastic Susceptible-Exposed-Infectious-Removed (SEIR) model for transmission dynamics analysis. Our approach uses the particle Markov chain Monte Carlo (PMCMC) method to estimate key epidemiological parameters, including the onset time, the transmission rate, and the recovery rate. The PMCMC algorithm integrates the advantageous aspects of both MCMC and particle filtering methodologies to yield a computationally feasible and effective means of approximating the likelihood function, especially when it is computationally intractable.

Results

To validate the proposed method, we conduct case studies on COVID-19 outbreaks in Wuhan, Shanghai and Nanjing, China, respectively. Using early-stage case reports, the PMCMC algorithm accurately predicted the onset time, key epidemiological parameters, and the basic reproduction number. These findings are consistent with empirical studies and the literature.

Conclusion

This study presents a robust Bayesian inference method for the timely investigation of emerging infectious diseases. By accurately estimating the onset time and essential epidemiological parameters, our approach is versatile and efficient, extending its utility beyond COVID-19.

Symptoms of depression among outpatients with suspected COVID-19 in metropolitan Local Government Areas of Kaduna State, Nigeria

BACKGROUND

The novel SARS-CoV-2 virus that causes Coronavirus disease (COVID-19) has redefined global health and response to Acute Respiratory Infection (ARI). The outbreak of a cluster of influenza-like illnesses in Wuhan, China, has morphed into a pandemic in the last quarter of 2019, stretching from South East Asia to Europe, The Americas, Africa, and the Australian subcontinent. We evaluated the prevalence of depression among outpatients diagnosed with ARI.

MATERIALS AND METHODS

We utilized a cross-sectional, observational design and investigated the prevalence of symptoms of depression among outpatients with ARI and described the characteristics of outpatients with ARI in Kaduna State.

RESULTS

The prevalence of symptoms of depression was 19.6% for respondents with symptoms of ARI and 14.4% for those without symptoms of ARI. On no risk of depression, we had a higher proportion of the respondents without symptoms of ARI (86%) than those with symptoms of depression (80%) (M = 318.4, SD = 29.62 case, and M = 344.0, SD = 14.2 control, r = 0.88, CI = 13.5 to 6.5, P = 0.000952). Likewise, in the category with mild risk of depression, respondents without symptoms of ARI were fewer (10%) than those with symptoms of depression (15%) (M = 58.4, SD = 26.0 case, and M = 42.1, SD = 12.7 control, r = 0.86, CI = 11.8 to 5.8, P = 0.0136. There was no significant difference between respondents with symptoms of ARI and without symptoms of ARI in the categories of moderate (M = 13.6, SD = 5.1 case, and M = 11.6, SD = 4.6 control, r = 0.87, CI = 2.3 to 2.1, P = 0.178) and high (M = 5.6, SD = 2.5 case, and M = 4.4, SD = 3.2 control, r = 0.61, CI = 1.2 to 1.5, P = 0.174) risk of depression.

CONCLUSION

Symptoms of depression were commoner among respondents who presented with symptoms of Acute Respiratory Infection (ARI) at the Outpatient Department (OPD). However, further explanatory research is needed to establish causality.

The Impact of Coping Styles on the Mental Health of Outstanding Physical Education Students in Shanghai During the Normalization Epidemic: The Chain Mediation Role of Meaning in Life and Prosocial Behavior

Purpose

The continuous spread of the epidemic has inflicted serious harm upon individual's mental well-being, and effective coping mechanisms are associated with positive mental health outcomes. Prosocial behavior and a sense of meaning in life can enhance individuals' subjective well-being, which can subsequently positively impact their mental health. Thus, in the context of epidemic prevention and control, this study investigates the relationship between the meaning in life, prosocial behavior, and coping styles of outstanding physical education students and the impact on their mental health.

Methods

The study involved a questionnaire survey on 498 outstanding physical education students, consisting of 297 boys (mean age = 13.16) and 201 girls (mean age = 12.87 years). Subsequently, the data was analyzed using the mediating effect and Bootstrap tests.

Results

The coping style positively predicted the meaning in life (β=0.294) and prosocial behavior (β=0.293). Conversely, mental health was predicted in a negative direction (β=-0.494). Mental health negatively predicted prosocial behavior (β=-0.810), although prosocial behavior positively predicted meaning in life (β=0.644). Finally, prosocial behavior negatively predicted mental health (β=-0.513). Additionally, the interplay between prosocial behavior and meaning in life is established in terms of both the individual and chain mediating roles.

Conclusion

This study demonstrates that coping styles during a normalized epidemic prevention and control situation directly impact the mental health of Shanghai's outstanding physical education students. Additionally, these coping styles indirectly influence mental health through the mediating effects of meaning in life and prosocial behaviors. Furthermore, meaning in life and prosocial behaviors act as chain mediators in this relationship.

Multi-cohort study on cytokine and chemokine profiles in the progression of COVID-19

Various substances in the blood plasma serve as prognostic indicators of the progression of COVID-19. Consequently, multi-omics studies, such as proteomic and metabolomics, are ongoing to identify accurate biomarkers. Cytokines and chemokines, which are crucial components of immune and inflammatory responses, play pivotal roles in the transition from mild to severe illness. To determine the relationship between plasma cytokines and the progression of COVID-19, we used four study cohorts to perform a systematic study of cytokine levels in patients with different disease stages. We observed differential cytokine expression between patients with persistent-mild disease and patients with mild-to-severe transformation. For instance, IL-4 and IL-17 levels significantly increased in patients with mild-to-severe transformation, indicating differences within the mild disease group. Subsequently, we analysed the changes in cytokine and chemokine expression in the plasma of patients undergoing two opposing processes: the transition from mild to severe illness and the transition from severe to mild illness. We identified several factors, such as reduced expression of IL-16 and IL-18 during the severe phase of the disease and up-regulated expression of IL-10, IP-10, and SCGF-β during the same period, indicative of the deterioration or improvement of patients' conditions. These factors obtained from fine-tuned research cohorts could provide auxiliary indications for changes in the condition of COVID-19 patients.

A cross-sectional mental-health survey of Chinese postgraduate students majoring in stomatology post COVID-19 restrictions

Background

The psychological status of Chinese postgraduate students majoring in stomatology after the COVID-19 restrictions still remains unclear. The objective of this study is to evaluate the mental status through a cross-sectional survey and gather related theoretical evidence for psychological intervention on postgraduate students majoring in stomatology.

Methods

An online survey was administered, and subjective well-being, anxiety, stress and depression symptoms were assessed using the 5-item World Health Organization Well-Being Index (WHO-5), item Generalized Anxiety Disorder Scale (GAD-7), 10-item Perceived Stress Scale (PSS-10), and Patient Health Questionnaire-9 (PHQ-9), respectively, wherein suicidal ideation and sleep-related problems were measured with PHQ-9 and Insomnia Severity Index (ISI).

Results

A total of 208 participants who completed one questionnaire were considered as valid. It was found that female respondents generally exhibited significantly higher levels of PSS-10, PHQ-9, and GAD-7 scores and shorter physical activity hours than male students. Students from rural areas demonstrated significantly higher levels of PHQ-9, suicidal ideation, and less portion of good or fair family economic support. Additionally, individuals from only-child families reported increased levels of activity hours (1.78 ± 2.07, p = 0.045) and a higher portion (55.10%, p = 0.007) of having clear future plan as compared with multiple-child families. The risk factors for anxiety symptoms (GAD-7 score) were higher scores of PSS-10 (OR = 1.15, 95% CI = 1.09-1.22), PHQ-9 (OR = 1.35, 95% CI = 1.22-1.49), and ISI-7 (OR = 1.14, 95% CI = 1.06-1.23), while owning a clear graduation plan was the protective factor (OR = 0.55, 95% CI = 0.31-0.98). Moreover, the risk factors for depressive symptoms (PHQ-9) included PSS-10 (OR = 1.10, 95% CI = 1.04-1.16), GAD-7 (OR = 1.38, 95% CI = 1.25-1.52), suicidal ideation (OR = 5.66, 95% CI = 3.37-9.51), and ISI-7 (OR = 1.17, 95% CI = 1.09-1.25). Approximately 98.08% of Chinese postgraduates studying stomatology reported experiencing at least moderate stress after the COVID-19 restrictions.

Conclusion

Within the limitations of this study, senior students were more inclined to stress, while anxiety symptoms were related to severer levels of stress, depression, and insomnia. Depressive symptoms were associated with higher levels of stress, anxiety, insomnia, suicidal ideation, and lower levels of self-reported well-being. Thus, psychological interventions for postgraduates should be timely and appropriately implemented by strengthening well-being, reasonably planning for the future, and good physique, thereby mitigating the psychological issues after COVID-19 restrictions.

Using a population-based Kalman estimator to model the COVID-19 epidemic in France: estimating associations between disease transmission and non-pharmaceutical interventions

In response to the COVID-19 pandemic caused by SARS-CoV-2, governments have adopted a wide range of non-pharmaceutical interventions (NPI). These include stringent measures such as strict lockdowns, closing schools, bars and restaurants, curfews, and barrier gestures such as mask-wearing and social distancing. Deciphering the effectiveness of each NPI is critical to responding to future waves and outbreaks. To this end, we first develop a dynamic model of the French COVID-19 epidemics over a one-year period. We rely on a global extended Susceptible-Infectious-Recovered (SIR) mechanistic model of infection that includes a dynamic transmission rate over time. Multilevel data across French regions are integrated using random effects on the parameters of the mechanistic model, boosting statistical power by multiplying integrated observation series. We estimate the parameters using a new population-based statistical approach based on a Kalman filter, used for the first time in analysing real-world data. We then fit the estimated time-varying transmission rate using a regression model that depends on the NPIs while accounting for vaccination coverage, the occurrence of variants of concern (VoC), and seasonal weather conditions. We show that all NPIs considered have an independent significant association with transmission rates. In addition, we show a strong association between weather conditions that reduces transmission in summer, and we also estimate increased transmissibility of VoC.

Changing clinical characteristics of pediatric inpatients with pneumonia during COVID-19 pandamic: a retrospective study

BACKGROUND

The COVID-19 pandemic have impacts on the prevalence of other pathogens and people's social lifestyle. This study aimed to compare the pathogen, allergen and micronutrient characteristics of pediatric inpatients with pneumonia prior to and during the COVID-19 pandemic in a large tertiary hospital in Shanghai, China.

METHODS

Patients with pneumonia admitted to the Department of Pediatric Pulmonology of Xinhua Hospital between March-August 2019 and March-August 2020 were recruited. And clinical characteristics of the patients in 2019 were compared with those in 2020.

RESULTS

Hospitalizations for pneumonia decreased by 74% after the COVID-19 pandemic. For pathogens, virus, mycoplasma pneumoniae (MP) and mixed infection rates were all much lower in 2020 than those in 2019 (P < 0.01). Regarding allergens, compared with 2019, the positive rates of house dust mite, shrimp and crab were significantly higher in 2020 (P < 0.01). And for micronutrients, the levels of vitamin B2, B6, C and 25-hydroxyvitamin D (25(OH)D) in 2020 were observed to be significantly lower than those in 2019 (P < 0.05). For all the study participants, longer hospital stay (OR = 1.521, P = 0.000), milk allergy (OR = 6.552, P = 0.033) and calcium (Ca) insufficiency (OR = 12.048, P = 0.019) were identified as high-risk factors for severe pneumonia by multivariate analysis.

CONCLUSIONS

The number of children hospitalized with pneumonia and incidence of common pathogen infections were both reduced, and that allergy and micronutrient status in children were also changed after the outbreak of the COVID-19 pandemic.

Impact of COVID-19 Nonpharmaceutical Interventions on Respiratory Syncytial Virus Infections in Hospitalized Children

BACKGROUND

Nonpharmaceutical interventions (NPIs) targeted at SARS-CoV-2 have remarkably affected the circulation of other respiratory pathogens, including respiratory syncytial virus (RSV). This study aimed to assess the changes in epidemiological and clinical characteristics of RSV infections in hospitalized children before and during the pandemic in Suzhou, China.

METHODS

We prospectively enrolled children aged < 18 years who were hospitalized in Soochow University Affiliated Children's Hospital with acute lower respiratory infection (ALRIs) from January 2018 to July 2022. Changes in epidemiological and clinical characteristics of RSV infections were analyzed.

RESULTS

Compared with the same period in 2018-2019, the difference in the overall positive rate of RSV was not statistically significant in 2020, while it increased significantly in 2021 (11.8% [662/5621] vs. 20.8% [356/1711], p < 0.001) and 2022 (9.0% [308/3406] vs. 18.9% [129/684], p < 0.001). Specifically, the positive rates declined considerably from October to December 2020 but sharply increased during the summer of 2021. Compared to prepandemic period, RSV infections were more frequently observed in older children during the pandemic. RSV-positive children exhibited milder clinical characteristics during the COVID-19 pandemic, including decreased proportion of patients with hospital stay ≥ 11 days (10.3% vs. 6.7%, p < 0.05), less requirement for oxygen therapy (13.7% vs. 6.9%, p < 0.001), and fewer cases of polypnea (12.2% vs. 9.7%, p < 0.05) and wheeze (50.1% vs. 42.9%, p < 0.001).

CONCLUSIONS

The implementation of multilayered NPIs targeted at COVID-19 has affected the activity of RSV. Ongoing monitoring of RSV is warranted as the changing RSV epidemiology can provide valuable insights for future healthcare system planning.

Government responses to the COVID-19 pandemic of the Gulf Cooperation Council countries: good practices and lessons for future preparedness

The COVID-19 pandemic has dramatically threatened the Gulf Cooperation Council (GCC) countries which have a large proportion of foreign workers. The governments of GCC countries have proactively implemented a comprehensive set of policy measures, and up to our knowledge, a systematic analysis of qualitative and quantitative evidence on the government response is still lacking. We summarized the GCC countries' government response and quantitatively measured that response using four indexes-the Government Response Index, the Stringency Index, the Vaccine Index, and the Initial Response Index, to analyse their response for future pandemic preparedness. Overall, the government response of all the GCC countries to the COVID-19 pandemic has been comprehensive, stringent, and timely. Notably, the GCC countries have implemented comprehensive vaccine policies. In addition, they have worked actively to protect foreign workers to improve their access to health services and secure their essential living conditions, regardless of their immigrant status. All the GCC countries dynamically adjusted their response to the evolving COVID-19 epidemiological burden and started to relax the stringency of the control policies after the Omicron wave, though the governments had different response magnitudes as measured by the four indexes. These findings have provided several important lessons for future pandemic response and preparedness for countries with similar economic, demographic, and health contexts in (1) prompt actions of containment and closure policies with dynamic adjusting, (2) strengthening health system policies, (3) comprehensive vaccination policies with universal access, (4) equitable and free access to testing, diagnosis, and treatment for all, and (5) strengthening the resilience of health systems.

Changes in Positive Childhood Experiences During the COVID-19 Pandemic

OBJECTIVE

Changes in family life associated with COVID-19 precautions may have reduced children's access to positive childhood experiences (PCEs). The purpose of this study is to examine the prevalence of PCEs before and during the COVID-19 pandemic among school-age children.

METHODS

This cross-sectional study used data from the 2018-19 National Survey of Children's Health (NSCH, n = 42,464) and the 2020-21 NSCH (n = 54,256) to examine the pre-pandemic period (June 2018-January 2020) and compared results to information obtained during the early pandemic period (June 2020-January 2022) using bivariate analyses and Z-tests.

RESULTS

PCEs declined in four of the seven PCEs measured, from 2018 to 2019-2020-2021: after-school activities, community volunteerism, guiding mentor, and resilient family, with all differences significant by P < .0001. After-school activities decreased from 79.8% to 72.2%, community volunteering decreased from 43.9% to 35.1%, guiding mentor decreased from 88.8% to 86.3%, and resilient family decreased from 92.7% to 84.6%. PCEs increased for safe neighborhood (64.7-67.2%), supportive neighborhood (55.8-57.5%), and connected caregiver (65.3-94.7%).

CONCLUSIONS

As children have experienced higher levels of parental stress and disruption during their lives during the COVID-19 pandemic, policymakers and program makers must find ways to increase exposure to PCEs following the pandemic. The quantification of these PCEs is a great start, with further research needed to describe ways that schools and community organizations have found to expose children to PCEs in safe ways.

Evaluating the Effectiveness of Public Health Measures During Infectious Disease Outbreaks: A Systematic Review

Over the previous three decades, the incidence of infectious disease outbreaks has considerably increased and the trend is expected to increase further. Public health measures are essential for controlling and preventing emerging outbreaks of infectious illnesses. This study is aimed at evaluating the effectiveness of public health measures during infectious disease outbreaks by summarizing the outcomes from the available evidence in the literature. A systematic review was carried out through a detailed search strategy using specific keywords applied across different electronic databases, including the Science Direct, PubMed, and EMBASE databases. Studies published between 2015 and 2024 were included with a focus on cohorts, clinical trials, longitudinal studies, case-control, and quasi-experimental studies. Low-quality studies and those published before 2015 along with incorrect findings or measures were excluded. A standardized form was used for data extraction. The quality of included studies and the risk of bias were assessed through relevant techniques. The obtained data was narrative synthesized and findings were organized systematically. The reviewed studies revealed that public health measures are considerably effective against infectious disease outbreaks. The success of various measures such as social isolation, confinement measures, and public education on hygiene against different outbreaks of respiratory infectious diseases has been well-established in the literature. Moreover, the timing of intervention application plays a vital role in their success. The implementation in the early phase of an outbreak is highly effective, as it protects more people from infection and controls the overall burden of the disease. The systematic review provided valuable insights into the efficiency of public health measures in monitoring outbreaks of infectious illnesses. The main findings suggest that appropriate public health interventions are effective in controlling the incidence of contagious disease outbreaks. Ongoing research strives to investigate measures that are most effective from the perspective of public health against various transmittable diseases to prevent future outbreaks.

Estimating the population effectiveness of interventions against COVID-19 in France: A modelling study

BACKGROUND

Non-pharmaceutical interventions (NPIs) and vaccines have been widely used to manage the COVID-19 pandemic. However, uncertainty persists regarding the effectiveness of these interventions due to data quality issues, methodological challenges, and differing contextual factors. Accurate estimation of their effects is crucial for future epidemic preparedness.

METHODS

To address this, we developed a population-based mechanistic model that includes the impact of NPIs and vaccines on SARS-CoV-2 transmission and hospitalization rates. Our statistical approach estimated all parameters in one step, accurately propagating uncertainty. We fitted the model to comprehensive epidemiological data in France from March 2020 to October 2021. With the same model, we simulated scenarios of vaccine rollout.

RESULTS

The first lockdown was the most effective, reducing transmission by 84 % (95 % confidence interval (CI) 83-85). Subsequent lockdowns had diminished effectiveness (reduction of 74 % (69-77) and 11 % (9-18), respectively). A 6 pm curfew was more effective than one at 8 pm (68 % (66-69) vs. 48 % (45-49) reduction), while school closures reduced transmission by 15 % (12-18). In a scenario without vaccines before November 2021, we predicted 159,000 or 168 % (95 % prediction interval (PI) 70-315) more deaths and 1,488,000 or 300 % (133-492) more hospitalizations. If a vaccine had been available after 100 days, over 71,000 deaths (16,507-204,249) and 384,000 (88,579-1,020,386) hospitalizations could have been averted.

CONCLUSION

Our results highlight the substantial impact of NPIs, including lockdowns and curfews, in controlling the COVID-19 pandemic. We also demonstrate the value of the 100 days objective of the Coalition for Epidemic Preparedness Innovations (CEPI) initiative for vaccine availability.

Performance of Three Anti-SARS-CoV-2 Anti-S and One Anti-N Immunoassays for the Monitoring of Immune Status and Vaccine Response

This study aimed to evaluate and compare the performance of three anti-S and one anti-N assays that were available to the project in detecting antibody levels after three commonly used SARS-CoV-2 vaccines (Pfizer, Moderna, and Johnson & Johnson). It also aimed to assess the association of age, sex, race, ethnicity, vaccine timing, and vaccine side effects on antibody levels in a cohort of 827 individuals. In September 2021, 698 vaccinated individuals donated blood samples as part of the Association for Diagnostics & Laboratory Medicine (ADLM) COVID-19 Immunity Study. These individuals also participated in a comprehensive survey covering demographic information, vaccination status, and associated side effects. Additionally, 305 age- and gender-matched samples were obtained from the ADLM 2015 sample bank as pre-COVID-19-negative samples. All these samples underwent antibody level analysis using three anti-S assays, namely Beckman Access SARS-CoV-2 IgG (Beckman assay), Ortho Clinical Diagnostics VITROS Anti-SARS-CoV-2 IgG (Ortho assay), Siemens ADVIA Centaur SARS-CoV-2 IgG (Siemens assay), and one anti-N antibody assay: Bio-Rad Platelia SARS-CoV-2 Total Ab assay (BioRad assay). A total of 827 samples (580 COVID-19 samples and 247 pre-COVID-19 samples) received results for all four assays and underwent further analysis. Beckman, Ortho, and Siemens anti-S assays showed an overall sensitivity of 99.5%, 97.6%, and 96.9%, and specificity of 90%, 100%, and 99.6%, respectively. All three assays indicated 100% sensitivity for individuals who received the Moderna vaccine and boosters, and over 99% sensitivity for the Pfizer vaccine. Sensitivities varied from 70.4% (Siemens), 81.5% (Ortho), and 96.3% (Beckman) for individuals who received the Johnson & Johnson vaccine. BioRad anti-N assays demonstrated 46.2% sensitivity and 99.25% specificity based on results from individuals with self-reported infection. The highest median anti-S antibody levels were measured in individuals who received the Moderna vaccine, followed by Pfizer and then Johnson & Johnson vaccines. Higher anti-S antibody levels were significantly associated with younger age and closer proximity to the last vaccine dose but were not associated with gender, race, or ethnicity. Participants with higher anti-S levels experienced significantly more side effects as well as more severe side effects (e.g., muscle pain, chills, fever, and moderate limitations) (p < 0.05). Anti-N antibody levels only indicated a significant correlation with headache. This study indicated performance variations among different anti-S assays, both among themselves and when analyzing individuals with different SARS-CoV-2 vaccines. Caution should be exercised when conducting large-scale studies to ensure that the same platform and/or assays are used for the most effective interpretation of the data.

The new era of cardiovascular research: revolutionizing cardiovascular research with 3D models in a dish

Cardiovascular research has heavily relied on studies using patient samples and animal models. However, patient studies often miss the data from the crucial early stage of cardiovascular diseases, as obtaining primary tissues at this stage is impracticable. Transgenic animal models can offer some insights into disease mechanisms, although they usually do not fully recapitulate the phenotype of cardiovascular diseases and their progression. In recent years, a promising breakthrough has emerged in the form of in vitro three-dimensional (3D) cardiovascular models utilizing human pluripotent stem cells. These innovative models recreate the intricate 3D structure of the human heart and vessels within a controlled environment. This advancement is pivotal as it addresses the existing gaps in cardiovascular research, allowing scientists to study different stages of cardiovascular diseases and specific drug responses using human-origin models. In this review, we first outline various approaches employed to generate these models. We then comprehensively discuss their applications in studying cardiovascular diseases by providing insights into molecular and cellular changes associated with cardiovascular conditions. Moreover, we highlight the potential of these 3D models serving as a platform for drug testing to assess drug efficacy and safety. Despite their immense potential, challenges persist, particularly in maintaining the complex structure of 3D heart and vessel models and ensuring their function is comparable to real organs. However, overcoming these challenges could revolutionize cardiovascular research. It has the potential to offer comprehensive mechanistic insights into human-specific disease processes, ultimately expediting the development of personalized therapies.

Trajectory of COVID-19 response and management strategy in China: scientific rationale driven strategy adjustments

The pneumonia caused by novel coronavirus SARS-CoV-2 infection in early December 2019, which was later named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO), rapidly spread across the world. China has made extraordinary efforts to this unprecedented pandemic, put its response and control at a very high level of infectious disease management (Category B but with measures for Category A), given top priority to the people and their lives, and balanced the pandemic control and socio-economic development. After more than three years' fighting against this disease, China downgraded the management of COVID-19 to Category B infectious disease on January 8, 2023 and the WHO declared the end of public health emergency on May 5, 2023. However, the ending of pandemic does not mean that the disease is no longer a health threat. Experiences against COVID-19 from China and the whole world should be learned to prepare well for the future public health emergencies. This article gives a systematic review of the trajectory of COVID-19 development in China, summarizes the critical policy arrangements and provides evidence for the adjustment during policy making process, so as to share experiences with international community and contribute to the global health for all humanity.

A 6-month exercise intervention clinical trial in women: effects of physical activity on multi-omics biomarkers and health during the first wave of COVID-19 in Korea

BACKGROUND

Coronavirus disease 2019 (COVID-19) was first reported in December 2019 and the first case in Korea was confirmed on January 20, 2020. Due to the absence of therapeutic agents and vaccines, the Korean government implemented social distancing on February 29, 2020. This study aimed to examine the effect of physical activity (PA) on health through changes in multi-omics biomarkers with a 6-month of exercise intervention during the first wave of COVID-19 in Korea.

METHODS

Twenty-seven healthy middle-aged women were recruited and 14 subjects completed the exercise intervention. The mean age (± SD) was 46.3 (± 5.33) and the mean BMI (± SD) was 24.9 (± 3.88). A total of three blood and stool samples were collected at enrollment, after period 1, and after period 2 (3-month intervals). The amount of PA was measured with an accelerometer and by questionnaire. Clinical variables were used, including blood pressure, grip strength, flexibility, and blood glucose levels and lipid markers obtained from laboratory tests. The concentration of blood metabolites was measured by targeted metabolomics. Fecal microbiome data were obtained by 16 S rRNA gene amplicon sequencing.

RESULTS

During the second half period (period 2), Coronavirus disease 2019 occurred and spread out in Korea, and PA decreased compared with the first half period (period 1) (185.9 ± 168.73 min/week to 102.5 ± 82.30 min/week; p = 0.0101). Blood pressure, hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) decreased in period 1 (p < 0.05) and tended to increase again during period 2 (p < 0.05). Forty metabolites were changed significantly during period 1 (FDR p < 0.05), and we found that 6 of them were correlated with changes in blood pressure, HbA1c, and LDL-C via network analysis.

CONCLUSIONS

Our results may suggest that exercise improves health through changes in biomarkers at multi-omics levels. However, reduced PA due to COVID-19 can adversely affect health, emphasizing the necessity for sustained exercise and support for home-based fitness to maintain health.

TRIAL REGISTRATION

The trial is retrospectively registered on ClinicalTrials.gov (NCT05927675; June 30, 2023).

SARS-CoV-2 trends in Italy, Germany and Portugal and school opening during the period of Omicron variant dominance: A quasi experimental study in the EuCARE project

OBJECTIVES

We investigated the impact of school reopening on SARS-CoV-2 transmission in Italy, Germany, and Portugal in autumn 2022 when the Omicron variant was prevalent.

METHODS

A prospective international study was conducted using the case reproduction number (Rc) calculated with the time parametrization of Omicron. For Germany and Italy, staggered difference-in-differences analysis was employed to explore the causal relationship between school reopening and Rc changes, accounting for varying reopening dates. In Portugal, interrupted time series analysis was used due to simultaneous school reopenings. Multivariable models were adopted to adjust for confounders.

RESULTS

In Italy and Germany, post-reopening Rc estimates were significantly lower compared to those from regions/states that had not yet reopened at the same time points, both in the student population (overall average treatment effect for the treated subpopulation [O-ATT]: -0.80 [95% CI: -0.94;-0.66] for Italy; O-ATT-0.30 [95% CI: -0.36;-0.23] for Germany) and the adult population (O-ATT: -0.04 [95% CI: -0.07;-0.01] for Italy; O-ATT: -0.07 [95% CI: -0.11;-0.03] for Germany). In Portugal, there was a significant decreasing trend in Rc following school reopenings compared to the pre-reopening period (sustained effect: -0.03 [95% CI: -0.04; -0.03] in students; -0.02 [95% CI: -0.03; -0.02] in adults).

CONCLUSIONS

We found no evidence of a causal relationship between school reopenings in autumn 2022 and Omicron SARS-CoV-2 transmission.

COVID-19's death transfer to Sub-Saharan Africa

The COVID-19 spread very quickly around the world following its discovery in China, in December 2019. Lockdowns implemented in China and the Global North to control the propagation of the virus and to save human lives have resulted in a global recession. The transmission of the recessionary effects from the Global North to the Global South is reflected in the decline in sub-Saharan Africa's (SSA) GDP and the associated increase in poverty. The purpose of this paper is to illustrate how the recession induced in China and the Global North by COVID-19 lockdowns may have had indirect effects on SSA mortality that are higher than those directly attributed to the pandemic itself. Our methodology relies on a three-step relationship: (i) the impact of lockdowns on the recession in the North, (ii) the impact of the recession in the North on income in SSA countries, and (iii) the impact of a decline in income on mortality in SSA. We show that COVID-19-induced lockdowns in the Global North, through the severe recessions they induced in the Global South, resulted in the transfer of between 538,000 and 679,000 deaths in one year to SSA, including the deaths of 140,000 to 177,000 children aged 0-5 years. This corresponds to a 6-7% increase in the crude death rate and a 5-6% increase in under-5 mortality. These figures are much higher than the number of deaths directly attributable to COVID-19 in SSA. Thus, policymakers must not lose sight of the indirect excess mortality caused by global economic recession triggered by the pandemic. Our results reveal the need to increase the resilience of SSA countries to exogenous shocks, including COVID-19, which, in addition to increasing poverty, may induce excessive mortality due to the high sensitivity of mortality in SSA countries to economic recession.

Prevalence and associated risk factors for mental health problems among young adults in Fiji Island during COVID-19: a cross-sectional study

Introduction

The COVID-19 pandemic has had a significant impact on mental health globally. To understand the impact of the pandemic on mental health in Fiji, this study aimed to investigate the prevalence of anxiety disorder and depression among the young adults.

Method

An online survey was conducted to assess the prevalence of anxiety disorder and depression among the general population in Suva, Fiji during the COVID-19 pandemic. A total of 1,119 Fiji adults participated in the study. The study was conducted between May 20 to June 30, 2022, using a snowball sampling via social media platforms. The Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales were used to measure anxiety and depression, respectively. The COVID-19 related stressors was evaluated using the adapted SARS stressors assessment. Univariate and multivariate logistic regression analysis was performed to determine the factors influencing mental health among respondents.

Results

The result shows that a significant portion of individuals experienced each of the stressors, with the highest prevalence seen for hearing information about the severity of COVID-19. The prevalence of anxiety and depression was found to be 45% and 49%, respectively. Being female, having pre-existing illness and COVID-19 stressors were a risk factor to develop anxiety and depression. On the other hand, employed individuals and having high BMI was a protective factor against developing depression during COVID-19 lockdown.

Conclusion

These findings highlight the importance of addressing the mental health needs of the Fijian population during the COVID-19 pandemic and beyond.

The combined impact of social networks and connectedness on anxiety, stress, and depression during COVID-19 quarantine: a retrospective observational study

Introduction

The COVID-19 pandemic and associated quarantine measures have precipitated a surge in mental health disorders, particularly depression and anxiety. Government policies and restrictions on physical activity have contributed to this phenomenon, as well as diminished subjective social connectedness and exacerbated objective social isolation. As two dimensions of social isolation, it is worth noting that subjectively perceived social connectedness serves as a protective factor for mental health, whereas the decline in the size of objectively evaluated social networks poses a significant risk. However, research investigating the combined influence of these two dimensions remains limited.

Methods

This study used an online survey to collect data to investigate the effects of objective social connectedness and objective social networks on anxiety, stress, and depression during COVID-19 quarantine. A total of 485 participants were analyzed using statistical methods, including paired t-test, Pearson correlation analysis, linear regression, cluster analysis, ANOVA, and moderated mediated.

Results

The study found that anxiety and depression scores increased during the quarantine, with age, education, and social connectedness scores associated with the increase. Pre-quarantine anxiety and depression levels were strongly correlated with mental health status during quarantine. Cluster analysis, respectively, revealed three clusters for those without increasing anxiety and depression scores. The study also found that objective social network influences the impact of subjective social connectedness on pre-quarantine mental health, which in turn affects anxiety and depression levels during quarantine.

Conclusion

The study identified that quarantine increased anxiety and depression, with age being protective, and education and subjective social connectedness as risk factors. The study also emphasizes the comprehensive impact of objective and subjective social isolation. Although individuals perceive the same degree of social connectedness, those with smaller social networks are more prone to developing symptoms of anxiety and depression, which are also more likely to worsen during quarantine.

Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study

BACKGROUND

The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH).

OBJECTIVE

This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH.

METHODS

Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups.

RESULTS

From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality.

CONCLUSIONS

Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817.

Association between physical activity levels and anxiety or depression among college students in China during the COVID-19 pandemic: A meta-analysis

BACKGROUND

This meta-analysis aimed to investigate the links between the level of physical activity and the risk of anxiety or depression among college students in China during the Coronavirus Disease 2019 pandemic.

METHODS

Eligible studies were searched from the PubMed, Embase, and Web of Science databases. The associations between them were assessed with odd ratio (OR) and 95% confidence interval (CI). The heterogeneity of the included studies was evaluated and subgroup analysis was performed. Sensitivity analysis was executed using leave-one-out method. Publication bias of included studies was evaluated. Ten studies with moderate quality were included.

RESULTS

Physical activity levels of college students were associated with reduced risk of depression (OR [95%CI] = 0.69 [0.58, 0.82], P < .001) and anxiety (OR [95%CI] = 0.71 [0.62, 0.80], P < .001). The measurement scale of depression or anxiety and whether multi-factor correction was performed or not did not influence the pooled results. The pooled results of depression and anxiety were stable and were not significantly influenced by a single study. No publication bias was observed in the included studies reporting depression and anxiety.

CONCLUSION

The physical activity level of college students is negatively correlated with anxiety and depression in China during the pandemic. During the Coronavirus Disease 2019 pandemic, it is necessary to strengthen the construction of university physical education courses. As an organized form of physical activity, physical education classes are a necessary and effective way to increase physical activity among college students.

The unintended consequences of inconsistent closure policies and mobility restrictions during epidemics

Background

Controlling the spread of infectious diseases-even when safe, transmission-blocking vaccines are available-may require the effective use of non-pharmaceutical interventions (NPIs), e.g., mask wearing, testing, limits on group sizes, venue closure. During the SARS-CoV-2 pandemic, many countries implemented NPIs inconsistently in space and time. This inconsistency was especially pronounced for policies in the United States of America (US) related to venue closure.

Methods

Here, we investigate the impact of inconsistent policies associated with venue closure using mathematical modeling and high-resolution human mobility, Google search, and county-level SARS-CoV-2 incidence data from the USA. Specifically, we look at high-resolution location data and perform a US-county-level analysis of nearly 8 million SARS-CoV-2 cases and 150 million location visits, including 120 million church visitors across 184,677 churches, 14 million grocery visitors across 7662 grocery stores, and 13.5 million gym visitors across 5483 gyms.

Results

Analyzing the interaction between venue closure and changing mobility using a mathematical model shows that, across a broad range of model parameters, inconsistent or partial closure can be worse in terms of disease transmission as compared to scenarios with no closures at all. Importantly, changes in mobility patterns due to epidemic control measures can lead to increase in the future number of cases. In the most severe cases, individuals traveling to neighboring jurisdictions with different closure policies can result in an outbreak that would otherwise have been contained. To motivate our mathematical models, we turn to mobility data and find that while stay-at-home orders and closures decreased contacts in most areas of the USA, some specific activities and venues saw an increase in attendance and an increase in the distance visitors traveled to attend. We support this finding using search query data, which clearly shows a shift in information seeking behavior concurrent with the changing mobility patterns.

Conclusions

While coarse-grained observations are not sufficient to validate our models, taken together, they highlight the potential unintended consequences of inconsistent epidemic control policies related to venue closure and stress the importance of balancing the societal needs of a population with the risk of an outbreak growing into a large epidemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44263-023-00028-z.

The role of the social sciences and humanities in pandemic preparedness responses: insights gained from COVID-19, HIV and AIDS and related epidemics

The COVID-19 pandemic, particularly from 2020 to mid-2022, debilitated the management of the HIV epidemic in Africa. The multiple effects included well-documented HIV service interruptions, curtailment of HIV prevention programmes, the associated marked increase in both the risk for HIV infection among key populations and vulnerability of sub-populations (e.g. adolescent girls and young women) who are the focus of these programmes and - as importantly but less well-documented - the diverse negative socio-economic effects that accentuate HIV risk and vulnerability generally (e.g. loss of earnings, gender-based violence, stigma, police harassment of people during "lockdowns"). The global biomedical response to COVID-19 was necessary and remarkable for mitigating the bio-physical impacts of the pandemic (e.g. wide-spread surveillance coupled with rapid updates on the epidemiology of infections, rapid development of vaccines and revisions of treatment). However, drawing upon the widespread criticisms of state responses to the socio-economic effects of the COVID-19 pandemic and of "lockdowns" themselves, this article elaborates a core argument within those criticisms, namely that key lessons learnt during the HIV and AIDS and other pandemics were ignored, at least during the early stages of COVID-19. Our critique is that better integration of the social sciences and humanities in responses to pandemics can counter the reflex tendency to uncritically adopt a biomedical paradigm and, more importantly, to enable consideration of the social determinants of health in pandemic responses. At root, we re-assert a key value of 'integrated' interventions, namely the accommodation of context-sensitive considerations in the formulation of strategies, policies, plans and programme designs.

Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages, which was defined by the World Health Organization as coronavirus disease 2019 (COVID-19). The pandemic is considered a significant threat to global public health till now. In this review, we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2, including its prototype and variants. The overall clinical features of variants of concern (VOC), heterogeneity in the clinical manifestations, radiology and pathology of COVID-19 patients are also discussed, along with advances in therapeutic agents.

Prevalence of Ureaplasma species among patients at a tertiary hospital in China: a 10-year retrospective study from 2013 to 2022

BACKGROUND

Ureaplasma species are common pathogens of the urogenital tract and can cause a range of diseases. Unfortunately, there is still a scarcity of large-scale and cross-sectional studies on the prevalence of Ureaplasma species in China to clarify their epidemic patterns.

METHODS

This study retrospectively analyzed the data of 18667 patients who visited Peking Union Medical College Hospital for showing various symptoms of (suspected) Ureaplasma species infection during the period 2013-2022. The overall prevalence of Ureaplasma species was calculated, and subgroup analyses were conducted in view of gender, age, specimen types, and diagnosis in every year within the period studied. Furthermore, previous literature that reported on the prevalence of Ureaplasma species in various regions of China was searched and summarized.

RESULTS

The overall positive rate of Ureaplasma species in this study reached 42.1% (7861/18667). Specifically, the prevalence of Ureaplasma species was significantly higher in female patients, while the highest detection rate was found in the 21-50 age group. From 2013 to 2022, there were no significant differences in positive rates of Ureaplasma species among years. However, the detection rate of Ureaplasma species was decreased in COVID-19 period (2020-2022) compared to pre-COVID-19 period (2017-2019). In view of the distribution of patients, outpatients predominated, but the detection rate was lower than inpatients. Urine was the most common specimen type, while cervical swabs had the highest detection rate of Ureaplasma species. When grouped by diagnosis, the highest positive rate of Ureaplasma species was seen in patients with adverse pregnancy outcomes and the lowest rate in patients with prostate disease. The previous literature, although heterogeneous, collectively suggested a high prevalence of Ureaplasma species in China.

CONCLUSIONS

Our study has shown that Ureaplasma species have reached a significant prevalence in China and demands adequate attention.

Association of gastrointestinal symptoms and skipping breakfast with anxiety and depressive symptoms in quarantined Chinese college students during the Shanghai 2022 lockdown: a cross sectional survey

BACKGROUND

This study aimed to evaluate the prevalence of anxiety and depressive symptoms among quarantined college students at school in Shanghai 2022 lockdown during the COVID-19 pandemic and investigate the association of gastrointestinal discomfort related-factors and skipping breakfast with anxiety and depressive symptoms.

METHODS

384 quarantined college students in Shanghai China were recruited in this cross-sectional study from April 5th to May 29th, 2022. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to assess anxiety and depressive symptoms, respectively.

RESULTS

The prevalence of anxiety and depressive symptoms were 56.8% and 62.8%, respectively. Longer quarantine duration, higher education level, skipping breakfast, stomachache or abdominal pain, and nausea or dyspepsia were significantly associated with anxiety symptoms. Moreover, longer quarantine duration, being woman, skipping breakfast, stomachache or abdominal pain, and nausea or dyspepsia were markedly related to depressive symptoms. Notably, regularly physical exercising and taking positive attitude towards COVID-19 were negatively correlated with anxiety and depressive symptoms.

CONCLUSIONS

More attention should be paid to anxiety and depressive symptoms of quarantined college students and universities should provide timely psychological monitoring and intervention services to mitigate the impact of negative emotions on students. Effectively relieving gastrointestinal symptoms, insisting on eat breakfast, regularly exercising, and taking a positive attitude towards to COVID-19 might contribute to preventing the anxiety and depressive symptoms for those college students experiencing a long-term quarantine.

Detection rates of norovirus gastroenteritis and factors associated with the infection before and during COVID-19 pandemic: a secondary analysis of surveillance data in Guangxi Zhuang Autonomous Region, Southern China

Background: Changes in oral and hand hygiene behaviors have been reported during the COVID-19 pandemic in 2020 which may be associated with the incidence of the norovirus infection, a common cause of gastroenteritis. Objective: To estimate the trends of detection rates of norovirus gastroenteritis and associated factors before COVID-19 in 2015-2019 and during the COVID-19 in 2020 in Guangxi, China. Methods: A secondary analysis of Guangxi surveillance data of gastroenteritis patients was conducted. The detection rate in 2020 was predicted using an autoregressive integrated moving average modeland associated factors were analyzed using multiple logistic regression adjusted for interaction effects. Results: Of 7,903 gastroenteritis patients, the overall detection rate of norovirus gastroenteritis was 12.8%, (14.3% before and 6.1% during COVID-19). Detection rates gradually decreased from 2015 to 2020, of which the slope of predicted line was slightly flatter than the actual line. The odds ratios of detection were double to triple increase during COVID-19 in the younger age group and having food intake outside their homes. Tourist city, season, and types of food were independent associated factors. Conclusion: The detection rates were higher during the COVID-19 year among the population aged 45 years or less and those who consumed food outside their home.

Heavy-tailed distributions of confirmed COVID-19 cases and deaths in spatiotemporal space

This paper conducts a systematic statistical analysis of the characteristics of the geographical empirical distributions for the numbers of both cumulative and daily confirmed COVID-19 cases and deaths at county, city, and state levels over a time span from January 2020 to June 2022. The mathematical heavy-tailed distributions can be used for fitting the empirical distributions observed in different temporal stages and geographical scales. The estimations of the shape parameter of the tail distributions using the Generalized Pareto Distribution also support the observations of the heavy-tailed distributions. According to the characteristics of the heavy-tailed distributions, the evolution course of the geographical empirical distributions can be divided into three distinct phases, namely the power-law phase, the lognormal phase I, and the lognormal phase II. These three phases could serve as an indicator of the severity degree of the COVID-19 pandemic within an area. The empirical results suggest important intrinsic dynamics of a human infectious virus spread in the human interconnected physical complex network. The findings extend previous empirical studies and could provide more strict constraints for current mathematical and physical modeling studies, such as the SIR model and its variants based on the theory of complex networks.

Responsibility of education in improving medical college students' ability to prevent and respond to public health emergencies in China - A systematic review

Background

The outbreak of coronavirus disease 2019 (COVID-19) has highlighted the critical importance of sufficient preparedness for public health emergencies. This places higher requirements on the ability of medical staff to deal with such emergencies. Nonetheless, education courses on public health emergencies in China are usually aimed at public health students, and not at all medical college students. Importantly, these medical students will become medical workers who are generally the first-contact personnel and play an irreplaceable role in responding to most public health emergencies. Therefore, it is urgent to strengthen educational courses to enable these students to adequately prevent and respond to public health emergencies.

Objectives

The purpose of this systematic review was to reveal the current unsatisfactory status of Chinese medical college students' knowledge and skills in dealing with public health emergencies and their training needs.

Methods

We searched EMBASE, PubMed, Google Scholar, Web of Science, CNKI, Wan Fang, and VIP Information Network for all associated original studies written in English and Chinese from the inception of these databases until March 12, 2022.

Results

This systematic review screened out 15 eligible studies that met the inclusion criteria. These studies demonstrated that Chinese medical college students generally have a low ability to deal with public health emergencies. Most students believe it is essential to master coping with public health emergencies and desire to acquire this knowledge. But the participation rate is low, and only a few students actively seek relevant knowledge.

Conclusion

The findings of this review illustrate the importance of improving medical college students' education to prevent and deal with public health emergencies. It is necessary to improve medical college students' education in responding to public health emergencies.Systematic Review Registration: PROSPERO, Identifier [CRD42023467374].

Analysis of Symptom Spectra and Associated Factors Among 536 Respondents During the COVID-19 Epidemic in China: A Cross-Sectional Study

Purpose

This study aims to identify common COVID-19 symptoms and asymptomatic infection rates during the epidemic in China. We also introduce the concepts of "Time-point asymptomatic rate" and "Period asymptomatic rate".

Object and Methods

A questionnaire survey was conducted online from December 2022 to January 5, 2023, collecting demographic characteristics, laboratory results, clinical symptoms, lifestyle and vaccination history. Statistical methods were used to analyze symptom characteristics, associated factors, and patterns during an 8-day observation period. Numerical variables were described by median M (Q1-Q3) or mean and standard deviation (). Categorical variables are described by frequency (N), ratio (%) or rate (%). The influencing factors were studied by Wilcoxon or Kruskal-Willis H rank sum test or logistic regression analysis, and the trend of symptom incidence by Spearman rank correlation. P value being ≤0.05 was statistically significant.

Results

Out of 536 participants, 493 (91.98%) were infected, with 3 asymptomatic cases and 490 symptomatic cases within 8 days. The time-point asymptomatic rate increased from 0.61% on day 1 to 15.42% on day 8. Fever, cough, and fatigue were the main symptoms, with additional symptoms such as vomiting, diarrhea, and hyposmia reported. Symptom durations varied, with cough and expectoration lasting longer and vomiting and diarrhea lasting shorter. Several symptoms showed a downward trend over time.

Conclusion

Our online survey highlighted that most COVID-19 patients experienced symptoms, and the time-point asymptomatic rate showed a dynamic change among the infected population. Onset patterns and demographic factors influence symptom occurrence and duration. These findings have implications for clinical practitioners and decision-makers in public health measures and strategies.

The Impact of Adolescents' Character Strengths on Quality of Life in Stressful Situations During COVID-19 in China: A Moderated Mediation Approach

PURPOSE

This study aimed to investigate the relationship between adolescents' character strengths and quality of life during the COVID-19 lockdown and to further explore the role of strengths use and perceived threats.

METHOD

A total of 804 adolescents from Wuhan, China were recruited to complete an online survey. The data collection was conducted between April and May 2020, during the lockdown of Wuhan due to the COVID-19 pandemic, which resulted in the suspension of school attendance for adolescents and the transition to online teaching. Mini Quality of Life Enjoyment and Satisfaction Questionnaire (Mini-Q-LES-Q) was used to measure adolescents' quality of life, while their character strengths, strengths use, and perceived threats were measured using the Three-Dimensional Inventory of Character Strengths (TICS), the Chinese version Strengths Use Scale (SUS) and Perceived threats of COVID-19 questionnaire.

RESULTS

The results of the study indicated that adolescents' character strengths could positively affect their quality of life, and strengths use played a partially mediating role, while the moderating effect of perceived threats was not significant.

DISCUSSION AND CONCLUSIONS

In the face of persistent pandemic effects or other similar stressful events in the future, the development of adolescents' character strengths and strengths use can effectively improve adolescents' quality of life, which provides a theoretical reference for future social work intervention.

Policy stringency and the spread of COVID-19: The moderating role of culture and its implications on first responses

There has been a noticeable variance between countries in the growth rate of COVID-19 since the start of the pandemic. Researchers attempted to understand this variance from two primary perspectives: the policies implemented to curb the spread of the virus [1] and the cross-country cultural differences [2]. However, little research to date has looked at the joint effects of policy responses and national culture. We argue that the effectiveness of restrictive policies depends on cultural values. Specifically, when policies are non-mandatary, cultural values influence people's voluntary adherence to these policies, and hence, the spread of COVID-19. We analyzed the growth data in daily new cases across 78 countries, focusing on the joint impact of containment policies and cultural values. We found that although policy responses (i.e., containment policies) significantly predicted the spread rate of COVID-19 over time, their effects were moderated by cultural variables as well. Implications for policymaking are discussed.

Monitoring the reproductive number of COVID-19 in France: Comparative estimates from three datasets

BACKGROUND

The effective reproduction number (Rt) quantifies the average number of secondary cases caused by one person with an infectious disease. Near-real-time monitoring of Rt during an outbreak is a major indicator used to monitor changes in disease transmission and assess the effectiveness of interventions. The estimation of Rt usually requires the identification of infected cases in the population, which can prove challenging with the available data, especially when asymptomatic people or with mild symptoms are not usually screened. The purpose of this study was to perform sensitivity analysis of Rt estimates for COVID-19 surveillance in France based on three data sources with different sensitivities and specificities for identifying infected cases.

METHODS

We applied a statistical method developed by Cori et al. to estimate Rt using (1) confirmed cases identified from positive virological tests in the population, (2) suspected cases recorded by a national network of emergency departments, and (3) COVID-19 hospital admissions recorded by a national administrative system to manage hospital organization.

RESULTS

Rt estimates in France from May 27, 2020, to August 12, 2022, showed similar temporal trends regardless of the dataset. Estimates based on the daily number of confirmed cases provided an earlier signal than the two other sources, with an average lag of 3 and 6 days for estimates based on emergency department visits and hospital admissions, respectively.

CONCLUSION

The COVID-19 experience confirmed that monitoring temporal changes in Rt was a key indicator to help the public health authorities control the outbreak in real time. However, gaining access to data on all infected people in the population in order to estimate Rt is not straightforward in practice. As this analysis has shown, the opportunity to use more readily available data to estimate Rt trends, provided that it is highly correlated with the spread of infection, provides a practical solution for monitoring the COVID-19 pandemic and indeed any other epidemic.

Non-pharmaceutical interventions to combat COVID-19 in the Americas described through daily sub-national data

This dataset covers national and subnational non-pharmaceutical interventions (NPI) to combat the COVID-19 pandemic in the Americas. Prior to the development of a vaccine, NPI were governments' primary tools to mitigate the spread of COVID-19. Variation in subnational responses to COVID-19 is high and is salient for health outcomes. This dataset captures governments' dynamic, varied NPI to combat COVID-19 for 80% of Latin America's population from each country's first case through December 2021. These daily data encompass all national and subnational units in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, and Peru. The dataset includes individual and aggregate indices of nine NPI: school closures, work suspensions, public event cancellations, public transport suspensions, information campaigns, local travel restrictions, international travel controls, stay-at-home orders, and restrictions on the size of gatherings. We also collected data on mask mandates as a separate indicator. Local country-teams drew from multiple data sources, resulting in high-quality, reliable data. The dataset thus allows for consistent, meaningful comparisons of NPI within and across countries during the pandemic.

COVID-19 Epidemiology during Delta Variant Dominance Period in 45 High-Income Countries, 2020-2021

The SARS-CoV-2 Delta variant, first identified in October 2020, quickly became the dominant variant worldwide. We used publicly available data to explore the relationship between illness and death (peak case rates, death rates, case-fatality rates) and selected predictors (percentage vaccinated, percentage of the population >65 years, population density, testing volume, index of mitigation policies) in 45 high-income countries during the Delta wave using rank-order correlation and ordinal regression. During the Delta-dominant period, most countries reported higher peak case rates (57%) and lower peak case-fatality rates (98%). Higher vaccination coverage was protective against peak case rates (odds ratio 0.95, 95% CI 0.91-0.99) and against peak death rates (odds ratio 0.96, 95% CI 0.91-0.99). Vaccination coverage was vital to preventing infection and death from COVID-19 during the Delta wave. As new variants emerge, public health authorities should encourage the uptake of COVID-19 vaccination and boosters.

Greenspace exposure is conducive to the resilience of public sentiment during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic significantly impacts people's sentiment and mental health, threatening their health and lives. We gathered 4.17 million geotagged social media posts from Weibo and scrutinized the nuances of the collective sentiments of netizens in four megacities in China during the first pandemic wave (from 1 December 2019 to 30 April 2020). Our findings suggest that the COVID-19 outbreak significantly reduced the Sentiment Index (SI) in China's cities, and the collective sentiments expressed in Wuhan were even more negative than those in the other three megacities. We explored the uncharted impacts of exposure to three geographical environment factors (GEFs) on SIs. Public exposure to greenspaces increased, while exposure to indoor built spaces decreased during the lockdown period. The exposure to sidewalks increased in rural areas but decreased in the main urban areas. The contributions of various GEFs to the SIs were the lowest during the lockdown period, and SIs were strongly affected by the pandemic. However, greenspace had the most potent effect on SIs, improving public sentiment resilience and mitigating mental health risks.

Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore

INTRODUCTION

During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES.

MATERIALS AND METHODS

A questionnaire assessing digital literacy, social connectedness, wellbeing and quality of life was administered. Socio-demographic variables, pre-existing internet-enabled, and willingness to participate in a home-based DLP was also collected. Logistic regression was used to identify demographic factors associated with digital literacy, smartphone ownership, and willingness to enroll in a DLP. Serial mediation analysis was also performed using a structural equation model framework.

RESULTS

A total of 302 participants were recruited. Female gender, older age, lower education levels were associated with lower digital literacy. Those who owned a smartphone tended to be younger and better educated. Older adults who were better educated, of Chinese descent (the ethnic majority in Singapore), and who had lower digital literacy, were most willing to enroll in the digital literacy education program. Social-use digital literacy had a positive indirect effect on well-being ([Formula: see text]) and Quality of life ([Formula: see text]), mediated by social connectedness and loneliness. In contrast, instrumental-use digital literacy had a negative indirect effect on well-being ([Formula: see text]) and Quality of life ([Formula: see text]), mediated by social connectedness and loneliness.

DISCUSSION

The results suggest there are demographic barriers to participation in DLPs and highlight the benefit of focusing on enhancing social-use digital literacy. Further study is needed to evaluate how well specific interventions to improve social-use digital literacy help to reduce social isolation and loneliness, and ultimately improve wellbeing and quality of life.

Content and User Engagement of Health-Related Behavior Tweets Posted by Mass Media Outlets From Spain and the United States Early in the COVID-19 Pandemic: Observational Infodemiology Study

BACKGROUND

During the early pandemic, there was substantial variation in public and government responses to COVID-19 in Europe and the United States. Mass media are a vital source of health information and news, frequently disseminating this information through social media, and may influence public and policy responses to the pandemic.

OBJECTIVE

This study aims to describe the extent to which major media outlets in the United States and Spain tweeted about health-related behaviors (HRBs) relevant to COVID-19, compare the tweeting patterns between media outlets of both countries, and determine user engagement in response to these tweets.

METHODS

We investigated tweets posted by 30 major media outlets (n=17, 57% from Spain and n=13, 43% from the United States) between December 1, 2019 and May 31, 2020, which included keywords related to HRBs relevant to COVID-19. We classified tweets into 6 categories: mask-wearing, physical distancing, handwashing, quarantine or confinement, disinfecting objects, or multiple HRBs (any combination of the prior HRB categories). Additionally, we assessed the likes and retweets generated by each tweet. Poisson regression analyses compared the average predicted number of likes and retweets between the different HRB categories and between countries.

RESULTS

Of 50,415 tweets initially collected, 8552 contained content associated with an HRB relevant to COVID-19. Of these, 600 were randomly chosen for training, and 2351 tweets were randomly selected for manual content analysis. Of the 2351 COVID-19-related tweets included in the content analysis, 62.91% (1479/2351) mentioned at least one HRB. The proportion of COVID-19 tweets mentioning at least one HRB differed significantly between countries (P=.006). Quarantine or confinement was mentioned in nearly half of all the HRB tweets in both countries. In contrast, the least frequently mentioned HRBs were disinfecting objects in Spain 6.9% (56/809) and handwashing in the United States 9.1% (61/670). For tweets from the United States mentioning at least one HRB, disinfecting objects had the highest median likes and retweets, whereas mask-wearing- and handwashing-related tweets achieved the highest median number of likes in Spain. Tweets from Spain that mentioned social distancing or disinfecting objects had a significantly lower predicted count of likes compared with tweets mentioning a different HRB (P=.02 and P=.01, respectively). Tweets from the United States that mentioned quarantine or confinement or disinfecting objects had a significantly lower predicted number of likes compared with tweets mentioning a different HRB (P<.001), whereas mask- and handwashing-related tweets had a significantly greater predicted number of likes (P=.04 and P=.02, respectively).

CONCLUSIONS

The type of HRB content and engagement with media outlet tweets varied between Spain and the United States early in the pandemic. However, content related to quarantine or confinement and engagement with handwashing was relatively high in both countries.

Reasons for Delayed Diagnosis of Pediatric Acute Appendicitis during the COVID-19 Era: A Narrative Review

Global pandemics cause health system disruptions. The inadvertent disruption in surgical emergency care during the Coronavirus Disease 2019 (COVID-19) pandemic has been the topic of several published studies. Our aim was to summarize the reasons that led to the delayed diagnosis of pediatric appendicitis during the COVID-19 era. This systematic literature search evaluated studies containing pediatric appendicitis patient data regarding outcomes, times to hospital admission or times from symptom onset to emergency department visit. Studies elucidating reasons for delays in the management of pediatric appendicitis were also reviewed. Ultimately, 42 studies were included. Several reasons for delayed diagnosis are analyzed such as changes to public health measures, fear of exposure to COVID-19, increased use of telemedicine, COVID-19 infection with concurrent acute appendicitis, recurrence of appendicitis after non-operative management and increased time to intraoperative diagnosis. Time to hospital admission in conjunction with patient outcomes was extracted and analyzed as an indicative measure of delayed management. Delayed diagnosis of acute appendicitis has been documented in many studies with various effects on outcomes. Suspicion of pediatric acute appendicitis must always lead to prompt medical examination, regardless of pandemic status. Telemedicine can be valuable if properly applied. Data from this era can guide future health system policies.

Estimating SARS-CoV-2 infections and associated changes in COVID-19 severity and fatality

Background

The difficulty in identifying SARS-CoV-2 infections has not only been the major obstacle to control the COVID-19 pandemic but also to quantify changes in the proportion of infections resulting in hospitalization, intensive care unit (ICU) admission, or death.

Methods

We developed a model of SARS-CoV-2 transmission and vaccination informed by official estimates of the time-varying reproduction number to estimate infections that occurred in Italy between February 2020 and 2022. Model outcomes were compared with the Italian National surveillance data to estimate changes in the SARS-CoV-2 infection ascertainment ratio (IAR), infection hospitalization ratio (IHR), infection ICU ratio (IIR), and infection fatality ratio (IFR) in five different sub-periods associated with the dominance of the ancestral lineages and Alpha, Delta, and Omicron BA.1 variants.

Results

We estimate that, over the first 2 years of pandemic, the IAR ranged between 15% and 40% (range of 95%CI: 11%-61%), with a peak value in the second half of 2020. The IHR, IIR, and IFR consistently decreased throughout the pandemic with 22-44-fold reductions between the initial phase and the Omicron period. At the end of the study period, we estimate an IHR of 0.24% (95%CI: 0.17-0.36), IIR of 0.015% (95%CI: 0.011-0.023), and IFR of 0.05% (95%CI: 0.04-0.08).

Conclusions

Since 2021, changes in the dominant SARS-CoV-2 variant, vaccination rollout, and the shift of infection to younger ages have reduced SARS-CoV-2 infection ascertainment. The same factors, combined with the improvement of patient management and care, contributed to a massive reduction in the severity and fatality of COVID-19.

Predictive value of ferritin, glucose, urea, and creatinine for COVID-19 severity and mortality in patients from Asir, Saudi Arabia

OBJECTIVES

To correlate demographics, blood groupings, and laboratory characteristics of hospitalized COVID-19 patients with disease severity and outcomes.

METHODS

This study included 294 COVID-19 patients. Data on patient age, gender, laboratory results, clinical severity, mortality, comorbidities, and blood group were obtained from medical records retrospectively.

RESULTS

High levels of ferritin (p<0.01), urea (p<0.0001), and creatinine (p<0.05) were detected in intensive care unit (ICU)-admitted patients. Ferritin (p<0.05), glucose (p<0.0001), urea (p<0.0001), and creatinine (p<0.0001) were significantly higher in non-survivor compared to survivor COVID-19 patients. Predictors for ICU admission among patients were ferritin (odd ratio [OR]=0.999, p=0.0055) and urea (OR=0.991, p=0.0001). Predictors for mortality were: age (OR=0.963, p=0.0001), ferritin (OR=0.999, p=0.0149), glucose (OR=0.993, p=0.0001), urea (OR=0.976, p=0.0001), and creatinine (OR=0.556, p=0.0001). The most reliable laboratory parameters in predicting mortality were: age (area under the curve [AUC]=0.685, p<0.0001), ferritin (AUC=0.610, p<0.05), glucose (AUC=0.681, p<0.0001), urea (AUC=0.856, p<0.0001), and creatinine (AUC=0.823, p<0.0001).

CONCLUSION

High ferritin, glucose, urea, and creatinine levels may predict poor outcomes in COVID-19 patients. These findings could help predict admissions to the ICU and mortality among such patients.

Public opinion on COVID-19 vaccine prioritization in Bangladesh: Who gets the vaccine and whom do you leave out?

One of the most challenging aspects of the COVID-19 pandemic is the inability to ensure equitable distribution of vaccines to fight the pandemic. Many governments around the globe had to prioritize and perform a triage in distributing the vaccines due to the limited supply as well as a lack of financial strength to acquire a sufficient number of vaccines in time. The present study assessed the public opinion in Bangladesh regarding vaccination prioritization strategy and its associated aspects. Due to the infectious nature of the viral transmission, the study used an online survey and collected a sample of 2291 respondents, distributed proportionally across sex, and income groups. Descriptive statistics and multinomial logistic regression modelling were utilized to conduct the analyses. The results emphasized unanimous preference of prioritized vaccination leaning towards the frontline workers, the severely sick and the elderly. However, the segregation across ethnicity was noted with no major preference among sexes or religion. The results reinforce the Bangladesh government's undertaken strategy of prioritization. However, the preference rankings varied across sociodemographic factors including self-assessed COVID-19 knowledge and income tiers, among others. The findings underline the necessity of improved risk communication strategies to ensure public confidence and conformity to vaccination efforts and their effective deployment across the country.

Non-Pharmacologic Interventions in COVID-19 Pandemic Management; a Systematic Review

Introduction

Different countries throughout the world have adopted non-pharmacologic interventions to reduce and control SARS - CoV-2. In this systematic approach, the impact of non-pharmacologic interventions in management of COVID-19 pandemic was assessed.

Methods

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, systematic search was carried out on the basis of a search strategy on PubMed, Web of Science, Scopus, and WHO databases on COVID-19. The impact of travel ban, personal protective equipment, distancing, contact tracing, school closure, and social distancing and the combined effect of interventions on COVID-19 were assessed.

Results

Of the 14,857 articles found, 44 were relevant. Studies in different countries have shown that various non-pharmacological interventions have been used during the COVID-19 pandemic. The travel ban, either locally or internationally in most of the countries, movement restriction, social distancing, lockdown, Personal Protective Equipment (PPE), quarantine, school closure, work place closure, and contact tracing had a significant impact on the reduction of mortality or morbidity of COVID-19.

Conclusion

Evidence shows that the implementation of non-pharmacologic interventions (NPIs), for this study suggests that the effectiveness of any NPI alone is probably limited, thus, a combination of various actions, for example, social distancing, isolation, and quarantine, distancing in the workplace and use of personal protective equipment, is more effective in reducing COVID-19.