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Urichuk M, Azzi JL, Leitao DJ. The Impact of COVID-19 Restrictions on Hospital Admissions of Common Head and Neck Infections. Laryngoscope 2024; 134:3542-3547. [PMID: 38415842 DOI: 10.1002/lary.31366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Following the emergence of COVID-19, multiple preventative measures were implemented to limit the spread of the disease. This study aims to elucidate the impact of COVID-19 restrictions on hospital admissions of otolaryngology-related infections. MATERIALS AND METHODS A retrospective chart review was conducted to capture all admissions for otolaryngology-related infections in the 2 years pre- and post-COVID-19 at the Health Sciences Centre in Winnipeg, Manitoba. These infections included croup, tracheitis, neck abscess, peritonsillar abscess, otitis media, mastoiditis, sinus infection, orbital infection, pharyngotonsillitis, retro/parapharyngeal abscess, and acute epiglottitis. Demographic information and admission details were collected and analyzed to compare pre- and post-COVID-19 admissions. Further analysis was conducted to compare hospital admissions of patients from rural/remote regions. RESULTS Between March 2018 and March 2022, 253 pediatric patients and 197 adults were admitted for otolaryngology-related infections. Total pediatric admissions decreased post-COVID-19 (154 pre-COVID-19, 99 post-COVID-19; p < 0.001) whereas adult admissions remained stable (107 pre-COVID-19, 90 post-COVID-19; p = 0.25). No significant difference in mean patient age, admission duration, surgical rates or in the proportion of admissions from patients from rural/remote regions was observed in the pediatric or adult cohort when comparing pre-COVID-19 data to post-COVID-19 data. Diagnosis-specific changes in admissions were observed in pediatric croup (40 pre-COVID-19, 15 post-COVID-19; p < 0.001) and in adult orbital infections (30 pre-COVID-19, six post-COVID-19; p < 0.001). CONCLUSION Following the implementation of COVID-19 restrictions, there was a decrease in admissions due to pediatric croup and adult orbital infections with an overall decrease in pediatric Otolaryngology-infection related admissions. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3542-3547, 2024.
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Affiliation(s)
- Matthew Urichuk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason Lee Azzi
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Darren J Leitao
- Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Umbreen G, Rehman A, Aslam S, Jabeen C, Iqbal M, Riaz A, Sadiq S, Maqsood R, Rashid HB, Afzal S, Arshad N, Mushtaq MH, Chaudhry M. Risk factors associated with influenza A (H1N1)pdm09: a nested case control study of TB patients with ILI in Lahore District, Pakistan. BMC Infect Dis 2024; 24:741. [PMID: 39060920 PMCID: PMC11282588 DOI: 10.1186/s12879-024-09263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/26/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Co-morbidity with respiratory viruses including influenza A, cause varying degree of morbidity especially in TB patients compared to general population. This study estimates the risk factors associated with influenza A (H1N1)pdm09 in TB patients with ILI. METHODS A cohort of tuberculosis (TB) patients who were admitted to and enrolled in a TB Directly Observed Therapy Program (DOTs) in tertiary care hospitals of Lahore (Mayo Hospital and Infectious Disease Hospital) were followed for 12 weeks. At the start of study period, to record influenza-like illness (ILI), a symptom card was provided to all the participants. Every participant was contacted once a week, in person. When the symptoms were reported by the participant, a throat swab was taken for the detection of influenza A (H1N1)pdm09. A nested case control study was conducted and TB patients with ILI diagnosed with influenza A (H1N1)pdm09 by conventional RT-PCR were selected as cases, while those who tested negative by conventional RT-PCR were enrolled as controls. All cases and controls in the study were interviewed face-to-face in the local language. Epidemiological data about potential risk factors were collected on a predesigned questionnaire. Logistic analysis was conducted to identify associated risk factors in TB patients with ILI. RESULTS From the main cohort of TB patients (n = 152) who were followed during the study period, 59 (39%) developed ILI symptoms; of them, 39 tested positive for influenza A (H1N1)pdm09, while 20 were detected negative for influenza A (H1N1)pdm09. In univariable analysis, four factors were identified as risk factors (p < 0.05). The final multivariable model identified one risk factor (sharing of towels, P = 0.008)) and one protective factor (wearing a face mask, p = < 0.001)) for influenza A (H1N1)pdm09 infection. CONCLUSION The current study identified the risk factors of influenza A (H1N1)pdm09 infection among TB patients with ILI.
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Affiliation(s)
- Gulshan Umbreen
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Abdul Rehman
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sadaf Aslam
- Department of Veterinary Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Chanda Jabeen
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Iqbal
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Aayesha Riaz
- Department of Patho-Biology, Faculty of Veterinary Animal Sciences, PMAS- Arid Agriculture University, Rawalpindi, Pakistan
| | - Shakera Sadiq
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Rubab Maqsood
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Hamad Bin Rashid
- Department of Veterinary Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Saira Afzal
- Department of Community Medicine, King Edward Medical University, Lahore, Pakistan
| | - Nimra Arshad
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Hassan Mushtaq
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mamoona Chaudhry
- Department of Epidemiology & Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan.
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Shi Y, Xu L, Jiang H, Cai Y, Bao C, Liu W. Analysis of factors influencing influenza outbreaks in schools in Taicang City, China. Front Public Health 2024; 12:1409004. [PMID: 39100958 PMCID: PMC11294167 DOI: 10.3389/fpubh.2024.1409004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
Objective This study aims to analyze the awareness of influenza prevention and control and the behavioral attitudes toward the work among parents and staff in schools in Taicang City and the impact of the vaccination rate among students on influenza outbreaks in schools. The findings can provide references for the development of effective control strategies for the spread of influenza. Methods An anonymous questionnaire survey was conducted on 10,962 students from 20 schools in Taicang City, with class as the unit of analysis. The survey investigated their awareness of influenza prevention and control, their attitudes, and the vaccination coverage. Results From January to June 2023, a total of 388 influenza outbreaks were reported in schools in Taicang City, involving 77 schools. There were 3,475 confirmed cases, with an average infection rate of 18.53%. In schools where influenza outbreaks had occurred, the incidence rate of those who received influenza vaccine was significantly lower than those who did not, and the vaccine protection rate was 28.22%. The knowledge awareness rates of "the main transmission routes of influenza" and "influenza vaccination can prevent influenza" among parents of students were 95.49 and 93.16%, respectively. The differences between schools involved in the epidemic and non-epidemic were statistically significant (p < 0.05). The correct attitudes of parents toward "actively reporting relevant symptoms to teachers when their children show symptoms" and "avoiding classes with diseases when their children are suspected to be sick" are 98.80 and 96.26%, respectively. The differences between schools with and without epidemic are statistically significant (p < 0.05). The correct attitudes of the class teacher toward "correct management and control of students with flu like symptoms in the class" and "taking correct prevention and control measures in the event of a flu epidemic in the class" were 89.36 and 92.55%, respectively. The differences between epidemic related and non-epidemic related classes were statistically significant (p < 0.05). Conclusion Enhance the knowledge level of influenza prevention and control among parents of students, Strengthening the training for class teachers in emergency response to infectious diseases and increasing vaccination coverage among students can effectively reduce the incidence of influenza and thereby the occurrence of cluster outbreaks in schools.
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Affiliation(s)
- Yao Shi
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
- Jiangsu Field Epidemiology Training Program, Jiangsu Provincial Centre for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Lei Xu
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Hai Jiang
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Yongbin Cai
- Taicang City Centre for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Changjun Bao
- Jiangsu Provincial Centre for Disease Control and Prevention, Jiangsu Institution of Public Health, Nanjing, Jiangsu, China
| | - Wendong Liu
- Jiangsu Provincial Centre for Disease Control and Prevention, Jiangsu Institution of Public Health, Nanjing, Jiangsu, China
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Orunta PC, Ndu CO, Ijioma CE, Ogedegbe OJ, Ogundipe FA, Eze-Njoku CP. Knowledge and Practice of Precautions and Prevention of COVID-19 Among Adolescents in Umuahia, Nigeria: A Cross-Sectional Study. Cureus 2024; 16:e64984. [PMID: 39161476 PMCID: PMC11332091 DOI: 10.7759/cureus.64984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges worldwide, particularly in developing countries with limited healthcare resources. Among the various demographics, adolescents represent a crucial group in understanding and curbing the spread of the virus. Aim This research aims to assess the level of knowledge and practice of COVID-19 prevention measures among adolescents in a developing country. Methodology This study's descriptive cross-sectional study design was appropriate for capturing a snapshot of adolescents' understanding of COVID-19 in Umuahia, Abia State, Nigeria, a developing country. The study's participants were secondary school students in Umuahia's urban and rural secondary schools, aged 10-19. Fisher's formula was used to calculate the sample size. A multistage systematic sampling method was used to select 424 participants. Data were gathered using a self-administered questionnaire. The Statistical Package for the Social Sciences (SPSS) software version 25 (IBM SPSS Statistics, Armonk, NY) was used to handle and evaluate the data that had been obtained. Results All the respondents were aware of COVID-19, primarily informed through social media and television (TV). It is concerning that less than half correctly identify the disease as caused by a virus (46.9%), with some falsely attributing it to bacteria (31.1%) or fungi (15.6%). While the majority of respondents knew about the existence of COVID-19 vaccines, only 63.4% were aware that there was no definitive cure for the disease. The most worrying finding was the limited awareness and practice of recommended precautions to prevent the spread of COVID-19. Handwashing with soap and water, social distancing, and using hand sanitizers were the most frequently recognized precautions. However, even these were poorly practiced, with less than 30% of the respondents following them regularly. It was also noted that misconceptions about precautions exist, including unusual practices such as regularly drinking hot water or eating bitter kola/pepperfruit. Also, the most prominent reason for refusal among the respondents for COVID-19 vaccines was parental refusal, accounting for 57.5% of negative responses. Conclusion The study's findings underscore the urgent need for tailored, accessible, and effective health education strategies to improve adolescents' understanding and adoption of COVID-19 preventive measures in the region.
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Arnold L, Bimczok S, Schütt H, Lisak-Wahl S, Buchberger B, Stratil JM. How to protect long-term care facilities from pandemic-like events? - A systematic review on the effectiveness of non-pharmacological measures to prevent viral respiratory infections. BMC Infect Dis 2024; 24:589. [PMID: 38880893 PMCID: PMC11181531 DOI: 10.1186/s12879-024-09271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long-term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non-pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear. METHODS We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE. RESULTS We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems. CONCLUSIONS Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics. TRIAL REGISTRATION CRD42022344149.
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Affiliation(s)
- Laura Arnold
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Simon Bimczok
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Hannah Schütt
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Stefanie Lisak-Wahl
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Barbara Buchberger
- Robert Koch Institute, Berlin, Germany
- University of Duisburg-Essen, Institute for Health Care Management and Research, Essen, Germany
| | - Jan M Stratil
- Robert Koch Institute, Berlin, Germany.
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.
- Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), ECDC Fellowship Programme, Stockholm, Sweden.
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Satwik R, Majumdar A, Mittal S, Tiwari N, Majumdar G. Fertility outcomes in women undergoing Assisted Reproductive Treatments after COVID-19 vaccination: A prospective cohort study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2024; 18:207-214. [PMID: 38973272 PMCID: PMC11245583 DOI: 10.22074/ijfs.2023.1990869.1444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 07/09/2024]
Abstract
BACKGROUND Vaccination against Coronavirus-19 disease (COVID-19) was widely administered from 2021 onwards. There is little information on how this vaccine affected fertility after assisted-reproductive-technology (ART). The aim of this study therefore was to determine if COVID-19 vaccination or time-since-vaccination influenced ART outcomes. MATERIALS AND METHODS In this prospective cohort study, 502 oocyte-retrieval-cycles and 582 subsequent embryo- transfer-cycles were grouped based on COVID-19 vaccine status of the female partner into those with no-exposure, 1-dose and ≥2-dose exposure. Within the exposed cohort, time-since-last-vaccination to embryotransfer- cycle (Ttr) was calculated in days. Main outcomes were mean-total-utilizable-embryos, mean-oocyteutilization- rates and cumulative-ongoing-pregnancy-rates per oocyte-retrieval-cycle, and ongoing-pregnancy and pregnancy-loss-rates per embryo-transfer cycle. The Beta-coefficient (ß) was calculated using linear regression for mean-total-utilizable-embryos and mean-oocyte-utilization-rates and adjusted-odds-ratio (OR) was calculated for cumulative-ongoing-pregnancy-rates, ongoing-pregnancy and pregnancy-loss-rates using binomial logistic regression. Influence of T(tr) on embryo-transfer outcomes was estimated using receiver-operator-curve (ROC) analysis and cut-offs determined that influenced embryo-transfer outcomes. RESULTS Mean-total-utilizable-embryos and mean-oocyte-utilization-rate per oocyte-retrieval-cycle in no-exposure, 1-dose and ≥2 dose were 2.7 ± 1.8 vs. 2.5 ± 1.9 vs. 2.7 ± 2.0, P=0.78, (ß=0.42, 95% confidence-interval (CI)=0.15 to 0.69) and 21.2 ± 13.2 vs. 25.1 ± 19.0 vs. 26.7 ± 18.8, P=0.08, (ß=3.94, 95% CI=1.26 to 6.23) respectively. Ongoing-pregnancy-rates and pregnancy-loss-rates per embryo-transfer-cycle were 27.3% vs. 24.4% vs. 32.5% (aOR=1.38, 95% CI=0.3-5.6, P=0.52), and 13.6% vs. 13.4% vs. 15.2%, (aOR=0.97, 95% CI=0.18-5.2, P=0.97) respectively. Cumulative-ongoing-pregnancy-rates per oocyte-retrieval-cycle were 36.5% vs. 34.5% vs. 35.5% (aOR=1.53, 95% CI=0.57 to 4.07, P=0.35). Median T(tr) was 146 days (IQR: 80-220). T(tr) negatively affected ongoing pregnancy rates for intervals <60 days (AUC=0.59, 95% CI=0.54-0.66, P<0.01). For T(tr) >60 vs. <60 days, the aOR for ongoing-pregnancy-per-embryo-transfer-cycle was 2.85 (95% CI=1.50-5.46, P<0.01). CONCLUSION Covid-19 vaccination does not negatively influence embryological-outcomes or cumulative-ongoing-pregnancies after ART-treatments. Duration since vaccination may have a weak negative effect on embryo-transfer-outcomes performed within 60 days.
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Affiliation(s)
- Ruma Satwik
- Centre of IVF and Human Reproduction, Institute of Obstetrics and Gynecology, Sir Ganga Ram Hospital, New Delhi, India. Emails: ,
| | - Abha Majumdar
- Centre of IVF and Human Reproduction, Institute of Obstetritics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Shweta Mittal
- Centre of IVF and Human Reproduction, Institute of Obstetritics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeti Tiwari
- Centre of IVF and Human Reproduction, Institute of Obstetritics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gaurav Majumdar
- Center of IVF and Human Reproduction, Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
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Li K, Rui J, Song W, Luo L, Zhao Y, Qu H, Liu H, Wei H, Zhang R, Abudunaibi B, Wang Y, Zhou Z, Xiang T, Chen T. Temporal shifts in 24 notifiable infectious diseases in China before and during the COVID-19 pandemic. Nat Commun 2024; 15:3891. [PMID: 38719858 PMCID: PMC11079007 DOI: 10.1038/s41467-024-48201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, along with the implementation of public health and social measures (PHSMs), have markedly reshaped infectious disease transmission dynamics. We analysed the impact of PHSMs on 24 notifiable infectious diseases (NIDs) in the Chinese mainland, using time series models to forecast transmission trends without PHSMs or pandemic. Our findings revealed distinct seasonal patterns in NID incidence, with respiratory diseases showing the greatest response to PHSMs, while bloodborne and sexually transmitted diseases responded more moderately. 8 NIDs were identified as susceptible to PHSMs, including hand, foot, and mouth disease, dengue fever, rubella, scarlet fever, pertussis, mumps, malaria, and Japanese encephalitis. The termination of PHSMs did not cause NIDs resurgence immediately, except for pertussis, which experienced its highest peak in December 2023 since January 2008. Our findings highlight the varied impact of PHSMs on different NIDs and the importance of sustainable, long-term strategies, like vaccine development.
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Affiliation(s)
- Kangguo Li
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Jia Rui
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Wentao Song
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Li Luo
- Health Care Departmen, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Yunkang Zhao
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Huimin Qu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Hong Liu
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Hongjie Wei
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Ruixin Zhang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Buasiyamu Abudunaibi
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Yao Wang
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Zecheng Zhou
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China
| | - Tianxin Xiang
- Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Jiangxi Hospital of China-Japan Friendship Hospital, Nanchang, China.
| | - Tianmu Chen
- State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Innovation Platform for Industry-Education Integration in Vaccine Research, School of Public Health, Xiamen University, Xiamen, China.
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Ramoti N, Siahaan AMP, Indharty S, Adella CA. Effect of face masks on dyspnea perception, cardiopulmonary parameters, and facial temperature in healthy adults. NARRA J 2024; 4:e574. [PMID: 38798847 PMCID: PMC11125298 DOI: 10.52225/narra.v4i1.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/26/2024] [Indexed: 05/29/2024]
Abstract
Respiratory droplets, naturally produced during expiration, can transmit pathogens from infected individuals. Wearing a face mask is crucial to prevent such transmission, yet the perception of dyspnea and uncomfortable breathing remains a common concern, particularly during epidemics. The aim of this study was to investigate the impact of face mask use on the perception of dyspnea, cardiopulmonary parameters, and facial temperature during physical activity. A randomized crossover study was conducted on healthy adults at a physiology laboratory located in the Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, in November 2022. Participants underwent five stages of physical exercise tests based on the Bruce Protocol under three conditions: without any face mask (control), wearing a surgical mask, and an N95 mask, forming the study's main groups. Dyspnea perception (measured by the Modified Borg Dyspnea Scale), cardiopulmonary parameters (heart rate, oxygen saturation, respiratory rate, blood pressure, and mean arterial pressure) and facial temperature were measured before the exercise test (pre-workout), at the end of stage 1, 2, 3, 4, 5, and after the whole exercise test (post-workout). A two-way repeated measures ANOVA was conducted, considering two factors: the type of mask (control, surgical mask, N95 mask) and the various stages of the exercise test. A total of 36 healthy adults were included in the study. We found that dyspnea perception was much worse in the N95 mask group, particularly during vigorous exercise. There was no significant difference between groups in cardiopulmonary parameters. However, participants wearing N95 had a greater supralabial temperature than those wearing surgical masks or no mask at all. It is recommended to undertake a more in-depth evaluation of cardiopulmonary physiological measures.
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Affiliation(s)
- Natanael Ramoti
- Department of Physiology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Andre MP. Siahaan
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Suzy Indharty
- Department of Neurosurgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Cut A. Adella
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Näher AF, Schulte-Althoff M, Kopka M, Balzer F, Pozo-Martin F. Effects of Face Mask Mandates on COVID-19 Transmission in 51 Countries: Retrospective Event Study. JMIR Public Health Surveill 2024; 10:e49307. [PMID: 38457225 PMCID: PMC10926949 DOI: 10.2196/49307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The question of the utility of face masks in preventing acute respiratory infections has received renewed attention during the COVID-19 pandemic. However, given the inconclusive evidence from existing randomized controlled trials, evidence based on real-world data with high external validity is missing. OBJECTIVE To add real-world evidence, this study aims to examine whether mask mandates in 51 countries and mask recommendations in 10 countries increased self-reported face mask use and reduced SARS-CoV-2 reproduction numbers and COVID-19 case growth rates. METHODS We applied an event study approach to data pooled from four sources: (1) country-level information on self-reported mask use was obtained from the COVID-19 Trends and Impact Survey, (2) data from the Oxford COVID-19 Government Response Tracker provided information on face mask mandates and recommendations and any other nonpharmacological interventions implemented, (3) mobility indicators from Google's Community Mobility Reports were also included, and (4) SARS-CoV-2 reproduction numbers and COVID-19 case growth rates were retrieved from the Our World in Data-COVID-19 data set. RESULTS Mandates increased mask use by 8.81 percentage points (P=.006) on average, and SARS-CoV-2 reproduction numbers declined on average by -0.31 units (P=.008). Although no significant average effect of mask mandates was observed for growth rates of COVID-19 cases (-0.98 percentage points; P=.56), the results indicate incremental effects on days 26 (-1.76 percentage points; P=.04), 27 (-1.89 percentage points; P=.05), 29 (-1.78 percentage points; P=.04), and 30 (-2.14 percentage points; P=.02) after mandate implementation. For self-reported face mask use and reproduction numbers, incremental effects are seen 6 and 13 days after mandate implementation. Both incremental effects persist for >30 days. Furthermore, mask recommendations increased self-reported mask use on average (5.84 percentage points; P<.001). However, there were no effects of recommendations on SARS-CoV-2 reproduction numbers or COVID-19 case growth rates (-0.06 units; P=.70 and -2.45 percentage points; P=.59). Single incremental effects on self-reported mask use were observed on days 11 (3.96 percentage points; P=.04), 13 (3.77 percentage points; P=.04) and 25 to 27 (4.20 percentage points; P=.048 and 5.91 percentage points; P=.01) after recommendation. Recommendations also affected reproduction numbers on days 0 (-0.07 units; P=.03) and 1 (-0.07 units; P=.03) and between days 21 (-0.09 units; P=.04) and 28 (-0.11 units; P=.05) and case growth rates between days 1 and 4 (-1.60 percentage points; P=.03 and -2.19 percentage points; P=.03) and on day 23 (-2.83 percentage points; P=.05) after publication. CONCLUSIONS Contrary to recommendations, mask mandates can be used as an effective measure to reduce SARS-CoV-2 reproduction numbers. However, mandates alone are not sufficient to reduce growth rates of COVID-19 cases. Our study adds external validity to the existing randomized controlled trials on the effectiveness of face masks to reduce the spread of SARS-CoV-2.
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Affiliation(s)
- Anatol-Fiete Näher
- Digital Global Public Health, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
- Method Development, Research Infrastructure, and Information Technology, Robert Koch Institute, Berlin, Germany
| | - Matthias Schulte-Althoff
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Information Systems, School of Business and Economics, Freie Universität, Berlin, Germany
| | - Marvin Kopka
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
- Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Felix Balzer
- Institute for Medical Informatics, Charité - Universitätsmedizin, Berlin, Germany
| | - Francisco Pozo-Martin
- Evidence-based Public Health Unit, Center for International Health Protection, Robert Koch Institute, Berlin, Germany
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10
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Andrup L, Krogfelt KA, Stephansen L, Hansen KS, Graversen BK, Wolkoff P, Madsen AM. Reduction of acute respiratory infections in day-care by non-pharmaceutical interventions: a narrative review. Front Public Health 2024; 12:1332078. [PMID: 38420031 PMCID: PMC10899481 DOI: 10.3389/fpubh.2024.1332078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Children who start in day-care have 2-4 times as many respiratory infections compared to children who are cared for at home, and day-care staff are among the employees with the highest absenteeism. The extensive new knowledge that has been generated in the COVID-19 era should be used in the prevention measures we prioritize. The purpose of this narrative review is to answer the questions: Which respiratory viruses are the most significant in day-care centers and similar indoor environments? What do we know about the transmission route of these viruses? What evidence is there for the effectiveness of different non-pharmaceutical prevention measures? Design Literature searches with different terms related to respiratory infections in humans, mitigation strategies, viral transmission mechanisms, and with special focus on day-care, kindergarten or child nurseries, were conducted in PubMed database and Web of Science. Searches with each of the main viruses in combination with transmission, infectivity, and infectious spread were conducted separately supplemented through the references of articles that were retrieved. Results Five viruses were found to be responsible for ≈95% of respiratory infections: rhinovirus, (RV), influenza virus (IV), respiratory syncytial virus (RSV), coronavirus (CoV), and adenovirus (AdV). Novel research, emerged during the COVID-19 pandemic, suggests that most respiratory viruses are primarily transmitted in an airborne manner carried by aerosols (microdroplets). Conclusion Since airborne transmission is dominant for the most common respiratory viruses, the most important preventive measures consist of better indoor air quality that reduces viral concentrations and viability by appropriate ventilation strategies. Furthermore, control of the relative humidity and temperature, which ensures optimal respiratory functionality and, together with low resident density (or mask use) and increased time outdoors, can reduce the occurrence of respiratory infections.
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Affiliation(s)
- Lars Andrup
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Karen A Krogfelt
- Department of Science and Environment, Molecular and Medical Biology, PandemiX Center, Roskilde University, Roskilde, Denmark
| | - Lene Stephansen
- Gladsaxe Municipality, Social and Health Department, Gladsaxe, Denmark
| | | | | | - Peder Wolkoff
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Anne Mette Madsen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
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11
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Jones AW, King BE, Cumella A, Hopkinson NS, Hurst JR, Holland AE. Use of infection control measures in people with chronic lung disease: mixed methods study. ERJ Open Res 2024; 10:00403-2023. [PMID: 38259806 PMCID: PMC10801757 DOI: 10.1183/23120541.00403-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/16/2023] [Indexed: 01/24/2024] Open
Abstract
Background The introduction of community infection control measures during the COVID-19 pandemic was associated with a reduction in acute exacerbations of lung disease. We aimed to understand the acceptability of continued use of infection control measures among people with chronic lung disease and to understand the barriers and facilitators of use. Methods Australian adults with chronic lung disease were invited to an online survey (last quarter of 2021) to specify infection control measures they would continue themselves post-pandemic and those they perceived should be adopted by the community. A subset of survey participants were interviewed (first quarter of 2022) with coded transcripts deductively mapped to the COM-B model and Theoretical Domains Framework. Results 193 people (COPD 84, bronchiectasis 41, interstitial lung disease 35, asthma 33) completed the survey. Physical distancing indoors (83%), handwashing (77%), and avoidance of busy places (71%) or unwell family and friends (77%) were measures most likely to be continued. Policies for the wider community that received most support were those during the influenza season including hand sanitiser being widely available (84%), wearing of face coverings by healthcare professionals (67%) and wearing of face coverings by the general population on public transport (66%). Barriers to use of infection control measures were related to physical skills, knowledge, environmental context and resources, social influences, emotion, beliefs about capabilities and beliefs about consequences. Conclusions Adults with chronic lung diseases in Australia are supportive of physical distancing indoors, hand hygiene, and avoidance of busy places or unwell family and friends as long-term infection control measures.
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Affiliation(s)
- Arwel W. Jones
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
| | - Bill E. King
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
| | | | | | - John R. Hurst
- UCL Respiratory, University College London, London, UK
| | - Anne E. Holland
- Respiratory Research@Alfred, Monash University, Melbourne, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Australia
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12
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Høeg TB, González-Dambrauskas S, Prasad V. Does equipoise exist for masking children for COVID-19? PUBLIC HEALTH IN PRACTICE 2023; 6:100428. [PMID: 37744300 PMCID: PMC10511791 DOI: 10.1016/j.puhip.2023.100428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
Clinical equipoise is characterized by genuine uncertainty within the medical community about the effectiveness of a medical intervention. Its existence is often deemed necessary for clinical trials and signals a need for higher quality evidence, most often with randomized controlled trials, before the intervention can be considered effective. A leading official of the United States' Centers for Disease Control and Prevention Director, when testifying before Congress in February of 2023, indicated there was no need for randomized controlled trials of masking because, owing to overwhelming evidence of benefit, there was no longer equipoise about masking children for COVID-19. We disagree with this statement and outline the reasons why in this piece. We review the concept of clinical equipoise specifically using the example of child masking. We list reasons equipoise still exists for masking children, including a lack of consensus among experts, contradictory medical evidence and recent and ongoing randomized efforts. Finally, we differentiate between clinical equipoise and ethical appropriateness. Despite ongoing equipoise about masking children, we outline why, owing to lack of evidence of net benefit, recommending this intervention does not currently appear to be medically ethical.
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Affiliation(s)
- Tracy Beth Høeg
- Department of Epidemiology and Biostatistics, University of California-San Francisco, USA
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California-San Francisco, USA
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13
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Brown E, Haslam A, Prasad V. Flu advice in the U.S. news media changed during the COVID-19 pandemic but not the evidence. Eur J Epidemiol 2023; 38:1115-1117. [PMID: 37697025 DOI: 10.1007/s10654-023-01037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Affiliation(s)
| | - Alyson Haslam
- Department of Epidemiology and Biostatistics, UCSF Mission Bay Campus, Mission Hall: Global Health & Clinical Sciences Building, 550 16th St, 2nd Fl, San Francisco, CA, 94158, USA
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, UCSF Mission Bay Campus, Mission Hall: Global Health & Clinical Sciences Building, 550 16th St, 2nd Fl, San Francisco, CA, 94158, USA.
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14
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Judson TJ, Zhang S, Lindan CP, Boothroyd D, Grumbach K, Bollyky JB, Sample HA, Huang B, Desai M, Gonzales R, Maldonado Y, Rutherford G. Association of protective behaviors with SARS-CoV-2 infection: results from a longitudinal cohort study of adults in the San Francisco Bay Area. Ann Epidemiol 2023; 86:1-7. [PMID: 37524216 DOI: 10.1016/j.annepidem.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE In an effort to decrease transmission during the first years of the COVID-19 pandemic, public health officials encouraged masking, social distancing, and working from home, and restricted travel. However, many studies of the effectiveness of these measures had significant methodologic limitations. In this analysis, we used data from the TrackCOVID study, a longitudinal cohort study of a population-based sample of 3846 adults in the San Francisco Bay Area, to evaluate the association between self-reported protective behaviors and incidence of SARS-CoV-2 infection. METHODS Participants without SARS-CoV2 infection were enrolled from August to December 2020 and followed monthly with testing and surveys (median of four visits). RESULTS A total of 118 incident infections occurred (3.0% of participants). At baseline, 80.0% reported always wearing a mask; 56.0% avoided contact with nonhousehold members some/most of the time; 9.6% traveled outside the state; and 16.0% worked 20 or more hours per week outside the home. Factors associated with incident infection included being Black or Latinx, having less than a college education, and having more household residents. The only behavioral factor associated with incident infection was working outside the home (adjusted hazard ratio 1.62, 95% confidence interval 1.02-2.59). CONCLUSIONS Focusing on protecting people who cannot work from home could help prevent infections during future waves of COVID-19, or future pandemics from respiratory viruses. This focus must be balanced with the known importance of directing resources toward those at risk of severe infections.
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Affiliation(s)
- Timothy J Judson
- Department of Medicine, University of California San Francisco, San Francisco.
| | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Christina P Lindan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
| | - Derek Boothroyd
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Kevin Grumbach
- Department of Family and Community Medicine, University of California San Francisco, San Francisco
| | - Jennifer B Bollyky
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA
| | - Hannah A Sample
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - Beatrice Huang
- Department of Medicine, University of California San Francisco, San Francisco
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Palo Alto, CA
| | - Ralph Gonzales
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco
| | - Yvonne Maldonado
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA; Department of Medicine, School of Medicine, Stanford University, Stanford, CA
| | - George Rutherford
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco
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15
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Joffe AR, Elliott A. Long COVID as a functional somatic symptom disorder caused by abnormally precise prior expectations during Bayesian perceptual processing: A new hypothesis and implications for pandemic response. SAGE Open Med 2023; 11:20503121231194400. [PMID: 37655303 PMCID: PMC10467233 DOI: 10.1177/20503121231194400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
This review proposes a model of Long-COVID where the constellation of symptoms are in fact genuinely experienced persistent physical symptoms that are usually functional in nature and therefore potentially reversible, that is, Long-COVID is a somatic symptom disorder. First, we describe what is currently known about Long-COVID in children and adults. Second, we examine reported "Long-Pandemic" effects that create a risk for similar somatic symptoms to develop in non-COVID-19 patients. Third, we describe what was known about somatization and somatic symptom disorder before the COVID-19 pandemic, and suggest that by analogy, Long-COVID may best be conceptualized as one of these disorders, with similar symptoms and predisposing, precipitating, and perpetuating factors. Fourth, we review the phenomenon of mass sociogenic (functional) illness, and the concept of nocebo effects, and suggest that by analogy, Long-COVID is compatible with these descriptions. Fifth, we describe the current theoretical model of the mechanism underlying functional disorders, the Bayesian predictive coding model for perception. This model accounts for moderators that can make symptom inferences functionally inaccurate and therefore can explain how to understand common predisposing, precipitating, and perpetuating factors. Finally, we discuss the implications of this framework for improved public health messaging during a pandemic, with recommendations for the management of Long-COVID symptoms in healthcare systems. We argue that the current public health approach has induced fear of Long-COVID in the population, including from constant messaging about disabling symptoms of Long-COVID and theorizing irreversible tissue damage as the cause of Long-COVID. This has created a self-fulfilling prophecy by inducing the very predisposing, precipitating, and perpetuating factors for the syndrome. Finally, we introduce the term "Pandemic-Response Syndrome" to describe what previously was labeled Long-COVID. This alternative perspective aims to stimulate research and serve as a lesson learned to avoid a repeat performance in the future.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - April Elliott
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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16
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Plachouras D, Kacelnik O, Rodríguez-Baño J, Birgand G, Borg MA, Kristensen B, Kubele J, Lyytikäinen O, Presterl E, Reilly J, Voss A, Zingg W, Suetens C, Monnet DL. Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare. Euro Surveill 2023; 28:2200718. [PMID: 37561052 PMCID: PMC10416576 DOI: 10.2807/1560-7917.es.2023.28.32.2200718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/10/2023] [Indexed: 08/11/2023] Open
Abstract
The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.
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Affiliation(s)
| | | | - Jesús Rodríguez-Baño
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology division, Hospital Universitario Virgen Macarena and Department of Medicine, University of Seville/CSIC, Biomedicine Institute of Seville, Seville, Spain
| | - Gabriel Birgand
- Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, Nantes, France
| | - Michael A Borg
- Infection Control Department, Mater Dei Hospital, Msida, Malta
| | | | - Jan Kubele
- Clinical Microbiology and ATB centre, Na Homolce Hospital, Prague, Czechia
| | | | - Elisabeth Presterl
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Jacqui Reilly
- Research Centre for Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, the Netherlands
| | - Walter Zingg
- Charité Universitätsmedizin, Berlin, Germany
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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17
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Lu Y, Okpani AI, McLeod CB, Grant JM, Yassi A. Masking strategy to protect healthcare workers from COVID-19: An umbrella meta-analysis. Infect Dis Health 2023; 28:226-238. [PMID: 36863978 PMCID: PMC9932689 DOI: 10.1016/j.idh.2023.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The burden of severe disease and death due to SARS-CoV-2 (COVID-19) pandemic among healthcare workers (HCWs) worldwide has been substantial. Masking is a critical control measure to effectively protect HCWs from respiratory infectious diseases, yet for COVID-19, masking policies have varied considerably across jurisdictions. As Omicron variants began to be predominant, the value of switching from a permissive approach based on a point of care risk assessment (PCRA) to a rigid masking policy needed to be assessed. METHODS A literature search was conducted in MEDLINE (Ovid platform), Cochrane Library, Web of Science (Ovid platform), and PubMed to June 2022. An umbrella review of meta-analyses investigating protective effects of N95 or equivalent respirators and medical masks was then conducted. Data extraction, evidence synthesis and appraisal were duplicated. RESULTS While the results of Forest plots slightly favoured N95 or equivalent respirators over medical masks, eight of the ten meta-analyses included in the umbrella review were appraised as having very low certainty and the other two as having low certainty. CONCLUSION The literature appraisal, in conjunction with risk assessment of the Omicron variant, side-effects and acceptability to HCWs, along with the precautionary principle, supported maintaining the current policy guided by PCRA rather than adopting a more rigid approach. Well-designed prospective multi-centre trials, with systematic attention to the diversity of healthcare settings, risk levels and equity concerns are needed to support future masking policies.
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Affiliation(s)
- Yijun Lu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada; Workplace Health & Safety, Interior Health, Kelowna, BC, V1Y OC5, Canada.
| | - Arnold Ikedichi Okpani
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada
| | - Christopher B McLeod
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada
| | - Jennifer M Grant
- Divisons of Infectious Diseases and Medical Microbiology University of British Columbia, Vancouver, BC, V6T 1Z3, Canada; Divisions of Medical Microbiology and Infectious Diseases Vancouver Coastal Health, BC, Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (BC), V6T 1Z3, Canada; Medical Practitioners Occupational Safety and Health, Vancouver Coastal Health, BC, Canada
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18
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Soriano-Arandes A, Brett A, Buonsenso D, Emilsson L, de la Fuente Garcia I, Gkentzi D, Helve O, Kepp KP, Mossberg M, Muka T, Munro A, Papan C, Perramon-Malavez A, Schaltz-Buchholzer F, Smeesters PR, Zimmermann P. Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Front Public Health 2023; 11:1175444. [PMID: 37564427 PMCID: PMC10411527 DOI: 10.3389/fpubh.2023.1175444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Brett
- Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabel de la Fuente Garcia
- Pediatric Infectious Diseases, National Pediatric Center, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, Patras, Greece
| | - Otto Helve
- Department of Health Security, Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kasper P. Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Mossberg
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Department of Physics, Universitat Politècnica de Catalunya (UPC·BarcelonaTech), Barcelona, Spain
| | | | - Pierre R. Smeesters
- Department of Pediatrics, University Hospital Brussels, Academic Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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19
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Paños-Crespo A, Traboulsi-Garet B, Sánchez-Garcés MÁ, Gay-Escoda C. Disinfection of the air and surfaces in the dental clinic using hydroxyl radical (OH-) based technology: A systematic review. J Clin Exp Dent 2023; 15:e494-e504. [PMID: 37388429 PMCID: PMC10306383 DOI: 10.4317/jced.60461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/28/2023] [Indexed: 07/01/2023] Open
Abstract
Background A systematic review was carried out to compare the disinfectant capacity of hydroxyl radicals (OH-) versus other products commonly used for disinfecting the air and surfaces. Material and Methods A literature search was made of the Cochrane Library, PubMed (MEDLINE) and Scopus databases. "In vitro" studies evaluating disinfection methods applicable to several surfaces and room air were included in the search. The search was carried out in April 2022, with no restrictions in terms of language or publication date. Results Of the 308 articles identified from the initial search, 8 were included for the quantitative analysis. All publications corresponded to experimental "in vitro" studies. Seven of them evaluated biocidal action against bacteria, and only two assessed activity against viral loads. The generation of contaminants secondary to application of the disinfectants was only analyzed in one of the studies, with the conclusion that the production of peroxyl radicals (RO2) derived from the oxidation of volatile organic compounds (VOCs) is greater when chemical surface disinfectants are used versus air disinfection systems. Conclusions The disinfection capacities of the currently available methods are similar, and none of them are able to replace the use of additional physical protection measures. Key words:Disinfection methods, hydroxyl radical, environment, surfaces, dentistry.
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Affiliation(s)
- Anais Paños-Crespo
- DDS. Master in Oral Surgery and Buccofacial Implantology. Faculty of Medicine and Dentistry, University of Barcelona. Barcelona (Spain)
| | - Bassel Traboulsi-Garet
- DDS. Master in Oral Surgery and Buccofacial Implantology. Faculty of Medicine and Dentistry, University of Barcelona. Barcelona (Spain)
| | - Maria-Ángeles Sánchez-Garcés
- MD, DDS, MS, PhD, EBOS. Associate Professor of Oral Surgery. Faculty of Medicine and Dentistry, University of Barcelona. Researcher of the IDIBELL Institute. Barcelona (Spain)
| | - Cosme Gay-Escoda
- MD, DDS, MS, PhD, EBOS, OMFS. Chairman of Oral and Maxillofacial Surgery. Faculty of Medicine and Dentistry, University of Barcelona. Director of the Master in Oral Surgery and Buccofacial Implantology (EFHRE International University / FUCSO). Coordinator / Researcher of the IDIBELL Institute. Head of the Department of Oral Surgery, Buccofacial Implantology and Maxillofacial Surgery. Teknon Medical Center. Barcelona (Spain)
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Hanane G, Amine Z, Roomila N, Prazuck T, Amirouche A, Olivier V, Benyamina A, Serreau R. COVID-19 seroprevalence among local authority workers from Orléans Métropole, the Community of Communes of the Terres du Val de Loire, the local public service management centre of the Loiret department and the Region Centre Val de Loire: a prospective epidemiological study. BMJ Open 2023; 13:e066504. [PMID: 37217267 DOI: 10.1136/bmjopen-2022-066504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE To evaluate the SARS-CoV-2 seroprevalence among local authority workers, depending on their position and potential interaction with the public. METHODS A cohort of volunteer participants was recruited among local authority workers of the Centre Val de Loire region in France, to be tested using a rapid serological test (COVID-PRESTO). The collected data were analysed by comparing different parameters including, gender, age, position held, and contact or not with the public. The study was carried out from August to December 2020 and included 3228 participants (n=3228), from 18 to 65 years old. RESULTS The seroprevalence of SARS-CoV-2 among local authority workers was estimated at 3.04%. No significant difference could be observed according to the position held by the workers and whether they were or not in contact with the public. Nevertheless, a significant difference was observed between the different investigating centres, in correlation with the geographical location. CONCLUSION Contact with members of the public was not a critical parameter for SARS-CoV-2 seroprevalence as long as protective measures are applied. Among the population included in the study, childcare workers were more at risk of getting infected by the virus. TRIAL REGISTRATION NUMBER NCT04387968.
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Affiliation(s)
| | - Zaouia Amine
- Unite de recherche clinique PARADICT-O, Orléans, France
| | | | - Thierry Prazuck
- Department of Infectious Diseases, Centre Hospitalier Regional d'Orleans, Orleans, France
| | - Ammar Amirouche
- Hopital Paul Brousse, Villejuif, France
- Université Paris-Saclay, Gif-sur-Yvette, France
| | - Vernay Olivier
- Communauté de Communes Terres du Val de Loire, Orléans, France
| | - Amine Benyamina
- Hopital Paul Brousse, Villejuif, France
- Université Paris-Saclay, Gif-sur-Yvette, France
| | - Raphaël Serreau
- Unite de recherche clinique PARADICT-O, Orléans, France
- Hopital Paul Brousse, Villejuif, France
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21
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Vickers DM, Hardie J, Eberspaecher S, Chaufan C, Pelech S. Counterfactuals of effects of vaccination and public health measures on COVID-19 cases in Canada: what could have happened? Front Public Health 2023; 11:1173673. [PMID: 37228725 PMCID: PMC10203614 DOI: 10.3389/fpubh.2023.1173673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/30/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- David M. Vickers
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Claudia Chaufan
- Health Policy and Global Health, Faculty of Health, York University, Toronto, ON, Canada
| | - Steven Pelech
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Kinexus Bioinformatics Corporation, Vancouver, BC, Canada
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22
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Kisielinski K, Hirsch O, Wagner S, Wojtasik B, Funken S, Klosterhalfen B, Kanti Manna S, Prescher A, Sukul P, Sönnichsen A. Physio-metabolic and clinical consequences of wearing face masks—Systematic review with meta-analysis and comprehensive evaluation. Front Public Health 2023; 11:1125150. [PMID: 37089476 PMCID: PMC10116418 DOI: 10.3389/fpubh.2023.1125150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/17/2023] [Indexed: 04/08/2023] Open
Abstract
BackgroundAs face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.MethodsA systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on n = 8,641, m = 2,482, f = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.ResultsWe found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO2 (overall Standard Mean Difference, SMD = −0.24, 95% CI = −0.38 to −0.11, p < 0.001) and minute ventilation (SMD = −0.72, 95% CI = −0.99 to −0.46, p < 0.001), simultaneous increased in blood-CO2 (SMD = +0.64, 95% CI = 0.31–0.96, p < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03–0.41, p = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03–0.39, p = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23–1.38, p = 0.006) and humidity (SMD +2.24, 95% CI = 1.32–3.17, p < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in n = 373 with a robust relationship to mask wearing (p < 0.006 to p < 0.001). Pooled symptom prevalence (n = 8,128) was significant for: headache (62%, p < 0.001), acne (38%, p < 0.001), skin irritation (36%, p < 0.001), dyspnoea (33%, p < 0.001), heat (26%, p < 0.001), itching (26%, p < 0.001), voice disorder (23%, p < 0.03), and dizziness (5%, p = 0.01).DiscussionMasks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.ConclusionFace mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.
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Affiliation(s)
- Kai Kisielinski
- Orthopaedic and Trauma Surgery, Clinical Medicine, Private Practice, Düsseldorf, Germany
- *Correspondence: Kai Kisielinski
| | - Oliver Hirsch
- Department of Psychology, Fachhochschule für Oekonomie und Management (FOM) University of Applied Sciences, Siegen, Germany
| | - Susanne Wagner
- Veterinary Medicine, Wagner Medical Science Liason (MSL) Management, Blankenfelde-Mahlow, Germany
| | - Barbara Wojtasik
- Department of Genetics and Biosystematics, Faculty of Biology, University of Gdańsk, Gdansk, Poland
| | - Stefan Funken
- Internal Medicine, Clinical Medicine, Private Practice, Moers, Germany
| | | | - Soumen Kanti Manna
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, Kolkata, India
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Rhine-Westphalia Technical University of Aachen, Aachen, Germany
| | - Pritam Sukul
- Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Department of Anesthesiology and Intensive Care, University Medicine Rostock, Rostock, Germany
- Pritam Sukul
| | - Andreas Sönnichsen
- Internal Medicine, Clinical Medicine, Private Practice, Gesundheit für Österreich e.V. (Health for Austria), Vienna, Austria
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23
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Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Bouza E. Insights for COVID-19 in 2023. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023. [PMID: 36510683 DOI: 10.3701/req/059.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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24
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Zhang Y, He H, Dai K, Lin Z, Fang Z, Zheng Z. Thermal responses of face-masked pedestrians during summer: An outdoor investigation under tree-shaded areas. BUILDING AND ENVIRONMENT 2023; 233:110058. [PMID: 36789268 PMCID: PMC9911159 DOI: 10.1016/j.buildenv.2023.110058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
During the SARS-CoV-2 (COVID-19) pandemic, most citizens were cooperative towards the face-masking policy; however, undeniably, face masking has increased complaints of thermal discomfort to varying degrees and resulted in potential health hazards during summer. Thus, a thermal comfort survey was conducted under tree-shaded areas generally preferred by pedestrians to explore the thermal response of face-masked pedestrians. Thirty-two subjects, with and without masks, participated in walking experiments, and their thermal parameters and physiological indicators were recorded; moreover, the subjects were asked to fill in subjective questionnaires. The results showed that although tree shades significantly reduced the average radiant temperature, dampness in the mask may cause some discomfort symptoms, among which intense sweating (54.55%) and tachycardia (42.18%) accounted for the largest proportion. Based on thermal indices, it could be concluded that face-masking does not significantly affect the thermal comfort of subjects walking in shaded areas. Notably, a 30-min walk in tree-shaded areas with face masking does not adversely affect human health or quality of life. Thus, the present assessment of the thermal safety of humans in shaded environments provides reference data for determining thermal comfort levels during outdoor walking with face masking.
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Affiliation(s)
- Yuchun Zhang
- School of Civil Engineering, Guangzhou University, Guangzhou, 510006, China
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, China
| | - Huiyu He
- Shenzhen General Integrated Transportation and Municipal Engineering Design & Research Institute Co., Ltd, Shenzhen, 518003, China
| | - Kunquan Dai
- School of Civil Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Zhang Lin
- Division of Building Science and Technology, City University of Hong Kong, Hong Kong, China
| | - Zhaosong Fang
- School of Civil Engineering, Guangzhou University, Guangzhou, 510006, China
| | - Zhimin Zheng
- School of Civil Engineering, Guangzhou University, Guangzhou, 510006, China
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25
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Al-Bazi A, Madi F, Monshar AA, Eliya Y, Adediran T, Khudir KA. Modelling the impact of non-pharmaceutical interventions on COVID-19 exposure in closed-environments using agent-based modelling. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2023. [DOI: 10.1080/20479700.2023.2189555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Affiliation(s)
- Ammar Al-Bazi
- Aston Business School, Aston University, Birmingham, UK
| | - Faris Madi
- Faculty of Engineering, Environment and Computing, Coventry University, Coventry, UK
| | | | - Yousif Eliya
- Department of Health Research Methods, Evidence & Impact, Health Sciences Centre, McMaster University, Hamilton, Canada
| | - Tunde Adediran
- Faculty of Engineering, Environment and Computing, Coventry University, Coventry, UK
| | - Khaled Al Khudir
- Faculty of Engineering, Environment and Computing, Coventry University, Coventry, UK
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26
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Mohamadian H, Faraji A, Ghorrabi AT, Ghobadi-Dashdebi K, Salahshouri A. The COVID-19 pandemic: knowledge, attitudes and practices of coronavirus (COVID-19) among patients with type 2 diabetes. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:11. [PMID: 36805712 PMCID: PMC9939854 DOI: 10.1186/s41043-023-00349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND It is necessary to evaluate COVID-19 data on Knowledge, Attitudes and Practices (KAP) to confirm effective protective practice and to reduce risk in society. Hence, the study was carried out to determine KAP towards COVID-19 and the factors associated with knowledge and practices among patients with type 2 diabetes (T2D). METHODS In this cross-sectional (descriptive-analytical) study, 357 patients with diabetes in Izeh participated in the study. The sampling method used was convenience sampling method. Data collection tool was a researcher-made questionnaire of demographic information and KAP of patients with T2D in relation to the new coronavirus. The validity and reliability of the research tool was confirmed using the content validity and test-retest. Data analysis was done in Stata.14.2 and Smartpls 3.2.8 using descriptive and analytical statistical tests. RESULTS The mean score of participants' KAP towards Covid-19 was 74.22 (16.30), 72.88 (14.87), and 70.51 (19.70), respectively. The lowest and the highest score of the patients' knowledge was in the field of transmission (56.60 (20.96)) and care and prevention of the COVID-19 (88.58 (21.88)), respectively. Residence was the most important factor predicting the practice of diabetic patients with an explanatory coefficient ([SMD 1.08 (95% CI 0.85 to 1.30), P < 0.001] and R2 = 0.87%). CONCLUSION Despite the good level of KAP of people towards the COVID-19 disease, there were answers showing poor knowledge, incorrect beliefs and attitudes, and insufficient practice regarding different aspects of the COVID-19 in some cases in our study. Residence was a strong predictor of type 2 diabetes mellitus (T2DM) patients' practice in terms of protective behaviors against Covid-19. Hence, educational needs evaluation based on residence is recommended, especially in rural T2DM patients.
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Affiliation(s)
- Hashem Mohamadian
- Department of Health Education and Promotion, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amrullah Faraji
- Health Services Management, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Tahmasebi Ghorrabi
- Health Care Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Kamel Ghobadi-Dashdebi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Salahshouri
- Department of Health Education and Promotion, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Noh JW, Lee WR, Kim LH, Cheon J, Kwon YD, Yoo KB. Influence of COVID-19-Related Interventions on the Number of Inpatients with Acute Viral Respiratory Infections: Using Interrupted Time Series Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2808. [PMID: 36833505 PMCID: PMC9956170 DOI: 10.3390/ijerph20042808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
After the first COVID-19 patient was diagnosed, non-pharmaceutical interventions such as social distancing and behavior change campaigns were implemented in South Korea. The social distancing policy restricted unnecessary gatherings and activities to prevent local transmission. This study aims to evaluate the effect of social distancing, a strategy for COVID-19 prevention, on the number of acute respiratory infection inpatients. This study used the number of hospitalized patients with acute respiratory infection from the Infectious Disease Portal of the Korea Centers for Disease Control and Prevention (KCDC) between the first week of January 2018, to the last week of January 2021. Intervention 1t represents the first patient occurrence of COVID-19, Intervention 2t represents the relaxing of the social distancing policy. We used acute respiratory infection statistics from Korea and segmented regression analysis was used. The analysis showed that the trend of the number of acute respiratory infection inpatients decreased after the implementation of the first patient incidence of COVID-19 due to prevention activities. After the relaxing of the social distancing policy, the number of inpatients with acute respiratory infections significantly increased. This study verified the effect of social distancing on the reduction in hospital admissions for acute respiratory viral infections.
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Affiliation(s)
- Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493, Republic of Korea
- Department of Health Administration, Graduate School, Yonsei University, Wonju 26493, Republic of Korea
| | - Woo-Ri Lee
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea
| | - Li-Hyun Kim
- Department of Healthcare Institution Support, National Health Insurance Service, Wonju 26464, Republic of Korea
| | - Jooyoung Cheon
- Department of Nursing Science, Sungshin Women’s University, Seoul 02844, Republic of Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Ki-Bong Yoo
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 26493, Republic of Korea
- Department of Health Administration, Graduate School, Yonsei University, Wonju 26493, Republic of Korea
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Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev 2023; 1:CD006207. [PMID: 36715243 PMCID: PMC9885521 DOI: 10.1002/14651858.cd006207.pub6] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Viral epidemics or pandemics of acute respiratory infections (ARIs) pose a global threat. Examples are influenza (H1N1) caused by the H1N1pdm09 virus in 2009, severe acute respiratory syndrome (SARS) in 2003, and coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 in 2019. Antiviral drugs and vaccines may be insufficient to prevent their spread. This is an update of a Cochrane Review last published in 2020. We include results from studies from the current COVID-19 pandemic. OBJECTIVES To assess the effectiveness of physical interventions to interrupt or reduce the spread of acute respiratory viruses. SEARCH METHODS We searched CENTRAL, PubMed, Embase, CINAHL, and two trials registers in October 2022, with backwards and forwards citation analysis on the new studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs investigating physical interventions (screening at entry ports, isolation, quarantine, physical distancing, personal protection, hand hygiene, face masks, glasses, and gargling) to prevent respiratory virus transmission. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. MAIN RESULTS We included 11 new RCTs and cluster-RCTs (610,872 participants) in this update, bringing the total number of RCTs to 78. Six of the new trials were conducted during the COVID-19 pandemic; two from Mexico, and one each from Denmark, Bangladesh, England, and Norway. We identified four ongoing studies, of which one is completed, but unreported, evaluating masks concurrent with the COVID-19 pandemic. Many studies were conducted during non-epidemic influenza periods. Several were conducted during the 2009 H1N1 influenza pandemic, and others in epidemic influenza seasons up to 2016. Therefore, many studies were conducted in the context of lower respiratory viral circulation and transmission compared to COVID-19. The included studies were conducted in heterogeneous settings, ranging from suburban schools to hospital wards in high-income countries; crowded inner city settings in low-income countries; and an immigrant neighbourhood in a high-income country. Adherence with interventions was low in many studies. The risk of bias for the RCTs and cluster-RCTs was mostly high or unclear. Medical/surgical masks compared to no masks We included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community). Wearing masks in the community probably makes little or no difference to the outcome of influenza-like illness (ILI)/COVID-19 like illness compared to not wearing masks (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; moderate-certainty evidence. Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence). Harms were rarely measured and poorly reported (very low-certainty evidence). N95/P2 respirators compared to medical/surgical masks We pooled trials comparing N95/P2 respirators with medical/surgical masks (four in healthcare settings and one in a household setting). We are very uncertain on the effects of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). N95/P2 respirators compared with medical/surgical masks may be effective for ILI (RR 0.82, 95% CI 0.66 to 1.03; 5 trials, 8407 participants; low-certainty evidence). Evidence is limited by imprecision and heterogeneity for these subjective outcomes. The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory-confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate-certainty evidence). Restricting pooling to healthcare workers made no difference to the overall findings. Harms were poorly measured and reported, but discomfort wearing medical/surgical masks or N95/P2 respirators was mentioned in several studies (very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients. Hand hygiene compared to control Nineteen trials compared hand hygiene interventions with controls with sufficient data to include in meta-analyses. Settings included schools, childcare centres and homes. Comparing hand hygiene interventions with controls (i.e. no intervention), there was a 14% relative reduction in the number of people with ARIs in the hand hygiene group (RR 0.86, 95% CI 0.81 to 0.90; 9 trials, 52,105 participants; moderate-certainty evidence), suggesting a probable benefit. In absolute terms this benefit would result in a reduction from 380 events per 1000 people to 327 per 1000 people (95% CI 308 to 342). When considering the more strictly defined outcomes of ILI and laboratory-confirmed influenza, the estimates of effect for ILI (RR 0.94, 95% CI 0.81 to 1.09; 11 trials, 34,503 participants; low-certainty evidence), and laboratory-confirmed influenza (RR 0.91, 95% CI 0.63 to 1.30; 8 trials, 8332 participants; low-certainty evidence), suggest the intervention made little or no difference. We pooled 19 trials (71, 210 participants) for the composite outcome of ARI or ILI or influenza, with each study only contributing once and the most comprehensive outcome reported. Pooled data showed that hand hygiene may be beneficial with an 11% relative reduction of respiratory illness (RR 0.89, 95% CI 0.83 to 0.94; low-certainty evidence), but with high heterogeneity. In absolute terms this benefit would result in a reduction from 200 events per 1000 people to 178 per 1000 people (95% CI 166 to 188). Few trials measured and reported harms (very low-certainty evidence). We found no RCTs on gowns and gloves, face shields, or screening at entry ports. AUTHORS' CONCLUSIONS The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions. There were additional RCTs during the pandemic related to physical interventions but a relative paucity given the importance of the question of masking and its relative effectiveness and the concomitant measures of mask adherence which would be highly relevant to the measurement of effectiveness, especially in the elderly and in young children. There is uncertainty about the effects of face masks. The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of RCTs did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness, and although this effect was also present when ILI and laboratory-confirmed influenza were analysed separately, it was not found to be a significant difference for the latter two outcomes. Harms associated with physical interventions were under-investigated. There is a need for large, well-designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, as well as the impact of adherence on effectiveness, especially in those most at risk of ARIs.
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Affiliation(s)
- Tom Jefferson
- Department for Continuing Education, University of Oxford, Oxford OX1 2JA, UK
| | - Liz Dooley
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Eliana Ferroni
- Epidemiological System of the Veneto Region, Regional Center for Epidemiology, Veneto Region, Padova, Italy
| | - Lubna A Al-Ansary
- Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mieke L van Driel
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Ghada A Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Elaine M Beller
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - John M Conly
- Cumming School of Medicine, University of Calgary, Room AGW5, SSB, Foothills Medical Centre, Calgary, Canada
- O'Brien Institute for Public Health and Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
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Wang AB, Zhang X, Gao LJ, Zhang T, Xu HJ, Bi YJ. A Review of Filtration Performance of Protective Masks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2346. [PMID: 36767714 PMCID: PMC9915213 DOI: 10.3390/ijerph20032346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Masks are essential and effective small protective devices used to protect the general public against infections such as COVID-19. However, available systematic reviews and summaries on the filtration performance of masks are lacking. Therefore, in order to investigate the filtration performance of masks, filtration mechanisms, mask characteristics, and the relationships between influencing factors and protective performance were first analyzed through mask evaluations. The summary of filtration mechanisms and mask characteristics provides readers with a clear and easy-to-understand theoretical cognition. Then, a detailed analysis of influencing factors and the relationships between the influencing factors and filtration performance is presented in. The influence of the aerosol size and type on filtration performance is nonlinear and nonconstant, and filtration efficiency decreases with an increase in the gas flow rate; moreover, fitness plays a decisive role in the protective effects of masks. It is recommended that the public should wear surgical masks to prevent COVID-19 infection in low-risk and non-densely populated areas. Future research should focus on fitness tests, and the formulation of standards should also be accelerated. This paper provides a systematic review that will be helpful for the design of masks and public health in the future.
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Affiliation(s)
- Ao-Bing Wang
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Xin Zhang
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Li-Jun Gao
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Tao Zhang
- School of Chemistry and Chemical Engineering, Jiangsu University, Zhenjiang 212013, China
| | - Hui-Juan Xu
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Yan-Jun Bi
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
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O'Grady HM, Harrison R, Snedeker K, Trufen L, Yue P, Ward L, Fifen A, Jamieson P, Weiss A, Coulthard J, Lynch T, Croxen MA, Li V, Pabbaraju K, Wong A, Zhou HY, Dingle TC, Hellmer K, Berenger BM, Fonseca K, Lin YC, Evans D, Conly JM. A two-ward acute care hospital outbreak of SARS-CoV-2 delta variant including a point-source outbreak associated with the use of a mobile vital signs cart and sub-optimal doffing of personal protective equipment. J Hosp Infect 2023; 131:1-11. [PMID: 36195200 PMCID: PMC9527227 DOI: 10.1016/j.jhin.2022.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/16/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The arrival of the Delta variant of SARS-CoV-2 was associated with increased transmissibility and illness of greater severity. Reports of nosocomial outbreaks of Delta variant COVID-19 in acute care hospitals have been described but control measures varied widely. AIM Epidemiological investigation of a linked two-ward COVID-19 Delta variant outbreak was conducted to elucidate its source, risk factors, and control measures. METHODS Investigations included epidemiologic analysis, detailed case review serial SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) testing of patients and healthcare workers (HCWs), viral culture, environmental swabbing, HCW-unaware personal protective equipment (PPE) audits, ventilation assessments, and the use of whole genome sequencing (WGS). FINDINGS This linked two-ward outbreak resulted in 17 patient and 12 HCW cases, despite an 83% vaccination rate. In this setting, suboptimal adherence and compliance to PPE protocols, suboptimal hand hygiene, multi-bedded rooms, and a contaminated vital signs cart with potential fomite or spread via the hands of HCWs were identified as significant risk factors for nosocomial COVID-19 infection. Sudden onset of symptoms, within 72 h, was observed in 79% of all Ward 2 patients, and 93% of all cases (patients and HCWs) on Ward 2 occurred within one incubation period, consistent with a point-source outbreak. RT-PCR assays showed low cycle threshold (CT) values, indicating high viral load from environmental swabs including the vital signs cart. WGS results with ≤3 SNP differences between specimens were observed. CONCLUSION Outbreaks on both wards settled rapidly, within 3 weeks, using a `back-to-basics' approach without extraordinary measures or changes to standard PPE requirements. Strict adherence to recommended PPE, hand hygiene, education, co-operation from HCWs, including testing and interviews, and additional measures such as limiting movement of patients and staff temporarily were all deemed to have contributed to prompt resolution of the outbreak.
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Affiliation(s)
- H M O'Grady
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - R Harrison
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Workplace Health and Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - K Snedeker
- Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L Trufen
- Workplace Health and Safety, Alberta Health Services, Edmonton, Alberta, Canada
| | - P Yue
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - L Ward
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - A Fifen
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - P Jamieson
- Department of Family Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - A Weiss
- Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - J Coulthard
- Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - T Lynch
- Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Genomics and Bioinformatics, Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada; Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - M A Croxen
- Alberta Public Heath Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada; Department of Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - V Li
- Alberta Public Heath Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - K Pabbaraju
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - A Wong
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - H Y Zhou
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T C Dingle
- Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - K Hellmer
- Site Administration, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - B M Berenger
- Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - K Fonseca
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Y-C Lin
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - D Evans
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - J M Conly
- Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada; Department of Pathology & Laboratory Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; W21C Research and Innovation Centre, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
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31
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Jain VM, Parihar SRS, Acharya S, Acharya S. Effects of wearing personal protective equipment (PPE) and its role in affecting the work efficiency of dentists during the COVID-19 pandemic. Work 2023; 76:3-10. [PMID: 36872823 DOI: 10.3233/wor-220083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The risk of exposure to COVID-19 infection through droplets/aerosol in dental clinics has renewed focus on the utility and possible adverse effects of using personal protective equipment (PPE) on dentists. OBJECTIVE To obtain information from a cross-section of dentists regarding their PPE usage and to evaluate the possible risk factors that can influence their work efficiency. METHODS A 31-item cross-sectional survey with a structured multiple-choice questionnaire was designed. Social media and emails were used to circulate the questionnaire among dental professionals worldwide. A total of 317 respondents returned the completed forms. RESULTS A total of 184 (55%) participants reported getting soaking wet while wearing PPE at the end of the working hours (approximately eight hours of working). Many respondents (n = 286, 90%) reported that the use of PPE resulted in reduced visibility of the operating field. The majority of respondents (84%) felt that their overall work efficiency had reduced after using PPE. Binary logistic regression had shown that two significant factors that were associated with reduced work efficiency included, pre-existing systemic illness and getting soaking wet from wearing a PPE. CONCLUSION Definite protocols should be introduced that mandate the doffing of PPE for every patient, in a separate well-ventilated area where the skin can recuperate from the heat and pressure points caused by the PPE. Dentists should take greater care in choosing the appropriate PPE to prevent exacerbation of pre-existing illnesses, which may reduce their work efficiency.
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Affiliation(s)
- Vedushi M Jain
- Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | | | - Shruthi Acharya
- Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Shashidhar Acharya
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, India
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Al-Jwadi RF, Mills EHA, Torp-Pedersen C, Andersen MP, Jørgensen IM. Consequences of COVID-19-related lockdowns and reopenings on emergency hospitalizations in pediatric patients in Denmark during 2020-2021. Eur J Pediatr 2023; 182:285-293. [PMID: 36331619 PMCID: PMC9638206 DOI: 10.1007/s00431-022-04682-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
UNLABELLED There is a considerable burden of children being hospitalized due to infectious diseases worldwide. The COVID-19 pandemic provided a unique opportunity to examine effects of worldwide efforts to control spread of infection. We aimed to investigate overall age-specific hospitalizations due to viral and bacterial infections and diseases triggered by respiratory tract infections during and after lockdown. This nationwide register-based observational study included children from 29 days to 17 years old hospitalized in all Danish pediatric emergency departments during the years 2015-2021. Main outcomes were ICD-10 diagnoses for infectious diseases and infection triggered illnesses. Fluctuations in hospitalization events were explored using figures with weekly events per 100,000. Total events followed a predictable pattern during 2015-2019. In 2020-2021, there was a drop in hospital encounters after lockdowns and surge after reopenings. In 2021, there was a surge of hospital encounters in the late summer due to respiratory syncytial virus infections and asthmatic bronchitis mostly in infants from 29 days to 2 years. For the infectious diseases, there was a dramatic decrease in events after lockdowns and immediate increase in cases that followed the same pattern of previous years after reopenings. Bacterial infections, like urinary tract infections, sepsis, and meningitis followed a steady pattern throughout all calendar-years. CONCLUSIONS Nationwide efforts to minimize infectious disease spread like lockdowns have a preventative and period lasting effect but reopenings/reunions result in surges of infectious diseases. This might be due to children not getting immunized steadily thereby increasing the pool of possible hosts for potential viral infections. WHAT IS KNOWN • There is a seasonal fluctuation in viral/respiratory infections in children with higher infection rates in the winter and lower rates in the summer. • RSV infection is a major source of concern. WHAT IS NEW • Major lockdowns and reopenings disrupt the seasonal fluctuations which can result in high surges in infections that increases the burden of children emergency departments and the risk of serious complications.
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Affiliation(s)
- Rada Faris Al-Jwadi
- Department of Pediatric and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark.
| | | | | | | | - Inger Merete Jørgensen
- Department of Pediatric and Adolescent Medicine, Nordsjællands Hospital, Hillerød, Denmark ,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, København, Denmark
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Zheng Z, Liang C, Li Z, Wu Y, Lin B, Fang J. Mask-Wearing and Handwashing Behaviors of Chinese Rural Residents during the Pandemic of COVID-19: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:779. [PMID: 36613099 PMCID: PMC9819408 DOI: 10.3390/ijerph20010779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To understand mask-wearing and handwashing behaviors of Chinese rural residents during the COVID-19 pandemic and to analyze the associated factors. METHODS This study used a multi-stage random sampling method to conduct a cross-sectional questionnaire survey during the period of July to December of 2021, in six counties located in Shandong, Shanxi, and Yunnan provinces representing the eastern, central, and western regions of China, respectively. A total of 3864 villagers were surveyed with a questionnaire, and 3832 valid questionnaires were finally analyzed. Descriptive statistics and logistic regression analysis were used for statistical analysis. RESULTS Around ninety-four percent (93.6%) of rural residents reported mask-wearing during the COVID-19 pandemic, but only 44.5% of them could replace masks in time. Multivariate logistic regression analysis showed that those who were female, aged 15-59, had an education level of high school and above, were divorced/widowed, worked as farmers (workers), or were rural residents in Shandong Province were more likely to wear masks. Furthermore, those who were female, aged 15-59, had an education level of high school and above, were unmarried and married, were business and service workers, or were rural residents in Shandong and Shanxi Province replaced masks more timely. Around seventy percent (69.7%) of rural residents reported using soap when washing their hands, but only 38.0% of rural residents could wash their hands properly. Multivariate logistic regression analysis showed that rural residents who were aged 35-59, had an education of high school and above, or lived in Shandong Province and Shanxi Province were more likely to wash their hands with soap. Those who were aged 15-59, had an education of high school and above, worked as farmers (workers), were employees of governmental departments and retirees, were business and service workers, or were students had higher proper handwashing rates. CONCLUSION During the COVID-19 pandemic, the proportion of Chinese rural residents wearing masks reached 93.6%, but only 44.5% were able to replace masks in time, gender, age, education level, marital status, occupation, and living place had an impact on mask-wearing. The proportion of Chinese rural residents who could wash hands with soap reached 69.7%, but only 38.0% could wash their hands properly. Age and education level were influencing factors for both washing-hand with soap and proper handwashing.
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White S, Jain A, Bangura A, Farrington M, Mekonen M, Nhial BC, Hoque E, Moniruzzaman M, Namegabe P, Walassa J, Majorin F. Facilitating hand hygiene in displacement camps during the COVID-19 pandemic: a qualitative assessment of a novel handwashing stand and hygiene promotion package. Confl Health 2022; 16:65. [PMID: 36527055 PMCID: PMC9756724 DOI: 10.1186/s13031-022-00492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Handwashing with soap is critical for the prevention of diarrhoeal diseases and outbreak related diseases, including interrupting the transmission of COVID-19. People living in large displacement settings are particularly vulnerable to such outbreaks, however, practicing handwashing is typically challenging in these contexts. METHODS We conducted a qualitative assessment of the implementation of a combined intervention to facilitate handwashing behaviour in displacement camps and in surrounding communities in Bangladesh, Ethiopia and the Democratic Republic of Congo during the COVID-19 pandemic. The intervention comprised a 'hardware' infrastructural component (provision of the Oxfam Handwashing Station) and a 'software' hygiene promotion package (Mum's Magic Hands). We used programmatic logbooks, interviews with implementation staff and focus group discussions with crisis-affected populations to assess the use, feasibility and acceptability of the intervention. RESULTS Both components of the intervention were viewed as novel and appealing by implementing staff and crisis-affected populations across the study sites. The acceptability of the handwashing station could be improved by redesigning the tap and legs, exploring local supply chain options, and by providing a greater number of facilities. The implementation of the hygiene promotion package varied substantially by country making it challenging to evaluate and compare. A greater focus on community engagement could address misconceptions, barriers related to the intuitiveness of the handwashing station design, and willingness to participate in the hygiene promotion component. CONCLUSIONS The combination of a 'hardware' and 'software' intervention in these settings appeared to facilitate both access and use of handwashing facilities. The acceptability of the combined intervention was partially because a great deal of effort had been put into their design. However, even when delivering well-designed interventions, there are many contextual aspects that need to be considered, as well as unintended consequences which can affect the acceptability of an intervention.
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Affiliation(s)
- Sian White
- grid.8991.90000 0004 0425 469XDepartment of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Abie Bangura
- grid.437028.a0000 0004 0450 9859Oxfam, John Smith Drive, Oxford, UK
| | | | | | - Bang Chuol Nhial
- Department of Public Health, Gambella University, Gambella Town, Gambella, Ethiopia
| | - Enamul Hoque
- Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206 Bangladesh
| | - Md. Moniruzzaman
- Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206 Bangladesh
| | | | - John Walassa
- Oxfam in DRC, Goma, Democratic Republic of Congo
| | - Fiona Majorin
- grid.8991.90000 0004 0425 469XDepartment of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Montesinos-Guevara C, Buitrago-Garcia D, Felix ML, Guerra CV, Hidalgo R, Martinez-Zapata MJ, Simancas-Racines D. Vaccines for the common cold. Cochrane Database Syst Rev 2022; 12:CD002190. [PMID: 36515550 PMCID: PMC9749450 DOI: 10.1002/14651858.cd002190.pub6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The common cold is a spontaneously remitting infection of the upper respiratory tract, characterised by a runny nose, nasal congestion, sneezing, cough, malaise, sore throat, and fever (usually < 37.8 ºC). Whilst the common cold is generally not harmful, it is a cause of economic burden due to school and work absenteeism. In the United States, economic loss due to the common cold is estimated at more than USD 40 billion per year, including an estimate of 70 million workdays missed by employees, 189 million school days missed by children, and 126 million workdays missed by parents caring for children with a cold. Additionally, data from Europe show that the total cost per episode may be up to EUR 1102. There is also a large expenditure due to inappropriate antimicrobial prescription. Vaccine development for the common cold has been difficult due to antigenic variability of the common cold viruses; even bacteria can act as infective agents. Uncertainty remains regarding the efficacy and safety of interventions for preventing the common cold in healthy people, thus we performed an update of this Cochrane Review, which was first published in 2011 and updated in 2013 and 2017. OBJECTIVES To assess the clinical effectiveness and safety of vaccines for preventing the common cold in healthy people. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (April 2022), MEDLINE (1948 to April 2022), Embase (1974 to April 2022), CINAHL (1981 to April 2022), and LILACS (1982 to April 2022). We also searched three trials registers for ongoing studies, and four websites for additional trials (April 2022). We did not impose any language or date restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) of any virus vaccine compared with placebo to prevent the common cold in healthy people. DATA COLLECTION AND ANALYSIS We used Cochrane's Screen4Me workflow to assess the initial search results. Four review authors independently performed title and abstract screening to identify potentially relevant studies. We retrieved the full-text articles for those studies deemed potentially relevant, and the review authors independently screened the full-text reports for inclusion in the review, recording reasons for exclusion of the excluded studies. Any disagreements were resolved by discussion or by consulting a third review author when needed. Two review authors independently collected data on a data extraction form, resolving any disagreements by consensus or by involving a third review author. We double-checked data transferred into Review Manager 5 software. Three review authors independently assessed risk of bias using RoB 1 tool as outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We carried out statistical analysis using Review Manager 5. We did not conduct a meta-analysis, and we did not assess publication bias. We used GRADEpro GDT software to assess the certainty of the evidence and to create a summary of findings table. MAIN RESULTS: We did not identify any new RCTs for inclusion in this update. This review includes one RCT conducted in 1965 with an overall high risk of bias. The RCT included 2307 healthy young men in a military facility, all of whom were included in the analyses, and compared the effect of three adenovirus vaccines (live, inactivated type 4, and inactivated type 4 and 7) against a placebo (injection of physiological saline or gelatin capsule). There were 13 (1.14%) events in 1139 participants in the vaccine group, and 14 (1.19%) events in 1168 participants in the placebo group. Overall, we do not know if there is a difference between the adenovirus vaccine and placebo in reducing the incidence of the common cold (risk ratio 0.95, 95% confidence interval 0.45 to 2.02; very low-certainty evidence). Furthermore, no difference in adverse events when comparing live vaccine preparation with placebo was reported. We downgraded the certainty of the evidence to very low due to unclear risk of bias, indirectness because the population of this study was only young men, and imprecision because confidence intervals were wide and the number of events was low. The included study did not assess vaccine-related or all-cause mortality. AUTHORS' CONCLUSIONS: This Cochrane Review was based on one study with very low-certainty evidence, which showed that there may be no difference between the adenovirus vaccine and placebo in reducing the incidence of the common cold. We identified a need for well-designed, adequately powered RCTs to investigate vaccines for the common cold in healthy people. Future trials on interventions for preventing the common cold should assess a variety of virus vaccines for this condition, and should measure such outcomes as common cold incidence, vaccine safety, and mortality (all-cause and related to the vaccine).
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Affiliation(s)
- Camila Montesinos-Guevara
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Diana Buitrago-Garcia
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Maria L Felix
- Departamento de Neonatología, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Claudia V Guerra
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Ricardo Hidalgo
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Maria José Martinez-Zapata
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Daniel Simancas-Racines
- Cochrane Ecuador, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
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Chiu YT, Tien N, Lin HC, Wei HM, Lai HC, Chen JA, Low YY, Lin HH, Hsu YL, Hwang KP. Detection of respiratory pathogens by application of multiplex PCR panel during early period of COVID-19 pandemic in a tertiary hospital in Central Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1144-1150. [PMID: 34674956 PMCID: PMC8493640 DOI: 10.1016/j.jmii.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Respiratory tract infections (RTIs) represent a major cause of clinical visits worldwide. Viral epidemiology of RTIs in adults has been less studied compared to children. FilmArray respiratory panel (FA-RP), a multiplex, real time polymerase chain reaction method can simultaneously detect the nucleic acids of multiple pathogens. The purpose of this study is to analyze the epidemiology and clinical presentations of an RTI cohort. METHODS This retrospective cohort study was conducted at China Medical University Hospital (CMUH) and China Medical University Children's Hospital (CMUCH), from January 2020 to June 2020. The FA-RP results were collected and analyzed according to upper versus lower RTIs. RESULTS Among 253 respiratory samples tested, 135 (53.4%) were from adults and 118 (46.6%) from children. A total positive rate of 33.9% (86/253) was found, with 21.48% (29/135) in adults and 48.31% (57/118) in children. Human rhinovirus/Enterovirus (HRV/EV) was detected in most of the age groups and was more common in URIs. HRV/EV was found as a frequent co-detection virus. Among children, HRV/EV was the most detected pathogen of URIs, while the most predominant pathogen in LRIs was Mycoplasma pneumoniae. CONCLUSIONS FA-RP has the potential to improve the detection rate of respiratory pathogens. The positive rate of FA-RP was higher in children compared to adults, which likely corresponds to the higher incidence of viral RTIs in children. Different pathogens may lead to different types of respiratory infections.
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Affiliation(s)
- Yu-Ting Chiu
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Mei Wei
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Huan-Cheng Lai
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Jiun-An Chen
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Yan-Yi Low
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan
| | - Hsiu-Hsien Lin
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yu-Lung Hsu
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan,Corresponding author. Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City, 40447, Taiwan. Fax: +886 4 22032798
| | - Kao-Pin Hwang
- Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan,Corresponding author. Division of Pediatric Infectious Diseases, China Medical University Children's Hospital, China Medical University, No. 2, Yude Rd., North Dist., Taichung City, 40447, Taiwan. Fax: +886 4 22064008
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Hospital-acquired coronavirus disease 2019 (COVID-19) among patients of two acute-care hospitals: Implications for surveillance. Infect Control Hosp Epidemiol 2022; 43:1761-1766. [PMID: 35438067 PMCID: PMC9947044 DOI: 10.1017/ice.2021.510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES We quantified hospital-acquired coronavirus disease 2019 (COVID-19) during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition. DESIGN Retrospective observational study during early phases of the COVID-19 pandemic, March 1-November 30, 2020. We identified laboratory-detected severe acute respiratory coronavirus virus 2 (SARS-CoV-2) from 30 days before admission through discharge. All cases detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired cases, or possible or probable hospital-acquired cases. SETTING The study was conducted in 2 acute-care hospitals in Chicago, Illinois. PATIENTS The study included all hospitalized patients including an inpatient rehabilitation unit. INTERVENTIONS Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient and staff cohort protocols, universal masking, and restricted visitation policies. RESULTS Among 2,667 patients with SARS-CoV-2, detection before hospital day 6 was most common (n = 2,612; 98%); detection during hospital days 6-14 was uncommon (n = 43; 1.6%); and detection after hospital day 14 was rare (n = 16; 0.6%). By chart review, most cases after day 5 were categorized as community acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6-14 and 53% of cases after day 14). The incidence rates of possible and probable hospital-acquired cases per 10,000 patient days were similar for ICU- and non-ICU patients at hospital A (1.2 vs 1.3 difference, 0.1; 95% CI, -2.8 to 3.0) and hospital B (2.8 vs 1.2 difference, 1.6; 95% CI, -0.1 to 4.0). CONCLUSIONS Most patients were protected by early and sustained application of infection-control precautions modified to reduce SARS-CoV-2 transmission. Using solely temporal criteria to discriminate hospital versus community acquisition would have misclassified many "late onset" SARS-CoV-2-positive cases.
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Face masks to prevent transmission of respiratory infections: Systematic review and meta-analysis of randomized controlled trials on face mask use. PLoS One 2022; 17:e0271517. [PMID: 36454947 PMCID: PMC9714953 DOI: 10.1371/journal.pone.0271517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups. DESIGN Systematic review and meta-analysis. We evaluated the risk of bias using the Cochrane Risk of Bias 2 tool (ROB2). DATA SOURCES We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published between 1981 and February 9, 2022. We followed the PRISMA 2020 guidelines. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomized controlled trials investigating the use of face mask intervention in mitigating the risk of spreading respiratory infections across different exposure settings. RESULTS We identified 2,400 articles for screening. 18 articles passed the inclusion criteria for both evidence synthesis and meta-analysis. There were N = 189,145 individuals in the face mask intervention arm and N = 173,536 in the control arm, and the follow-up times ranged from 4 days to 19 months. Our results showed between-study heterogeneity (p < 0.0001). While there was no statistically significant association over all studies when the covariate unadjusted intervention effect estimates were used (RR = 0.977 [0.858-1.113], p = 0.728), our subgroup analyses revealed that a face mask intervention reduced respiratory infections in the adult subgroup (RR = 0.8795 [0.7861-0.9839], p = 0.0249) and in a community setting (RR = 0.890 [0.812-0.975], p = 0.0125). Furthermore, our leave-one-out analysis found that one study biased the results towards a null effect. Consequently, when using covariate adjusted odds ratio estimates to have a more precise effect estimates of the intervention effect to account for differences at the baseline, the results showed that a face mask intervention did reduce respiratory infections when the biasing study was excluded from the analysis (OR = 0.8892 [0.8061-0.9810], p = 0.0192). CONCLUSION Our findings support the use of face masks particularly in a community setting and for adults. We also observed substantial between-study heterogeneity and varying adherence to protocol. Notably, many studies were subject to contamination bias thus affecting the efficacy of the intervention, that is when also some controls used masks or when the intervention group did not comply with mask use leading to a downward biased effect of treatment receipt and efficacy. TRIAL REGISTRATION PROSPERO registration number CRD42020205523.
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Loeb M, Bartholomew A, Hashmi M, Tarhuni W, Hassany M, Youngster I, Somayaji R, Larios O, Kim J, Missaghi B, Vayalumkal JV, Mertz D, Chagla Z, Cividino M, Ali K, Mansour S, Castellucci LA, Frenette C, Parkes L, Downing M, Muller M, Glavin V, Newton J, Hookoom R, Leis JA, Kinross J, Smith S, Borhan S, Singh P, Pullenayegum E, Conly J. Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers : A Randomized Trial. Ann Intern Med 2022; 175:1629-1638. [PMID: 36442064 PMCID: PMC9707441 DOI: 10.7326/m22-1966] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is uncertain if medical masks offer similar protection against COVID-19 compared with N95 respirators. OBJECTIVE To determine whether medical masks are noninferior to N95 respirators to prevent COVID-19 in health care workers providing routine care. DESIGN Multicenter, randomized, noninferiority trial. (ClinicalTrials.gov: NCT04296643). SETTING 29 health care facilities in Canada, Israel, Pakistan, and Egypt from 4 May 2020 to 29 March 2022. PARTICIPANTS 1009 health care workers who provided direct care to patients with suspected or confirmed COVID-19. INTERVENTION Use of medical masks versus fit-tested N95 respirators for 10 weeks, plus universal masking, which was the policy implemented at each site. MEASUREMENTS The primary outcome was confirmed COVID-19 on reverse transcriptase polymerase chain reaction (RT-PCR) test. RESULTS In the intention-to-treat analysis, RT-PCR-confirmed COVID-19 occurred in 52 of 497 (10.46%) participants in the medical mask group versus 47 of 507 (9.27%) in the N95 respirator group (hazard ratio [HR], 1.14 [95% CI, 0.77 to 1.69]). An unplanned subgroup analysis by country found that in the medical mask group versus the N95 respirator group RT-PCR-confirmed COVID-19 occurred in 8 of 131 (6.11%) versus 3 of 135 (2.22%) in Canada (HR, 2.83 [CI, 0.75 to 10.72]), 6 of 17 (35.29%) versus 4 of 17 (23.53%) in Israel (HR, 1.54 [CI, 0.43 to 5.49]), 3 of 92 (3.26%) versus 2 of 94 (2.13%) in Pakistan (HR, 1.50 [CI, 0.25 to 8.98]), and 35 of 257 (13.62%) versus 38 of 261 (14.56%) in Egypt (HR, 0.95 [CI, 0.60 to 1.50]). There were 47 (10.8%) adverse events related to the intervention reported in the medical mask group and 59 (13.6%) in the N95 respirator group. LIMITATION Potential acquisition of SARS-CoV-2 through household and community exposure, heterogeneity between countries, uncertainty in the estimates of effect, differences in self-reported adherence, differences in baseline antibodies, and between-country differences in circulating variants and vaccination. CONCLUSION Among health care workers who provided routine care to patients with COVID-19, the overall estimates rule out a doubling in hazard of RT-PCR-confirmed COVID-19 for medical masks when compared with HRs of RT-PCR-confirmed COVID-19 for N95 respirators. The subgroup results varied by country, and the overall estimates may not be applicable to individual countries because of treatment effect heterogeneity. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research, World Health Organization, and Juravinski Research Institute.
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Affiliation(s)
- Mark Loeb
- Department of Pathology and Molecular Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (M.L.)
| | - Amy Bartholomew
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (A.B., J.N., P.S.)
| | | | - Wadea Tarhuni
- University of Saskatchewan, Saskatoon, Saskatchewan, and Canadian Cardiac Research Centre, Windsor, Ontario, Canada (W.T.)
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt (M.Hassany)
| | - Ilan Youngster
- Shamir Medical Center, Tzrifin, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (I.Y.)
| | - Ranjani Somayaji
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Oscar Larios
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Joseph Kim
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Bayan Missaghi
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
| | - Joseph V Vayalumkal
- Department of Pediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (J.V.V.)
| | - Dominik Mertz
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (D.M., R.H.)
| | - Zain Chagla
- Department of Medicine, McMaster University, and St. Joseph's Healthcare, Hamilton, Ontario, Canada (Z.C.)
| | | | - Karim Ali
- Niagara Health System, Niagara, Ontario, Canada (K.A.)
| | | | - Lana A Castellucci
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (L.A.C.)
| | - Charles Frenette
- McGill University Health Centre, Montreal, Quebec, Canada (C.F.)
| | | | - Mark Downing
- Unity Health-St. Joseph's, Toronto, Ontario, Canada (M.D.)
| | - Matthew Muller
- Unity Health-St. Michael's, Toronto, Ontario, Canada (M.M.)
| | - Verne Glavin
- Brantford Community Health System, Brantford, Ontario, Canada (V.G.)
| | - Jennifer Newton
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (A.B., J.N., P.S.)
| | - Ravi Hookoom
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada (D.M., R.H.)
| | - Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (J.A.L.)
| | | | - Stephanie Smith
- University of Alberta Hospital, Edmonton, Alberta, Canada (S.S.)
| | - Sayem Borhan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (S.B.)
| | - Pardeep Singh
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada (A.B., J.N., P.S.)
| | | | - John Conly
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada (R.S., O.L., J.Kim, B.M., J.C.)
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Fretheim A, Elgersma IH, Helleve A, Elstrøm P, Kacelnik O, Hemkens LG. Effect of Wearing Glasses on Risk of Infection With SARS-CoV-2 in the Community: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2244495. [PMID: 36454571 PMCID: PMC9716386 DOI: 10.1001/jamanetworkopen.2022.44495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
Importance Observational studies have reported an association between the use of eye protection and reduced risk of infection with SARS-CoV-2 and other respiratory viruses, but, as with most infection control measures, no randomized clinical trials have been conducted. Objectives To evaluate the effectiveness of wearing glasses in public as protection against being infected with SARS-CoV-2 and other respiratory viruses. Design, Setting, and Participants A randomized clinical trial was conducted in Norway from February 2 to April 24, 2022; all adult members of the public who did not regularly wear glasses, had no symptoms of COVID-19, and did not have COVID-19 in the last 6 weeks were eligible. Intervention Wearing glasses (eg, sunglasses) when close to others in public spaces for 2 weeks. Main Outcomes and Measures The primary outcome was a positive COVID-19 test result reported to the Norwegian Surveillance System for Communicable Diseases. Secondary outcomes included a positive COVID-19 test result and respiratory infection based on self-report. All analyses adhered to the intention-to-treat principle. Results A total of 3717 adults (2439 women [65.6%]; mean [SD] age, 46.9 [15.1] years) were randomized. All were identified and followed up in the registries, and 3231 (86.9%) responded to the end of study questionnaire. The proportions with a reported positive COVID-19 test result in the national registry were 3.7% (68 of 1852) in the intervention group and 3.5% (65 of 1865) in the control group (absolute risk difference, 0.2%; 95% CI, -1.0% to 1.4%; relative risk, 1.10; 95% CI, 0.75-1.50). The proportions with a positive COVID-19 test result based on self-report were 9.6% (177 of 1852) in the intervention group and 11.5% (214 of 1865) in the control group (absolute risk difference, -1.9%; 95% CI, -3.9% to 0.1%; relative risk, 0.83; 95% CI, 0.69-1.00). The risk of respiratory infections based on self-reported symptoms was lower in the intervention group (30.8% [571 of 1852]) than in the control group (34.1% [636 of 1865]; absolute risk difference, -3.3%; 95% CI, -6.3% to -0.3%; relative risk, 0.90; 95% CI, 0.82-0.99). Conclusions and Relevance In this randomized clinical trial, wearing glasses in the community was not protective regarding the primary outcome of a reported positive COVID-19 test. However, results were limited by a small sample size and other issues. Glasses may be worth considering as one component in infection control, pending further studies. Trial Registration ClinicalTrials.gov Identifier: NCT05217797.
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Affiliation(s)
- Atle Fretheim
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Ingeborg Hess Elgersma
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Elstrøm
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Oliver Kacelnik
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
- Division for Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars G. Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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Li S, Gu J. “We are pests, we have no future”: The prediction of anxiety by perceived discrimination in patients with coronavirus: Mediating role of psychological resilience. Front Psychol 2022; 13:979186. [DOI: 10.3389/fpsyg.2022.979186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
In a short amount of time, the COVID-19 pandemic has played havoc on social security, and people infected with coronavirus may have suffered from both physical and mental health issues requiring treatment. The purpose of our study was to examine the effect of perceived discrimination on anxiety in patients with coronavirus and to observe the role of psychological resilience as a mediator in this process. 376 patients with coronavirus were given a questionnaire, and 26 of them participated in in-depth interviews. Our results demonstrated that perceived discrimination in patients with coronavirus was predictive of anxiety and that strong perceptions of discrimination reduced patients’ psychological resilience levels, thereby triggering severe anxiety. Furthermore, psychological resilience was demonstrated to be a significant predictor of anxiety severity. Psychological resilience has been shown to act as a mediator between perceived discrimination and anxiety. As a response to COVID-19, the government, the media, and the general public should treat patients with coronavirus scientifically and rationally, minimize the secondary psychological damage caused by the perception of discrimination to the special groups of society represented by patients with coronavirus during the pandemic, correct the erroneous stigma generated by the traditional communication process, and prevent the spread of the psychosocial virus.
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Anunciação L, Portugal A, Andrade L, Marques L, Landeira‐Fernandez J. Disentangling crucial factors of the pandemic in Brazil: Effect of lockdown restrictions on mental health. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4713-e4723. [PMID: 35758148 PMCID: PMC9349699 DOI: 10.1111/hsc.13878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/01/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Quarantine and social distance restrictions have been enforced worldwide to reduce the spread of coronavirus disease 2019 (COVID-19). The effects of these measures on mental health are recognised, but remaining unclear, is whether these effects are a consequence of the virus itself or policies that are enforced to prevent it. The present study investigated the impact of lockdown restrictions on anxiety and depression at two different times in 2020. Data were collected from 118 participants from all regions of Brazil. After easing quarantine restrictions in the second half of 2020, two natural groups were formed. One group included participants who voluntarily remained at home (n = 73). The other group consisted of those who decided to leave home (n = 45). A linear mixed model was used to determine the effects of group and time and their interaction. The McNemar test was used to determine intragroup differences in perceptions and concerns about COVID-19. Logistic regression identified predictors of high and stable depression and anxiety. None of the factors or their interactions was significant. Indicators of depression and anxiety remained stable over time, regardless of whether the participants left home or remained at home. Significantly, a strong and stable agreement with quarantine was found. The participants agreed that COVID-19 was a threat to public health. Political orientation was a predictor of high and stable levels of depression but not anxiety. Participants who self-identified as liberal politically were at a greater risk of developing depression. The results suggest that the lockdown policy did not contribute to disruptions of mental health, which instead was a consequence of the pandemic and virus itself. We also found wide and strong support amongst the participants for lockdown and mandatory stay-at-home policies.
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Affiliation(s)
- Luis Anunciação
- Pontifical Catholic University of Rio de Janeiro – BrazilRio de JaneiroBrazil
| | - Anna Portugal
- Federal University of Rio de JaneiroRio de JaneiroBrazil
| | - Lucas Andrade
- Federal University of Rio de JaneiroRio de JaneiroBrazil
| | - Louise Marques
- Federal University of Rio de JaneiroRio de JaneiroBrazil
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Baumkötter R, Yilmaz S, Zahn D, Fenzl K, Prochaska JH, Rossmann H, Schmidtmann I, Schuster AK, Beutel ME, Lackner KJ, Münzel T, Wild PS. Protective behavior and SARS-CoV-2 infection risk in the population - Results from the Gutenberg COVID-19 study. BMC Public Health 2022; 22:1993. [PMID: 36316662 PMCID: PMC9623959 DOI: 10.1186/s12889-022-14310-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/26/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND During the SARS-CoV-2 pandemic, preventive measures like physical distancing, wearing face masks, and hand hygiene have been widely applied to mitigate viral transmission. Beyond increasing vaccination coverage, preventive measures remain urgently needed. The aim of the present project was to assess the effect of protective behavior on SARS-CoV-2 infection risk in the population. METHODS Data of the Gutenberg COVID-19 Study (GCS), a prospective cohort study with a representative population-based sample, were analyzed. SARS-CoV-2 infections were identified by sequential sampling of biomaterial, which was analyzed by RT-qPCR and two antibody immunoassays. Self-reported COVID-19 test results were additionally considered. Information on protective behavior including physical distancing, wearing face masks, and hand hygiene was collected via serial questionnaire-based assessments. To estimate adjusted prevalence ratios and hazard ratios, robust Poisson regression and Cox regression were applied. RESULTS In total, 10,250 participants were enrolled (median age 56.9 [43.3/68.6] years, 50.8% females). Adherence to preventive measures was moderate for physical distancing (48.3%), while the use of face masks (91.5%) and the frequency of handwashing (75.0%) were high. Physical distancing appeared to be a protective factor with respect to SARS-CoV-2 infection risk independent of sociodemographic characteristics and individual pandemic-related behavior (prevalence ratio [PR] = 0.77, 95% confidence interval [CI] 0.62-0.96). A protective association between wearing face masks and SARS-CoV-2 transmission was identified (PR = 0.73, 95% CI 0.55-0.96). However, the protective effect declined after controlling for potential confounding factors (PR = 0.96, 95% CI 0.68-1.36). For handwashing, this investigation did not find a beneficial impact. The adherence to protective behavior was not affected by previous SARS-CoV-2 infection or immunization against COVID-19. CONCLUSION The present study suggests primarily a preventive impact of physical distancing of 1.5 m, but also of wearing face masks on SARS-CoV-2 infections, supporting their widespread implementation. The proper fit and use of face masks are crucial for effectively mitigating the spread of SARS-CoV-2 in the population.
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Affiliation(s)
- Rieke Baumkötter
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine Main, Mainz, Germany
| | - Simge Yilmaz
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine Main, Mainz, Germany
| | - Daniela Zahn
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Katharina Fenzl
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Jürgen H. Prochaska
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine Main, Mainz, Germany ,grid.410607.4Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heidi Rossmann
- grid.410607.4Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander K. Schuster
- grid.410607.4Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- grid.410607.4Department of Psychosomatic Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Karl J. Lackner
- grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine Main, Mainz, Germany ,grid.410607.4Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Münzel
- grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine Main, Mainz, Germany ,grid.410607.4Cardiology I, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp S. Wild
- grid.410607.4Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany ,grid.452396.f0000 0004 5937 5237German Center for Cardiovascular Research (DZHK), partner site Rhine Main, Mainz, Germany ,grid.410607.4Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany ,grid.424631.60000 0004 1794 1771Institute of Molecular Biology (IMB), Mainz, Germany
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Gaaloul ben Hnia N, Komen MK, Wlaschin KF, Parthasarathy RV, Landgrebe KD, Bouvier NM. Intranasal antisepsis to reduce influenza virus transmission in an animal model. Influenza Other Respir Viruses 2022; 17:e13035. [PMID: 36225128 PMCID: PMC9835424 DOI: 10.1111/irv.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Seasonal influenza annually causes significant morbidity and mortality, and unpredictable respiratory virus zoonoses, such as the current COVID-19 pandemic, can threaten the health and lives of millions more. Molecular iodine (I2 ) is a broad-spectrum, pathogen-nonspecific antiseptic agent that has demonstrated antimicrobial activity against a wide range of bacteria, virus, and fungi. METHODS We investigated a commercially available antiseptic, a non-irritating formulation of iodine (5% povidone-iodine) with a film-forming agent that extends the duration of the iodine's antimicrobial activity, for its ability to prevent influenza virus transmission between infected and susceptible animals in the guinea pig model of influenza virus transmission. RESULTS We observed that a once-daily topical application of this long-lasting antiseptic to the nares of either the infected virus-donor guinea pig or the susceptible virus-recipient guinea pig, or to the nares of both animals, prior to virus inoculation effectively reduced transmission of a highly transmissible influenza A virus, even when the donor and recipient guinea pigs shared the same cage. Daily treatment of the recipient guinea pig starting 1 day after initial exposure to an infected donor guinea pig in the same cage was similarly effective in preventing detectable influenza virus infection in the recipient animal. CONCLUSIONS We conclude that a daily application of this antiseptic formulation is efficacious in reducing the transmission of influenza A virus in the guinea pig model, and further study in this and other preclinical models is warranted.
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Affiliation(s)
| | | | | | | | | | - Nicole M. Bouvier
- Department of MicrobiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Division of Infectious Diseases, Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Morales Varas G, Sánchez Casado M, Padilla Peinado R, Morán Gallego F, Buj Vicente M, Rodríguez Villamizar A. Effects of vaccination against COVID-19 on the evolution of critically ill patients. Med Intensiva 2022; 46:588-590. [PMID: 35879183 PMCID: PMC9250934 DOI: 10.1016/j.medine.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 06/15/2023]
Affiliation(s)
- G Morales Varas
- Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
| | - M Sánchez Casado
- Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - R Padilla Peinado
- Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - F Morán Gallego
- Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - M Buj Vicente
- Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - A Rodríguez Villamizar
- Unidad de Cuidados Intensivos, Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
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46
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Jamrozik E. Public health ethics: critiques of the "new normal". New Bioeth 2022; 40:1-16. [PMID: 36167921 PMCID: PMC9514707 DOI: 10.1007/s40592-022-00163-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022]
Abstract
The global response to the recent coronavirus pandemic has revealed an ethical crisis in public health. This article analyses key pandemic public health policies in light of widely accepted ethical principles: the need for evidence, the least restrictive/harmful alternative, proportionality, equity, reciprocity, due legal process, and transparency. Many policies would be considered unacceptable according to pre-pandemic norms of public health ethics. There are thus significant opportunities to develop more ethical responses to future pandemics. This paper serves as the introduction to this Special Issue of Monash Bioethics Review and provides background for the other articles in this collection.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and Humanities, University of Oxford, Old Rd, OX3 7LF, Headington, Oxford, UK.
- Monash Bioethics Centre, Monash University, Melbourne, Australia.
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
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Ghoroghi A, Rezgui Y, Wallace R. Impact of ventilation and avoidance measures on SARS-CoV-2 risk of infection in public indoor environments. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156518. [PMID: 35688237 PMCID: PMC9172255 DOI: 10.1016/j.scitotenv.2022.156518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND The literature includes many studies which individually assess the efficacy of protective measures against the spread of the SARS-CoV-2 virus. This study considers the high infection risk in public buildings and models the quality of the indoor environment, related safety measures, and their efficacy in preventing the spread of the SARS-CoV-2 virus. METHODS Simulations are created that consider protective factors such as hand hygiene, face covering and engagement with Covid-19 vaccination programs in reducing the risk of infection in a university foyer. Furthermore, a computational fluid dynamics model is developed to simulate and analyse the university foyer under three ventilation regimes. The probability of transmission was measured across different scenarios. FINDINGS Estimates suggest that the Delta variant requires the air change rate to be increased >1000 times compared to the original strain, which is practically not feasible. Consequently, appropriate hygiene practices, such as wearing masks, are essential to reducing secondary infections. A comparison of different protective factors in simulations found the overall burden of infections resulting from indoor contact depends on (i) face mask adherence, (ii) quality of the ventilation system, and (iii) other hygiene practices. INTERPRETATION Relying on ventilation, whether natural, mechanical, or mixed, is not sufficient alone to mitigate the risk of aerosol infections. This is due to the internal configuration of the indoor space in terms of (i) size and number of windows, their location and opening frequency, as well as the position of the air extraction and supply inlets, which often induce hotspots with stagnating air, (ii) the excessive required air change rate. Hence, strict reliance on proper hygiene practices, namely adherence to face coverings and hand sanitising, are essential. Consequently, face mask adherence should be emphasized and promoted by policymakers for public health applications. Similar research may need to be conducted using a similar approach on the Omicron (B.1.1.529) variant.
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Affiliation(s)
- Ali Ghoroghi
- School of Engineering, Cardiff University, Cardiff, UK.
| | - Yacine Rezgui
- School of Engineering, Cardiff University, Cardiff, UK
| | - Ruth Wallace
- School of Engineering, Cardiff University, Cardiff, UK
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Bhardwaj S, Choudhary ML, Jadhav S, Vipat V, Ghuge R, Salvi S, Kulkarni R, Kinikar A, Padbidri V, Bafna S, Bavdekare A, D'costa P, Gujar N, Potdar V. A retrospective analysis of respiratory virus transmission before and during the COVID-19 pandemic in Pune the western region of India. Front Public Health 2022; 10:936634. [PMID: 36159243 PMCID: PMC9494283 DOI: 10.3389/fpubh.2022.936634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] Open
Abstract
Background SARS-CoV-2 was first reported in China in December 2019 and quickly spread across the world. Non-pharmaceutical interventions (NPIs) are the key to control the transmission of respiratory viruses. To stop the spread, NPI is widely recommended and is still followed by most countries. Methods At the National Influenza Center of the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), the surveillance of severe acute respiratory illness and acute respiratory illness cases for influenza and other respiratory viruses is in place. In this study, we analyzed surveillance data on respiratory viruses and/or SARS-CoV-2 testing from January 2017 to December 2021. Multiplex real-time PCR was used to detect the respiratory viruses. Results Our findings indicate that during the pandemic, the positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and human coronavirus declined significantly. Conclusion The annual distinct seasonal outbreaks of influenza, RSV, and other respiratory viruses as observed during the pre-COVID-19 period were not observed during the COVID-19 pandemic in years 2020 and 21. Social distancing, lock-downs, and non-pharmaceutical interventions may play an important role in the reduction of respiratory viruses. Understanding the seasonal respiratory virus decline could help public health experts prepare for future respiratory virus pandemics.
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Affiliation(s)
- Sumit Bhardwaj
- Influenza, National Institute of Virology (ICMR), Pune, India
| | | | - Sheetal Jadhav
- Influenza, National Institute of Virology (ICMR), Pune, India
| | - Veena Vipat
- Influenza, National Institute of Virology (ICMR), Pune, India
| | - Rohan Ghuge
- Influenza, National Institute of Virology (ICMR), Pune, India
| | - Sonali Salvi
- B. J. Medical College and Sassoon Hospital, Pune, India
| | | | - Aarti Kinikar
- B. J. Medical College and Sassoon Hospital, Pune, India
| | | | | | | | | | | | - Varsha Potdar
- Influenza, National Institute of Virology (ICMR), Pune, India,*Correspondence: Varsha Potdar
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White S, Heath T, Mutula AC, Dreibelbis R, Palmer J. How are hygiene programmes designed in crises? Qualitative interviews with humanitarians in the Democratic Republic of the Congo and Iraq. Confl Health 2022; 16:45. [PMID: 36056391 PMCID: PMC9438112 DOI: 10.1186/s13031-022-00476-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions-all of which may also be rapidly evolving. METHODS We conducted in-depth interviews with 36 humanitarian staff involved in hygiene programme design in two crisis-affected settings-one a conflict affected setting (Iraq) and the other amid a cholera outbreak (Democratic Republic of the Congo). Interviews explored decision-making in each phase of the humanitarian project cycle and were thematically analysed. RESULTS Participants considered the design and implementation of hygiene programmes in crises to be sub-optimal. Humanitarians faced sector-specific challenges as well as more general constraints associated with operating within the humanitarian system. Programme-design decisions were made naturalistically and relied heavily on the intuitions and assumptions of senior staff. National organisations were often side-lined from programme design processes despite being in a better position to gather situational data. Consequently, programme design and decision-making processes adopted by humanitarians were similar across the two settings studied and led to similar types of hygiene promotion activities being delivered. CONCLUSION Hygiene programming in crises-affected settings could be strengthened by initiatives targeted at supporting humanitarian staff during the pre-implementation programme design phase. This may include rapid assessment tools to better understand behavioural determinants in crisis-affected contexts; the use of a theory of change to inform the selection of programme activities; and funding mechanisms which encourage equitable partnerships, phased programming, regular adaptation and have programmatic components targeted at sustainability and sector capacity building. Initiatives aimed at sector reform should be cognisant of inter and intra-organisational dynamics, the ways that expertise is created and valued by the sector, and humanitarian habits and norms that arise in response to system constraints and pressures. These micro-organisational processes affect macro-level outcomes related to programme quality and acceptability and determine or limit the roles of national actors in programme design processes.
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Affiliation(s)
- Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Thomas Heath
- Independent Consultant, Goma, Democratic Republic of the Congo
| | | | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Palmer
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Walach H, Traindl H, Prentice J, Weikl R, Diemer A, Kappes A, Hockertz S. Carbon dioxide rises beyond acceptable safety levels in children under nose and mouth covering: Results of an experimental measurement study in healthy children. ENVIRONMENTAL RESEARCH 2022; 212:113564. [PMID: 35636467 PMCID: PMC9142210 DOI: 10.1016/j.envres.2022.113564] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 05/09/2023]
Abstract
Nose and mouth covering (NMC) has been made compulsory for children in many countries during the Covid-19 pandemic. We wanted to determine the average CO2 levels in inhaled air with NMC in children between age 6 and 17. We used short term measurements under surgical masks and FFP2 masks according to European norm EN 149, compared to baseline in an experimental, intra-individually controlled study over 25 min. CO2 content was measured every 15 s using an automated dual-wavelength infrared CO2 measurement device (G100, Geotech, Leamington Spa, UK) over 25 min in a short-term experimental setting, with children seated. After baseline measurement children were provided with two types of commonly worn NMC: surgical masks and FFP2--masks in randomized sequence for 3 min each. We kept ambient CO2-levels below 1000 parts per million (ppm) through frequent ventilation. We measured breathing frequency and pulse as potential physiological moderator variables. Forty-five children, 25 boys, 20 girls, with a mean age of 10.7 years (standard deviation 2.6) were measured. We measured 13,100 ppm (SD 380) under surgical mask and 13,900 ppm (SD 370) under FFP2 mask in inhaled air. A linear model with age as a covariate showed a highly significant effect of the condition (p < 1*10-9). We measured 2,700 ppm (SD 100) CO2 at pre-baseline and 2,800 ppm (SD 100) at post-baseline, a non-significant small difference. Appropriate contrasts revealed that the change was due to the masks only and the difference between the two types of masks was small and not significant. Wearing of NMC (surgical masks or FFP2- -masks) raises CO2 content in inhaled air quickly to a very high level in healthy children in a seated resting position that might be hazardous to children's health.
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Affiliation(s)
| | | | | | - Ronald Weikl
- Obstetric, Gynecological and General Practice, Passau, Germany.
| | | | - Anna Kappes
- Anna Kappes, Psychotherapeutic Practice for Children and Youths, Müllheim, Germany.
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