Community-based prevention and control of COVID-19: Experience from China

Psychological crisis intervention for students during COVID‐19 lockdown in China

Objectives

This study aims to describe the experience and practice of an intervention process for mental health crisis with 14,093 students living in a suddenly quarantined campus during the COVID‐19 pandemic.

Methods

An expert committee of psychiatrists, psychologists and student counsellors was formed to manage the psychological crisis experienced by students. The committee provided online and onsite support, disclosed timely information, attended various online courses and facilitated various activities. Using the PHQ‐9, GAD‐7 and ISI scales, psychological weekly reports, student files and emergencies, students who were likely to have a crisis event were screened, and their degree of crisis was evaluated. A “one person–one case–one team” intervention was conducted for high‐risk students.

Results

Of the 14,093 students, 11,121 finished all three online questionnaires. Based on the results of the screening tests, 732 students were placed in the prioritised attention group, 293 in the crisis group and 33 (10 [3.41%] male and 23 [7.85%] female) showed severe suicidal intentions. In total, 186 (3.26%) students declared poor sleep quality, while 610 (10.05%) students were found to have depression. The number of students affected with generalised anxiety was 650 (10.77%). Clinical intervention was successful with no untoward incidents.

Conclusions

With strong support from the government, and the cooperation between multidisciplinary experts and the comprehensive intervention programme, the study obtained positive results. However, the limitations include the partial online survey responses and incomplete records of intervention. Nevertheless, the findings of this study could provide a foundation for further research.

Factors affecting pregnant women in undergoing pregnancy during COVID-19 pandemic: A survey in ACEH

COVID-19 pandemic is a threat to public health caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Significant increases in cases occurred worldwide, including in Indonesia and Aceh Province. Pregnant women as a vulnerable group need to equip themselves with knowledge, attitudes, and practices to prevent themselves from being infected with the virus. This study aimed to determine the knowledge, attitude, and practice factors among pregnant women undergoing pregnancy in the COVID-19 pandemic. A cross-sectional online survey in Aceh was carried out among 148 pregnant women between May 3rd and May 14th, 2020. This study was conducted using a knowledge, attitude, and practice questionnaire adapted to pregnancy conditions during the COVID-19 pandemic. Responses were analyzed and categorized by using univariate analysis. The study identified that most pregnant women aged 31-35 years old (41.2%) and had higher education as their latest education (59.5%). This study found 94.6% of participants were knowledgeable on pregnancies carried out during the COVID-19 pandemic. Furthermore, 60.1% had a positive attitude, and 60.8% of pregnant women had good practice in carrying pregnancy during the COVID-19 pandemic. In conclusion, the knowledge, attitude, and practice factors of pregnant women were quite adequate. However, antenatal education is still needed to reduce anxiety in pregnant women and their family.

Which Matters More in Fighting COVID-19—Government Policy or Community Participation?

Objective

As a heavily populated megacity, Shanghai faces major epidemic risks. However, Shanghai's control of COVID-19 has been successful owing to both the strict government policy and wide community participation. Here, we investigated the impact of these stakeholders and examined who played a major role across different epidemic stages.

Design

We extended the classic susceptible-exposed-infectious-recovered (SEIR) model considering the heterogeneous contact structure in four social sceneries, i.e., school, workplace, public entertainment venues, and neighborhood community, which could reflect the impact of lockdown policy and wide participation of residents happened at the community level.

Result

The simulation results showed that without lockdown policy and only with community participation, the daily new confirmed cases would gradually increase to more than 7,000 [292/1,000,000] at the end of Sep. However, without community participation and only with a lockdown policy, the daily new confirmed cases sharply decreased to 30 [1.2/1,000,000] at the end of the 1st month and remained low for several months. However, when a lockdown policy was gradually lifted, the new confirmed cases increased exponentially, eventually reaching more than 17,000 [708/1,000,000]. Therefore, a government lockdown policy was necessary for the rapid control of COVID-19 during the outbreak stage while community participation is more important in keeping the number of new confirmed cases low during the reopening stage.

Conclusion

Government lockdown policy and community participation play different roles in the control of COVID-19 at different stages of the epidemic: although the government played a leading role in setting up policies, the broader participation of community fever clinics (CFCs) and the general public were especially crucial in winning the battle against COVID-19 in the long run.

Changes in lifestyles and depressive symptom among patients with chronic diseases during COVID-19 lockdown

This study aims to investigate the impact of COVID-19 lockdown on lifestyle behaviors and depressive symptom among patients with NCDs (noncommunicable diseases). We incorporated a COVID-19 survey to the WELL China cohort, a prospective cohort study with the baseline survey conducted 8–16 months before the COVID-19 outbreak in Hangzhou, China. The COVID-19 survey was carried out to collect information on lifestyle and depressive symptom during lockdown. A total of 3327 participants were included in the COVID-19 survey, including 2098 (63.1%) reported having NCDs at baseline and 1457 (44%) without NCDs. The prevalence of current drinkers decreased from 42.9% before COVID-19 lockdown to 23.7% during lockdown, current smokers from 15.9 to 13.5%, and poor sleepers from 23.9 to 15.3%, while low physical activity increased from 13.4 to 25.2%, among participants with NCDs (P < 0.05 for all comparisons using McNemar's test). Participants with NCDs were more likely than those without to have depressive symptom (OR, 1.30; 95% CI 1.05–1.61), especially among those who need to refill their medication during the COVID-19 lockdown (OR, 1.52; 95% CI 1.15–2.02). Our findings provide insight into the development of targeted interventions to better prepare patients with NCDs and healthcare system to meet the challenge of future pandemic and lockdown.

Association Between Social Support and Perceived Stress: A Cross-Sectional Study on Staffs of the Epidemic Prevention During the Covid-19 Epidemic in China

Background

The Coronavirus Disease 2019 (COVID-19) lockdown considerably affects people's life in China, both physically and mentally. Staffs of the epidemic prevention and control in the community have played an irreplaceable role during community lockdown period in Wuhan. However, few studies have focused on their health status during epidemic prevention. This study aimed to appraise the available evidence of health conditions of them and explore the influencing factors.

Method

Used a multistage sampling method, we conducted a survey in staffs of the epidemic prevention and control in the community (N = 503). Descriptive analysis was used to characterize the respondents. T-test and analysis of variance were for group differences analysis. Confirmatory factor analysis (CFA) was used to verify the scale validity, correlation analysis and pathway analysis and Structural equation model (SEM) was used to study the relationship between stress perception, social support, mental resilience and sleep quality. Statistical analysis was performed with SPSS 26.0, R version 4.1.3 and Mplus 8.3.

Results

The mean Perceived Stress Scale (PSS) score of the respondents was 13.28 ± 7.31 and 51.1% had higher PSS score than the normal. In the absence of social support, people's sleeping quality and psychological resilience may decrease, their perceived stress may elevate and compromise mental health correspondingly. Social support could affect perceived stress directly, while Sleep quality and psychology resilience played significant partial mediating roles in social support affecting perceived stress. The mediating effects accounted for 50.8% of the total.

Conclusion

Staffs of the epidemic prevention and control in the community suffered from poor sleep quality and high level of stress perception. Establishment of good social support may effectively reduce their stress and this effect is mediated by sleep quality and psychological resilience. Physical health status would affect the staffs' mental health and they more attention should be paid to those with poor physical health.

Services and surveillance during the pandemic lockdown: Residents’ committees in Wuhan and Beijing

The COVID-19 pandemic caused a lockdown of Wuhan, and strict control was imposed in many major Chinese cities, including the national capital of Beijing. Residents’ committee workers at the grass-roots level have played a critical role in the enforcement of the government’s pandemic prevention and control measures, through their day-to-day service and surveillance as local community managers. This article examines their work in Wuhan and Beijing neighbourhoods during the most critical periods of the outbreak, from late January to June 2020, and the challenges the workers faced as executors of the government’s community-based prevention policy. The two cities have developed different community strategies because of very different epidemiological situations and city functions.

Development and Validation of an RNA Binding Protein-associated Prognostic Model for Hepatocellular Carcinoma

Background and Aims

The survival rate of patients with hepatocellular carcinoma is variable. The abnormal expression of RNA-binding proteins (RBPs) is closely related to the occurrence and development of malignant tumors. The primary aim of this study was to identify RBPs related to the prognosis of liver cancer and to construct a prognostic model of liver cancer.

Methods

We downloaded the hepatocellular carcinoma gene sequencing data from The Cancer Genome Atlas (cancergenome.nih.gov/) database, constructed a protein-protein interaction network, and used Cytoscape to realize the visualization. From among 325 abnormally expressed genes for RBPs, 9 (XPO5, enhancer of zeste 2 polycomb repressive complex 2 subunit [EZH2], CSTF2, BRCA1, RRP12, MRPL54, EIF2AK4, PPARGC1A, and SEPSECS) were selected for construction of the prognostic model. Then, we further verified the results through the Gene Expression Omnibus (www.ncbi.nlm.nih.gov/geo/) database and in vitro experiments.

Results

A prognostic model was constructed, which determined that the survival time of patients in the high-risk group was significantly shorter than that of the low-risk group (p<0.01). Univariate and multivariate Cox regression analysis suggested that the risk score was an independent prognostic factor (p<0.01). We also constructed a nomogram based on the risk score, survival time, and survival status. At the same time, we verified the high expression and cancer-promoting effects of EZH2 in tumors.

Conclusions

Survival, receiver operating characteristic curve and independent prognostic analyses demonstrated that we constructed a good prognostic model, which might be useful for estimating the survival of patients with hepatocellular carcinoma.

Emotional and Behavioral Changes in Older Adults With High Risk of Cognitive Impairment During the COVID-19 Pandemic

COVID-19 is not only a threat to physical health but also a stressor to mental health, particularly for older adults. Previous studies have indicated that healthy older adults have resilience to cope with such stressful event through emotional and behavioral effort. However, very few have investigated the coping ability of older adults with High Risk of Cognitive Impairment (HRCI), as they are characterized with risk factors that can make them more vulnerable to COVID-19 in both physical and mental aspects. To examine whether older adults with HRCI were able to cope with and recover from the outbreak of COVID-19, we investigated the changes of their self-reported emotional states and intentions of taking protective behaviors between the outbreak period (data collected from February 17th to 24th, 2020) and the remission period (data collected from April 7th to 20th, 2020). The results showed that compared with the outbreak period, older adults with HRCI showed better emotional states and higher levels of intention to take more protective behaviors during the remission period. Subgroup analysis showed that even those who showed relatively poor coping abilities during the outbreak period could gradually improve their emotional states and intend to take more protective behaviors later on in the remission period. Therefore, these results suggested that older adults with HRCI were able to cope with and recover from the pandemic outbreak.

Outcome evaluation of COVID-19 infected patients by disease symptoms: a cross-sectional study in Ilam Province, Iran

BACKGROUND

Novel coronavirus disease-19 (COVID-19) was declared as a global pandemic in 2020. With the spread of the disease, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. This study aimed to evaluate clinical outcomes of COVID-19 patients by disease symptoms in Ilam province, Iran.

METHODS

This was a cross-sectional study. Data were collected from integrated health system records for all hospitals affiliated with the Ilam University of Medical Sciences between 26-Jan-2020 and 02-May-2020. All patients with a confirmed positive test were included in this study. Descriptive analyses, chi-square test, and binary logistic regression model were performed by using SPSS version 22.

RESULTS

The mean age of participants was 46.47 ± 18.24 years. Of the 3608 patients, 3477 (96.1%) were discharged, and 129 (3.9%) died. 54.2% of the patients were male and were in the age group of 30-40 years. Cough, sore throat, shortness of breath or difficulty breathing, and fever or chills were the most common symptoms. Patients with symptoms of shortness of breath, abnormal radiographic findings of the chest, and chest pain and pressure were relatively more likely to die. According to binary logistic regression results, the probability of death in patients with shortness of breath, abnormal chest radiographic findings, and chest pain was 1.34, 1.24, and 1.32 times higher, respectively, than for those without.

CONCLUSION

Our study provides evidence that the presentation of some symptoms significantly impacts outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19.

Association between contact with a general practitioner and depressive symptoms during the COVID-19 pandemic and lockdown: a large community-based study in Hangzhou, China

OBJECTIVES

To determine the association of general practitioner (GP) contact with depressive symptoms during the COVID-19 pandemic and lockdown in China.

DESIGN

In April 2020, a follow-up survey was conducted on the basis of a baseline survey conducted between October 2018 and May 2019.

SETTING

The survey was embedded in the Stanford Wellness Living Laboratory-China (WELL China) study, an ongoing prospective community-based cohort study during 2018-2019.

PARTICIPANTS

The survey was conducted by telephone interview among 4144 adult urban residents participating in the WELL China study at baseline. We collected information on sociodemographic characteristics, depressive symptoms and GP contact during the lockdown period (February to March 2020).

PRIMARY AND SECONDARY OUTCOME MEASURES

Depressive symptoms were measured using the WHO-Five Well-being Index, comprising five questionnaire items that briefly indicate psychological well-being. Logistic regression models were applied to assess the association between GP contact and depressive symptoms.

RESULTS

In total, 3356 participants responded to the survey; 203 were excluded owing to missing data on depressive symptoms, leaving 3153 participants in the present study. During lockdown, 449 participants had GP contact. GP contact was significantly negatively associated with prevalent depressive symptoms (OR, 0.67; 95% CI 0.51 to 0.89; p<0.01) and incident depressive symptoms (OR 0.68; 95% CI 0.51 to 0.93; p<0.05). Stratified analysis showed a significant negative association between depressive symptoms and GP contact in individuals who were 45-64 years old (p<0.01), had a middle or high education (p<0.01) and had self-reported non-communicable diseases (p<0.05).

CONCLUSIONS

Contact with GPs during the COVID-19 pandemic and lockdowns may have a negative association with depressive symptoms in community-dwelling populations. Given the possibility of further surges in COVID-19 infections, GPs' contact in the community should be enhanced.

Sleep quality and associated factors during the COVID-19 epidemic among community non-medical anti-epidemic Workers of Wuhan, China

BACKGROUND

Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, community non-medical anti-epidemic workers have played an important role in the prevention of COVID-19 in China. The present study aimed to assess sleep quality and its associated factors among community non-medical anti-epidemic workers.

METHOD

A survey was conducted using anonymous online questionnaire to collect information from 16 March 2020 to 24 March 2020. A total of 474 participants were included, with a 94.23% completion rate. The questionnaire contained demographic data, physical symptoms, and contact history with COVID-19. The researchers assessed perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS), assessed perceived stress by the Perceived Stress Scale (PSS), and measured sleep quality by the Pittsburgh Sleep Quality Index (PSQI) questionnaire.

RESULTS

Among the participants, 46.20% reported poor sleep quality. A binary logistic regression revealed that having educational background of junior college or above, being a member of the police force, having contacted individuals with confirmed or suspected COVID-19 infection, having chronic disease(s), having illness within 2 weeks, and having high or moderate perceived stress were significant factors associated with an increased risk of poor sleep quality.

CONCLUSION

Demographic factors, physical symptoms, history of contact with COVID-19, and perceived stress are significantly associated with poor sleep quality of community non-medical anti-epidemic workers. Thus, targeting these factors might be helpful in enhancing sleep quality of community workers.

Psychological Health, Sleep Quality, Behavior, and Internet Use Among People During the COVID-19 Pandemic: A Cross-Sectional Study

Background: The COVID-19 pandemic has led to an increase in the risk of suicide, uncertainty, mental stress, terror, annoyance, weariness, financial issues, and frustration. We aim to determine the prevalence of insomnia, depressive and anxiety symptoms, and their associated factors among Libyan populations during the COVID-19 pandemic and the civil war. Methods: An online cross-sectional survey was conducted among the Libyan population between July 18 and August 23, 2020. The data collected included basic demographic characteristics, level of education, employment status, COVID-19-related questions, and questions about abuse and domestic violence. This study assessed the psychological status of participants who were screened for anxiety symptoms using the seven-item Generalized Anxiety Disorder scale (GAD-7). Depressive symptoms were also screened for using the two-item Patient Health Questionnaire (PHQ-2) and the Insomnia Severity Index (ISI). Binomial logistic regression was used to predict the probability of insomnia, anxiety and depressive symptoms. Results: A total of 10,296 responses were recorded. Among the participants, 4,756 (46.2%) obtained a cut-off score of ≥ 3 which indicated depressive symptoms. For anxiety, 1,952 participants (19%) obtained a cut-off score of ≥ 15, which indicated anxiety symptoms. For the ISI, the mean (SD) was 11.4 (6.1) for the following categories: no clinical insomnia (0-7) 3,132 (30.4%), sub-threshold insomnia (1-7) 3,747 (36.4%), moderate severity clinical insomnia (8-14) 2,929 (28.4%), and severe clinical insomnia (15-21) 488 (4.7%). Logistic regression analysis showed that depressive symptoms were statistically associated with age, marital status, education level, occupational category, financial problems during the COVID-19 pandemic, health status, having a COVID-19 infection, current health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between anxiety symptoms and age, education level, occupational status, financial problems during the COVID-19 pandemic, having a COVID-19 infection, health status, suicide ideation, abuse or domestic violence, and lockdown compliance (p < 0.05). The regression analysis revealed a statistically significant association between insomnia and all study variables with the exception of age, educational level, and occupational status (p < 0.05). Conclusion: Confronted with the COVID-19 outbreak, the Libyan population exhibited high levels of psychological stress manifested in the form of depressive and anxiety symptoms, while one-third of the Libyan population suffered from clinical insomnia. Policymakers need to promote effective measures to reduce mental health issues and improve people's quality of life during the civil war and the COVID-19 pandemic.

Implications of COVID-19-induced nationwide lockdown on children's behaviour in Punjab, India

BACKGROUND

Lockdown is one of the prevalent tools that are used to control the spread of COVID-19 virus in India. Under the circumstances created during lockdown period, children are deprived from the social interaction and companionship; because of which, they are susceptible to psychiatric disorders. Therefore, in this study, efforts were to understand the impacts of lockdown on the mental status of the children of India and their specific causes.

STUDY DESIGN

It is a questionnaire-based study.

METHODS

A web-based questionnaire was prepared, and 400 parents from four districts of Punjab, India, namely, Ludhiana, Sahibzada Ajit Singh (SAS) Nagar, Sangrur and Ferozepur, were telephonically interviewed. Further, the information collected from the interviews was statistically analysed using Statistical Package for the Social Sciences (SPSS) software.

RESULTS

Findings from this study revealed that 73.15% and 51.25% of the children were having signs of increased irritation and anger, respectively; 18.7% and 17.6% of the parents also mentioned the symptoms of depression and anxiety, respectively, among their children, which were also augmented by the changes in their diet, sleep, weight and more usage of the electronic equipment. Children (~76.3%) persistently urge to go outdoors and play with their friends; therefore, they could lag in social development. Further, observations from Pearson's correlation revealed that during lockdown, children's mental health is significantly related to the area of their house, number of children in the family, qualification of their mother and socio-economic status of their family.

CONCLUSIONS

This study made it evident that the mental health of the children residing in Punjab, India, was compromised during the lockdown period induced by the COVID-19 pandemic. Findings of this study may also trigger the international authorities to frame the guidelines of lockdown in the interest of mental health of their native children.

A three-generation family cluster with COVID-19 infection: should quarantine be prolonged?

OBJECTIVES

Families are a transmission route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) because of the close contact. Monitoring of the viral load will be a valuable method to reduce the optimal number of quarantine days, especially in presymptomatic and symptomatic carriers of their households. The traditional three-generation families living together are seen frequently in East Asia, including in Taiwan.

STUDY DESIGN

We report on a family cluster with six individuals infected with coronavirus disease in Taiwan.

METHODS

The current public policy in Taiwan is quarantine for at least 14 days, based on the incubation period, or until the patient has tested negative three days in a row using the SARS-CoV-2 reverse transcription polymerase chain reaction. Details on the onset date of clinical symptoms, throat swab conversion, and course of disease were collected from medical records retrospectively.

RESULTS

In the household of this three-generation Taiwanese family, the infection rate was 60%. The ratio of males to females was 4:2, and the age range was 11-85 years. The prevalence of asymptomatic disease was 33.3% (2/6). The longest throat swab conversion time was 37 days, and the estimated course of disease from symptoms to first conversion of throat swab was 59 days.

CONCLUSIONS

Large families, including three-generation families in a single dwelling, should be monitored when the index case is found. Presymptomatic and symptomatic family members could be quarantined for an appropriate duration which, in our experience, is 2 months.