Preventing COVID-19 and Its Sequela: "There Is No Magic Bullet... It's Just Behaviors"

Applying the health belief model to examine college students' early stage adoption of non-pharmaceutical interventions in response to COVID-19

OBJECTIVE

Amidst the COVID-19 pandemic, colleges worked to minimize transmission through non-pharmaceutical interventions (NPIs). The objective of this study was to apply the Health Belief Model to assess correlates of US college students' early stage NPI uptake.

PARTICIPANTS

Sample includes 1,223 students from a medium-sized university who participated in an anonymous health survey.

METHODS

Logistic regression assessed associations between HBM factors and consistent adoption of five individual NPI strategies. Multivariate linear regression assessed HBM correlates of NPI adoption overall.

RESULTS

Correlates of NPI uptake varied by strategy. Only perceived NPI benefits were significantly associated with NPI adoption individually and overall. Perceived susceptibility was associated with use of hand sanitizer, facemasks, and general NPI adoption. Perceived severity was associated with avoidance of large social gatherings only.

CONCLUSION

The HBM appears valuable for understanding students' NPI adoption. Results suggest university health initiatives should prioritize education on the efficacy of particular preventive behaviors.

Self-rated health status and hygienic behaviour of pregnant women in Hungary during the pandemic

OBJECTIVES

The aim of our research was to investigate the self-rated health status, health behaviour and hygiene habits of pregnant women, and to explore the influencing factors during the pandemic.

METHODS

The sample included 1,200 pregnant women who gave birth in the most progressive institutions of the three examined counties in Hungary; 839 questionnaires were returned, based on which the willingness to answer can be said to be 69.9%. After data cleaning, 640 questionnaires were added to the database. Descriptive statistical analyses and correlation tests were performed, during which we used the Pearson's chi-square test and Fisher's exact test.

RESULTS

Socio-demographic factors show a significant correlation with the perceived state of health and the degree of responsibility for health, however, the existence of a chronic disease does not affect either the self-assessed state of health or hygienic behaviour. Factors influencing hygienic behaviour include residence, education, assessed income, and gestational age. We found no correlation between health status and hygienic attitude.

CONCLUSIONS

Our results draw attention to the fact that among pregnant women - especially pregnant women with low socioeconomic status - education about hygiene habits is of particular importance. Teamwork is needed in this area, which should start during the period of preparation for pregnancy, but at the latest in the early stages of pregnancy.

Academic and healthcare efforts from Cessation to complete resumption of professional football tournaments during COVID-19 pandemic: A narrative review

The Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus led to over 626 million infections and 6.5 million deaths worldwide and forced to cancel or postpone several sporting events. Effective control techniques are therefore urgently required to avoid COVID-19 spread at these local and global events. This narrative review addressed the healthcare and research efforts on the intersections between COVID-19 and major professional sports leagues worldwide, with special reference to the FIFA World Cup football 2022. This explained how the broader transformation of COVID-19 from being a potential risk to an urgent pandemic public health emergency, caused the world of Football to halt between February and March 2020. This review could add to the growing literature on the importance of scientific research in understanding the relationship between mass sports events and COVID-19 trajectory, concerning studies conducted globally and particularly for the recommencement of major professional football competitions. The information outlined in the article may help sports organizations understand the risks associated with sports and their settings and improve their preparedness for future events under unprecedented circumstances. There were tremendous global healthcare and research efforts to deal with this unprecedented pandemic. The successful FIFA World Cup football tournament was an indicator of the success of these efforts.

COVID-19 pandemic lockdown modulation of physico-chemical parameters of surface water, Karamana river basin, Southwest India: A weighted arithmetic index and geostatistical perspective

The coronavirus disease or COVID-19 pandemic continues imposing restrictions on the human population from full-scale normal/routine activities all over the world. This study primarily spotlights the consequences of the COVID-19-pandemic-lockdown on physicochemical parameters of water (samples) of the Karamana river system (KRS) during the pre-monsoons (or January) of 2021 and 2022, using the Weighted Arithmetic Index method and Geostatistical analysis (ArcMap 10.2). Even though the Karamana river supported the water needs of the people during the past several decades, the quality of water deteriorated due to the rising population and consequent anthropogenic activities. Hence, it is imperative to evaluate the water quality during the post-COVID-19 lockdowns and document the spatial distribution of parameters listed in the BIS (Bureau of Indian standard) IS10500, 2012. This was accomplished by establishing a water quality index (WQI), Geostatistical analysis, and weighted overlay analysis (WOA). The estimated WQI suggested that about 45.11km2 (6.43%) area has declined from the excellent category of water quality between 2021 and 2022. Similarly, WOA results deciphered that the area under the poor category has drastically and negatively changed from 27.85 km2 (4.0%) to 60.42 km2 (8.6%) after revoking of lockdown restrictions. The lessons learned from syn-Covid-19, the spike or uptrend of the water quality compared to the past decades, offer ample scientific basis to policymakers, administrators, and environmentalists for restoration of river system health from huge anthropogenic stress.

Navigating COVID-19 and related challenges to completing clinical trials: Lessons from the PATRIOT and STEP-UP randomized prevention trials

BACKGROUND/AIMS

High follow-up is critical in randomized clinical trials. We developed novel approaches to modify in-person visits and complete follow-up during COVID-19. Since these strategies are broadly applicable to circumstances wherein follow-up is difficult, they may help in contingency planning. The objective of this article is to develop and evaluate new approaches to replace detailed, in-person study visits for two trials focused on preventing diabetic foot complications.

METHODS

A quasi-experimental pre-post design compared approaches for follow-up during COVID-19 to approaches pre-COVID-19. Study subjects were outpatients at two Veterans Affairs Medical Centers. Following a research "hold," research resumed in February 2021 for Self-monitoring, Thermometry and Educating Patients for Ulcer Prevention (STEP UP) (n = 241), which focused on preventing recurrent foot ulcers, and in April 2021 for Preventing Amputation by Tailored Risk-based Intervention to Optimize Therapy (PATRIOT) (n = 406), which focused on preventing pre-ulcerative and ulcerative lesions. To complete data collection, we shortened visits, focused on primary and secondary outcomes, and conducted virtual visits when appropriate. For STEP UP, we created a 20-min assessment process that could be administered by phone. Since PATRIOT required plantar photographs to assess foot lesions, we conducted short face-to-face visits. We explored differences and assessed proportion completing visit, visit completion/100 person-months and compared COVID-19 to pre- COVID-19 using unadjusted risk ratios, incidence rate ratios, all with associated 95% confidence intervals (CIs). Finally, we report time-to-visit curves.

RESULTS

In both studies, participants whose follow-up concluded pre- COVID-19 seemed older than those whose follow-up concluded during COVID-19 (PATRIOT: 68.0 (67.2, 68.9) versus 65.2 years (61.9, 68.5); STEP UP: 67.5 (66.2, 68.9) versus 65.3 (63.3, 67.3)). For STEP UP, we completed 91 visits pre- COVID-19 (37.8% (31.6%, 44.2%)) and 63 visits during COVID-19 (78.8% (68.2%, 87.1%)). This was over 1309 person-months pre-COVID-19, and over 208.8 person-months during COVID-19; the visit completion rate/100 person-months were: pre-COVID-19 7.0 (5.6, 8.5), COVID-19 30.2 (23.2, 38.6); risk ratio: 2.1 (1.7, 2.5); and incidence rate ratio 4.3 (3.1, 5.9). Similarly, for PATRIOT, we completed 316 visits pre-COVID-19 (77.8% (73.5%, 81.8%)) and 27 assessments during COVID-19 (84.4% (67.2%, 94.7%)). This was over 1192.7 person-months pre-COVID-19 and 39.3 person-months during COVID-19. The visit completion rate/100 person-months in PATRIOT were: pre-COVID-19 2.7 (2.4, 3.0), COVID-19 6.9 (4.5, 10); risk ratio 1.1 (0.9, 1.3); incidence rate ratio 2.6 (1.8, 3.8). For both studies, the follow-up curves began separating at < 2 months.

CONCLUSIONS

We achieved higher completion rates during COVID-19 compared to pre-COVID-19 by modifying visits and focusing on primary and secondary outcomes. These strategies prevent excessive missing data, support more valid conclusions, and improve efficiency. They may provide important alternative strategies to achieving higher follow-up in randomized clinical trials.

The Effect of Intolerance of Uncertainty on State Anxiety in the Regular Epidemic Prevention and Control Phase in the Context of Informatization: A Moderated Chain Mediation Model

The COVID-19 pandemic has led to a generally high level of state anxiety resulting from the high contagiousness of the disease and strict prevention and control policies. The present study mainly focused on the relationship between the individual intolerance of uncertainty and state anxiety in the regular epidemic prevention and control phase in China, and aimed to investigate the mediating role of information overload and rumination, as well as the moderating role of self-compassion. A total of 992 Chinese residents from 31 provinces participated in this study, and completed questionnaires regarding intolerance of uncertainty, information overload, self-compassion, rumination, and state anxiety. Descriptive statistics and correlation analyses, as well as tests for mediating effects and moderated chain mediating effects, were performed on the data using SPSS 26.0 and Process 3.5 macro program. The findings indicated that intolerance of uncertainty significantly predicted individual state anxiety. Information overload mediates the effects of intolerance of uncertainty and state anxiety. Rumination also mediates the effect of uncertainty intolerance on state anxiety. Information overload and rumination have a chain mediation effect on the link between intolerance of uncertainty and state anxiety. Self-compassion mediates the effect of information overload on rumination. The results illuminate theoretical and practical implications in the regular epidemic prevention and control phases and reveal the protective role of self-compassion.

The effect of SARS-CoV-2 infection on cardiac function in post-COVID-19 survivors: A systematic review and meta-analysis

The longitudinal trajectories of cardiac structure and function following SARS-CoV-2 infection are unclear. Therefore, this meta-analysis aims to elucidate the effect of SARS-CoV-2 infection on cardiac function in coronavirus disease 2019 (COVID-19) survivors after recovery. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1st August 2022. A systematic review and meta-analysis were performed to calculate the pooled effects size and 95% confidence interval of each outcome. A total of 21 studies including 2394 individuals (1436 post-COVID-19 cases and 958 controls) were included in the present meta-analysis. The pooled analyses compared with control groups showed a significant association between post-COVID-19 and reduced left ventricular ejection fraction (LV EF), LV end-diastolic volume (LV EDV), LV stroke volume (LV SV), mitral annular plane systolic excursion (MAPSE), global longitudinal strain, right ventricular EF (RV EF), RV EDV, RV ESV, RV SV, tricuspid annular plane systolic excursion, and increased LV mass. Subgroup analysis based on the severity of COVID-19 in the acute phase and subsequent chronic outcomes revealed that LV EF, MAPSE, RV EF, and RV ESV only decreased in studies including patients with a history of intensive care unit admission. Cardiac impairment after SARS-CoV-2 infection persisted in recovered COVID-19 patients even after 1 year. Future studies are warranted to determine the biological mechanisms underlying the long-term cardiovascular consequences of COVID-19.

Infection control behaviours, intra-household transmission and quarantine duration: a retrospective cohort analysis of COVID-19 cases

OBJECTIVES

To study COVID-19 (Delta Variant) cases and close contacts co-located within households. Focusing on epidemiology of transmission of COVID-19, quarantine duration and utilisation of infection control behaviours under a telehealth model of care in an elimination setting.

METHODS

A retrospective cohort analysis examined household spread of infection, duration of quarantine and change in PCR CT value during illness. A survey explored infection control behaviours used by household members during isolation and quarantine.

RESULTS

The cohort was 141 individuals in 35 households. Thirty-seven were index cases, and 48 became positive during quarantine, most within 10 days. Whole-household infection occurred in 12 households with multiple members. Behaviours focused on fomite transmission reduction rather than preventing aerosol transmission. The median duration of close contact household quarantine was 25 days. The majority of COVID-19 cases were de-isolated after 14 days with no evidence of further community transmission.

CONCLUSION

Intrahousehold transmission was not universal and, if it occurred, usually occurred quickly. Behaviours utilised focused on fomites, suggesting a need for improved education regarding the potential utilisation of strategies to prevention the transmission of aerosols. Households experienced long durations of home-based quarantine.

IMPLICATIONS FOR PUBLIC HEALTH

The impact of long quarantine durations must be considered, particularly where most community benefit from quarantine is achieved within 10 days from exposure in the setting of the Delta Variant. Education of households regarding aerosol risk reduction is a potential strategy in the household setting of individuals at risk of disease progression.

Longitudinal behavioral changes and factors related to reinforced risk aversion behavior among patients with chronic kidney disease during the COVID-19 pandemic

In patients with chronic kidney disease (CKD), coronavirus disease 2019 (COVID-19) has a higher mortality rate than the general population; therefore, prevention is vital. To prevent COVID-19 infection, it is important to study individuals' risk aversion behavior. The objective of this study was to understand how the behavioral characteristics of physical distancing, hygiene practice, and exercise changed in patients with CKD during the COVID-19 pandemic and to identify the characteristics of patients who showed weakened or strengthened behavioral changes. We analyzed data from the Study on Kidney Disease and Environmental Chemicals (Clinical Trial No. NCT04679168), that examined a prospective cohort of patients with CKD. This cohort included patients with CKD who visited the participating hospitals for the first time between June and October 2020 and the second time between October 2020 and January 2021. Data on demographics, socio-economic details, and behavioral characteristics were collected through a questionnaire survey. Using a multivariable logistic regression model, we identified whether COVID-19 infection risk perception and previous strong behavioral changes affected behavioral changes during the first and second visits. A total of 277 patients (33.2% females) were included in the analysis. Nine out of 12 behaviors were reinforced at the first visit, and five out of nine reinforced behaviors were weakened at the second visit. A high-risk perception of COVID-19 infection was not associated with the tendency of overall behavioral reinforcement or maintaining behaviors in an enhanced state at the second visit. Strong behavioral changes at the patients' first visit to the hospital were associated with a tendency to strengthen or maintain reinforced behaviors at the second visit (adjusted odds ratio 1.99, 95% confidence interval 1.19-3.34; P = 0.009). Even if the initial COVID-19 risk perception is high, behavioral changes worsen over time. Individuals who showed more active behavioral changes at the beginning of the COVID-19 pandemic tended to maintain reinforced behavior over time. Continuous education and monitoring are needed to maintain changed behaviors, especially in patients with a high initial COVID-19 risk perception.

Learning From the Past: The Role of Social and Behavior Change Programming in Public Health Emergencies

The contributions of social and behavior change research/programming in 6 recent epidemics highlight the importance of further integrating such expertise into outbreak response.

Exploring the Impacts of Preventative Health Behaviors with Respect to COVID-19: An Altruistic Perspective

This study aims to explore the impact of gender and anxiety on various preventative health behaviors, and the relationships among these preventative health behaviors, individual well-being and depression, from the perspective of altruism. This study employed an online questionnaire survey, and 136 males and 204 females participated in the survey. The results of this study showed that females exhibited better preventative health behaviors than males, including hygiene habits, social distancing and behaviors intended to help others mitigate the epidemic. Anxiety regarding COVID-19 infection encouraged individuals to adopt hygienic habits and social distancing measures rather than to help others mitigate the epidemic. Hygiene habits improved the individual's psychological well-being. Helping others mitigate the epidemic improved the individual's psychological well-being and social well-being and contributed to reducing individual depression. However, the preventative health behavior involved in social distancing was not conducive to emotional well-being or social well-being. Affective elements are related to individual behaviors. Therefore, the use of prosocial, altruistic language may play an important role with respect to encouraging people to comply with preventative health behaviors in the context of COVID-19. In addition, it is worth noting that different preventative health behaviors may have different effects on people's mental health, especially when implementing social distancing-related epidemic mitigation behaviors. The question of how to prevent negative psychological effects in restricted actors must be answered, and the degree of life satisfaction experienced by those actors must also be taken into account.

Recommencement of football competition with spectators during the active phase of the COVID-19 pandemic in a Middle Eastern country

BACKGROUND

With the global spread of COVID-19 infection caused by the severe acute respiratory syndrome coronavirus-2 virus (SARS-CoV-2), all the national and international sports events were ceased early in 2020. The sport activities have been reinstated since then, albeit without spectators. However, several governments have established a variety of risk-mitigation measures to gradually reintroduce the spectators to stadiums.

OBJECTIVES

We aimed to evaluate the implementation of a strict health protocol to ensure the resumption of professional football with spectators and to access its effectiveness in limiting the spread of COVID-19 infections within the community.

METHODS

This was a retrospective, observational study involving football players, match officials, local organizing committee members, working in close coordination, and over 16,000 spectators in the state of Qatar. We examined data from the Amir Cup final (December 18th, 2020), which was played under a strict protocol that included extensive reverse transcription-Polymerase chain reaction (RT-PCR) testing for players and match officials, as well as the utility of COVID-19 rapid antigen and antibody testings as screening tools for spectators to ensure their safe return to the stadiums. In addition, we reviewed the guidelines and protocols that were put in place to organize Qatar's Amir Cup Football Final, which drew over 16,000 spectators in the stadium.

RESULTS

A total of 16,171 spectators undertook rapid antigen and antibody tests for the Amir cup final (from December16-December18, 2020). Fifteen Spectators (n = 15) returned with a positive result for COVID-19 infection during the final event (positivity rate = 0.12%). All players underwent RT-PCR testing 48 h before the match. None of the players tested positive for COVID-19 infections. 1311 individuals reported having symptoms related to COVID-19 post final of Amir Cup. These spectators were tested for COVID-19 RT-PCR with an overall positivity rate (positive/reactive) to be 0.42% (69/16171).

CONCLUSION

This report shows a meagre incidence rate of COVID-19 infections during and post-Amir Cup football final. Based on the low infectivity rate reported during and post the Amir Cup, we propose that supervised and controlled resumption of football matches with spectators can be carried out safely following a strict testing and tracing protocol. Similar infection control policies can be replicated with a higher number of spectators.

Correlates of attitudes toward COVID-19-related public health policies and prevention practices in six states

Objectives:

The COVID-19 pandemic rapidly impacted communities, however there is limited information about the beliefs, behaviors, and trust in government responses of populations across the country. It may be especially useful to understand state-based and regional differences that people reported early in the pandemic, to inform national and regional public health policies and communication strategies. This paper reports on correlates of perceptions of state and federal policies and prevention practices in six states with varying trajectories of COVID-19 cases and deaths, during the first major wave of the pandemic.

Methods:

A cross-sectional survey of COVID-19 policies, perceptions, and behaviors in six states (three in the northeast/mid-Atlantic and three in the southeastern United States), was conducted in April 2020 using an online platform of research volunteers. The survey asked about demographics; use of and belief about the effectiveness of preventive behaviors; experience with COVID-19 testing, diagnosis, quarantine, and hospitalization; risk behaviors and perception; opinion of local, state, and federal government guidelines and information; sources of information; and scales measuring time perspective and collectivism/individualism.

Results:

Responses from 1476 adults in six states showed that the most often-practiced prevention practices involved social distancing, and that reactions to federal government policies differed regionally and by political party affiliation.

Conclusions:

These findings improve understanding of how Americans view government responses to the pandemic, and their prevention practices, early in the pandemic. These data will help to create more effective public health policies to control the pandemic and achieve public support for control measures.

Family vulnerability, disruption, and chaos predict parent and child COVID-19 health-protective behavior adherence

INTRODUCTION

This study examined the role of family functioning in predicting family adherence to health-protective behaviors (HPBs) aimed at reducing COVID-19 spread. Pre-COVID-19 family functioning, disruptions to family functioning (cohesion, conflict, routines), and family chaos during the COVID-19 pandemic were tested as pathways to HPB adherence.

METHOD

We utilized a sample of N = 204 families, comprising parents who had children (MAge = 4.17). Parents (MAge = 27.43) completed one survey prior to COVID-19 onset in the United States, and twice during COVID-19, at a 2-week interval. Structural equation modeling was used to test three potential pathways between prepandemic family-level functioning and HPB adherence during the COVID-19 pandemic.

RESULTS

Findings indicated that families with higher levels of chaos during COVID-19 demonstrated consistently lower HPB adherence across all three models. Additionally, disruptions in family cohesion from pre-COVID was associated with lower levels of parent and child HPB adherence. Family conflict was indirectly associated with HPB adherence via family chaos during COVID-19; whereas family routines were not associated with HPB adherence at all.

DISCUSSION

These findings suggest that family functioning is a meaningful predictor of HPB adherence. Family-based support may be effective in improving HPB adherence by focusing on promoting cohesion and reducing conflict and chaos for families coping with reduced community support and resources. Strategies for family-based supports are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Safe Return to Campus in Times of COVID-19: A Survey Study among University Personnel to Inform Decision Makers

Halfway through 2021 in the midst of a public health crisis, a new academic year was fast approaching. Dutch universities were preparing to reopen their campuses to students and personnel in a safe manner. As the vaccination uptake was increasing and societies were slowly reopening, inviting students and personnel to campus became the next step to "the new normal". To absorb this change seamlessly, it was considered important to investigate personnel's beliefs about returning to campus and their perceptions of a safe working environment. An online survey was conducted among personnel (N = 1965) of Maastricht University, the Netherlands. University personnel's beliefs about a safe return to campus were assessed. The data were collected between 11 June and 28 June 2021. This study showed that, while most personnel (94.7%) were already vaccinated or willing to do so, not all personnel did feel safe to return to campus in September 2021. Over half of the respondents (58%) thought that the university is a safe place to return to work when the new academic year starts. However, the remainder of personnel felt unsafe or were uncertain for various reasons such as meeting in large groups or becoming infected. Moreover, when returning to campus, employees stated that they would require some time to reacclimate to their former work culture. The group who felt relatively more unsafe indicated that returning in September was too risky and that they worried about being infected. They wanted the safety guidelines to still be in force. On the other hand, the "safe" group stated safely returning to be "certainly possible" and trusted that others would still stick to the prevention guidelines. The findings led to practical recommendations for the University Board as they were preparing for organizing research and teaching for the upcoming academic year in the context of the COVID-19 pandemic. A brief intervention was developed: a webinar in which the data were linked to the board's plans for safe returning. This study demonstrates that university boards may use research among personnel to develop adequate measures promoting safety and feelings of safety among personnel in similar future situations.

Knowledge, Attitude, and Practice (KAP) toward COVID-19 Pandemic among the Public in Taiwan: A Cross-Sectional Study

Purpose: Knowledge, attitude, and practice (KAP) models are often used by researchers in the field of public health to explore people’s healthy behaviors. Therefore, this study mainly explored the relationships among participants’ sociodemographic status, COVID-19 knowledge, affective attitudes, and preventive behaviors. Method: This study adopted an online survey, involving a total of 136 males and 204 females, and used a cross-sectional study to investigate the relationships between variables including gender, age, COVID-19 knowledge, positive affective attitudes (emotional wellbeing, psychological wellbeing, and social wellbeing), negative affective attitudes (negative self-perception and negative perceptions of life), and preventive behaviors (hygiene habits, reducing public activities, and helping others to prevent the epidemic). Results: The majority of participants in the study were knowledgeable about COVID-19. The mean COVID-19 knowledge score was 12.86 (SD = 1.34, range: 7−15 with a full score of 15), indicating a high level of knowledge. However, the key to decide whether participants adopt COVID-19 preventive behaviors was mainly their affective attitudes, especially positive affective attitudes (β = 0.18−0.25, p< 0.01), rather than COVID-19 disease knowledge (β = −0.01−0.08, p > 0.05). In addition, the sociodemographic status of the participants revealed obvious differences in the preventive behaviors; females had better preventive behaviors than males such as cooperating with the epidemic prevention hygiene habits (t = −5.08, p< 0.01), reducing public activities (t = −3.00, p< 0.01), and helping others to prevent the epidemic (t = −1.97, p< 0.05), while the older participants were more inclined to adopt preventive behaviors including epidemic prevention hygiene habits (β = 0.18, p = 0.001, R2 = 0.03), reducing public activities (β = 0.35, p< 0.001, R2 = 0.13), and helping others to prevent the epidemic (β = 0.27, p< 0.001, R2 = 0.07). Conclusions: Having adequate COVID-19 knowledge was not linked to higher involvement in precautionary behaviors. Attitudes toward COVID-19 may play a more critical function in prompting individuals to undertake preventive behaviors, and different positive affective attitudes had different predictive relationships with preventive behaviors.

Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors: Lessons from the COVID-19 Pandemic (Preprint)

Background

Objective

Methods

Results

Conclusions

Factors influencing protective behavior in the post-COVID-19 period in China: a cross-sectional study

BACKGROUND

The study aimed to explore the factors influencing protective behavior and its association with factors during the post-COVID-19 period in China based on the risk perception emotion model and the protective action decision model (PADM).

METHODS

A total of 2830 valid questionnaires were collected as data for empirical analysis via network sampling in China. Structural equation modeling (SEM) was performed to explore the relationships between the latent variables.

RESULTS

SEM indicated that social emotion significantly positively affected protective behavior and intention. Protective behavioral intention had significant direct effects on protective behavior, and the direct effects were also the largest. Government trust did not have a significant effect on protective behavior but did have a significant indirect effect. Moreover, it was found that government trust had the greatest direct effect on social emotion. In addition, we found that excessive risk perception level may directly reduce people's intention and frequency of engaging in protective behavior, which was not conducive to positive, protective behavior.

CONCLUSION

In the post-COVID-19 period, theoretical framework constructed in this study can be used to evaluate people's protective behavior. The government should strengthen its information-sharing and interaction with the public, enhance people's trust in the government, create a positive social mood, appropriately regulate people's risk perception, and, finally, maintain a positive attitude and intent of protection.

Successful Reboot of High-Performance Sporting Activities by Japanese National Women's Handball Team in Tokyo, 2020 during the COVID-19 Pandemic: An Initiative Using the Japan Sports-Cyber Physical System (JS-CPS) of the Sports Research Innovation Project (SRIP)

The COVID-19 pandemic has negatively impacted sporting activities across the world. However, practical training strategies for athletes to reduce the risk of infection during the pandemic have not been definitively studied. The purpose of this report was to provide an overview of the challenges we encountered during the reboot of high-performance sporting activities of the Japanese national handball team during the 3rd wave of the COVID-19 pandemic in Tokyo, Japan. Twenty-nine Japanese national women's handball players and 24 staff participated in the study. To initiate the reboot of their first training camp after COVID-19 stay-home social policy, we conducted: web-based health-monitoring, SARS-CoV-2 screening with polymerase chain reaction (PCR) tests, real-time automated quantitative monitoring of social distancing on court using a moving image-based artificial intelligence (AI) algorithm, physical intensity evaluation with wearable heart rate (HR) and acceleration sensors, and a self-reported online questionnaire. The training camp was conducted successfully with no COVID-19 infections. The web-based health monitoring and the frequent PCR testing with short turnaround times contributed remarkably to early detection of athletes' health problems and to risk screening. During handball, AI-based on-court social-distance monitoring revealed key time-dependent spatial metrics to define player-to-player proximity. This information facilitated appropriate on- and off-game distancing behavior for teammates. Athletes regularly achieved around 80% of maximum HR during training, indicating anticipated improvements in achieving their physical intensities. Self-reported questionnaires related to the COVID management in the training camp revealed a sense of security among the athletes that allowed them to focus singularly on their training. The challenges discussed herein provided us considerable knowledge about creating and managing a safe environment for high-performing athletes in the COVID-19 pandemic via the Japan Sports-Cyber Physical System (JS-CPS) of the Sports Research Innovation Project (SRIP, Japan Sports Agency, Tokyo, Japan). This report is envisioned to provide informed decisions to coaches, trainers, policymakers from the sports federations in creating targeted, infection-free, sporting and training environments.

Social distancing and preventive practices of government employees in response to COVID-19 in Ethiopia

Public health and social interventions are critical to mitigate the spread of the coronavirus disease 2019 (COVID-19) pandemic. Ethiopia has implemented a variety of public health and social measures to control the pandemic. This study aimed to assess social distancing and public health preventive practices of government employees in response to COVID-19. A cross-sectional study was conducted among 1,573 government employees selected from 46 public institutions located in Addis Ababa. Data were collected from 8th to 19th June 2020 using a paper-based self-administered questionnaire and analyzed using SPSS version 23.0. Descriptive statistics were used to summarize the data. Binary logistic regression analyses were used to identify factors associated with outcome variables (perceived effectiveness of facemask wearing to prevent coronavirus infection, and COVID-19 testing). Majority of the participants reported facemask wearing (96%), avoiding close contact with people including handshaking (94.8%), consistently followed government recommendations (95.6%), frequent handwashing (94.5%), practiced physical distancing (89.5%), avoided mass gatherings and crowded places (88.1%), restricting movement and travelling (71.8%), and stayed home (35.6%). More than 80% of the participants perceived that consistently wearing a facemask is highly effective in preventing coronavirus infection. Respondents from Oromia perceived less about the effectiveness of wearing facemask in preventing coronavirus infection (adjusted OR = 0.27, 95% CI:0.17-0.45). About 19% of the respondents reported that they had ever tested for COVID-19. Respondents between 40-49 years old (adjusted OR = 0.41, 95% CI:0.22-0.76) and 50-66 years (adjusted OR = 0.43, 95% CI:0.19-0.95) were less likely tested for coronavirus than the younger age groups. Similarly, respondents from Oromia were less likely to test for coronavirus (adjusted OR = 0.26, 95% CI:0.12-0.56) than those from national level. Participants who were sure about the availability of COVID-19 testing were more likely to test for coronavirus. About 57% of the respondents perceived that the policy measures in response to the pandemic were inadequate. The findings showed higher social distancing and preventive practices among the government employees in response to COVID-19. Rules and regulations imposed by the government should be enforced and people should properly apply wearing facemasks, frequent handwashing, social and physical distancing measures as a comprehensive package of COVID-19 prevention and control strategies.

Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

BACKGROUND

Coronavirus disease 2019 (COVID-19) has been implicated in a wide spectrum of cardiac manifestations following the acute phase of the disease.

OBJECTIVES

To assess the range of cardiac sequelae after COVID-19 recovery.

DATA SOURCES

PubMed, Embase, Scopus (inception through 17 February 2021) and Google scholar (2019 through 17 February 2021).

STUDY ELIGIBILITY CRITERIA

Prospective and retrospective studies, case reports and case series.

PARTICIPANTS

Adult patients assessed for cardiac manifestations after COVID-19 recovery.

EXPOSURE

Severe acute respiratory syndrome coronavirus 2 infection diagnosed by PCR.

METHODS

Systematic review.

RESULTS

Thirty-five studies (fifteen prospective cohort, seven case reports, five cross-sectional, four case series, three retrospective cohort and one ambidirectional cohort) evaluating cardiac sequelae in 52 609 patients were included. Twenty-nine studies used objective cardiac assessments, mostly cardiac magnetic resonance imaging (CMR) in 16 studies, echocardiography in 15, electrocardiography (ECG) in 16 and cardiac biomarkers in 18. Most studies had a fair risk of bias. The median time from diagnosis/recovery to cardiac assessment was 48 days (1-180 days). Common short-term cardiac abnormalities (<3 months) included increased T1 (proportion: 30%), T2 (16%), pericardial effusion (15%) and late gadolinium enhancement (11%) on CMR, with symptoms such as chest pain (25%) and dyspnoea (36%). In the medium term (3-6 months), common changes included reduced left ventricular global longitudinal strain (30%) and late gadolinium enhancement (10%) on CMR, diastolic dysfunction (40%) on echocardiography and elevated N-terminal proB-type natriuretic peptide (18%). In addition, COVID-19 survivors had higher risk (risk ratio 3; 95% CI 2.7-3.2) of developing heart failure, arrythmias and myocardial infarction.

CONCLUSIONS

COVID-19 appears to be associated with persistent/de novo cardiac injury after recovery, particularly subclinical myocardial injury in the earlier phase and diastolic dysfunction later. Larger well-designed and controlled studies with baseline assessments are needed to better measure the extent of cardiac injury and its clinical impact.

Investing in Public Health Infrastructure to Address the Complexities of Homelessness

Homelessness is now recognized as a significant public health problem in North America and throughout advanced economies of the world. The causes of homelessness are complex but the lack of affordable housing, unemployment, poverty, addiction, and mental illness all contribute to the risk for homelessness. We argue that homelessness is increasingly exacerbated by system-wide infrastructure failures occurring at the municipal, state, and federal government levels and whose catastrophic impacts on population health and the response to the COVID-19 pandemic are the consequence of the decades-long devolution of government and neglect to invest in public infrastructure, including a modern public health system.

COVID-19 in Oromia Region of Ethiopia: a review of the first 6 months' surveillance data

INTRODUCTION

Despite unrelenting efforts to contain its spread, COVID-19 is still causing unprecedented global crises. Ethiopia reported its first case on 13 March 2020 but has an accelerated case load and geographical distribution recently. In this article, we described the epidemiology of COVID-19 in Oromia Region, the largest and most populous region in Ethiopia, during the early months of the outbreak.

METHODS

We analysed data from the COVID-19 surveillance database of the Oromia Regional Health Bureau. We included all reverse transcription-PCR-confirmed cases reported from the region between 13 March and 13 September 2020.

RESULTS

COVID-19 was confirmed in 8955 (5.5%) of 164 206 tested individuals. The test positivity rate increased from an average of 1.0% in the first 3 months to 6.3% in August and September. About 70% (6230) of the cases were men; the mean age was 30.0 years (SD=13.3), and 90.5% were <50 years of age. Only 64 (0.7%) of the cases had symptoms at diagnosis. Cough was the most common among symptomatic cases reported in 48 (75.0%), while fever was the least. Overall, 4346 (48.5%) have recovered from the virus; and a total of 52 deaths were reported with a case fatality rate of 1.2%. However, we should interpret the reported case fatality rate cautiously since in 44 (84.6%) of those reported as COVID-19 death, the virus was detected from dead bodies.

CONCLUSION

Despite the steady increase in the number of reported COVID-19 cases, Ethiopia has so far avoided the feared catastrophe from the pandemic due to the milder and asymptomatic nature of the disease. However, with the current pattern of widespread community transmission, the danger posed by the pandemic remains real. Thus, the country should focus on averting COVID-19-related humanitarian crisis through strengthening COVID-19 surveillance and targeted testing for the most vulnerable groups.

Positive environmental effects of the coronavirus 2020 episode: a review

The outbreak of COVID-19 has made a global catastrophic situation that caused 1,039,406 deaths out of 35,347,404 infections, and it will also cause significant socio-economic losses with poverty increasing from 17.1 to 25.9%. Although the spreading rate of COVID-19 is very high on October 6, 2020, the death rate is still less than 2.94%. Nonetheless, this review article shows that the lockdown has induced numerous positive impacts on the environment and on energy consumption. For instance, the lockdown has decreased the electricity demand by 30% in Italy, India, Germany, and the USA, and by 12-20% in France, Germany, Spain, India, and the UK. Additionally, the expenditure of the fuel supply has been decreased by 4% in 2020 as compared to the previous years (2012-2019). In particular, The global demand for coal fuel has been reduced by 8% in March and April 2020 as compared to the same time in 2019. In terms of harmful emissions, the lockdowns reduced the emissions of nitrous oxides by 20-30% in China, Italy, France, Spain, and by 77.3% in São Paulo, Brazil. Similarly, the particulate matter level has been reduced from 5-15% in Western Europe, to 200% in New Delhi, India, which in turn has enhanced the air quality in a never-seen manner in recent times. In some places, such as New York, USA, CO2 emission was also reduced by 5-10%. The water quality, in several polluted areas, has also been remarkably enhanced, for example, the dissolved oxygen content in the Ganga River, India, has increased by about 80%. Traffic congestion has also been reduced worldwide, and in some areas, it has been reduced by 50%, such as New York and Los Angeles, USA. Overall, while the COVID-19 pandemic has shrinked the global economy by 13-32%, the pandemic has also clearly benefited to other sectors, which must be considered as the spotlight for the permanent revival of the global ecosystem.

A review of deciphering the successes and learning from the failures in preventive and health policies to stop the COVID-19 pandemic

Since the onset of the COVID-19 pandemic, some countries have had successful experiences as well as failures. Countries have taken significant and different approaches to reducing the spread of COVID-19. This chapter states the soft method and herd immunity policy of some European countries (e.g., Sweden) in the early days of the epidemic, which failed. Most countries (e.g., Italy) that enacted a mandatory lockdown during the epidemic soon realized that this trend should not continue for longer periods because of side effects, namely social and economic troubles. Some other countries (e.g., Germany) imposed a social distancing of two meters in public places, which have been effective in reducing infection. Nowadays, reports indicate that some Asian countries have had more success than most European and American countries in taking containment measures. Hong Kong and Singapore are among the most successful countries in the world since the beginning of the pandemic, while the United States and Brazil are among the countries that have handled the development of the pandemic worst. Wearing a face mask in combination with social distancing is effective around 50% of the time. However, a complete combination of the following contention policies must be carried out by all countries, always considering the political, social, and above all, economic characteristics of each of them: (1) use face masks in public places, (2) keep suitable physical distancing, (3) extremely thorough hand hygiene, and (4) isolate all infected people. This should also include improving the ventilation in enclosed environments, designing safe routes in public and particular business locations, together with cleaning and disinfection activities.

Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19

INTRODUCTION

As an emerging infectious disease, the clinical and virologic course of COVID-19 requires better investigation. The aim of this study is to identify the potential risk factors associated with persistent positive nasopharyngeal swab real-time reverse transcription‒polymerase chain reaction tests in a large sample of patients who recovered from COVID-19.

METHODS

After the acute phase of SARS-CoV-2 epidemic infection, the Fondazione Policlinico A. Gemelli IRCSS of Rome established a post-acute care service for patients discharged from the hospital and recovered from COVID-19. Between April 21 and May 21, 2020, a total of 137 individuals who officially recovered from COVID-19 were enrolled in this study. All patients were tested for the SARS-CoV-2 virus with nucleic acid RT-PCR tests. Analysis was conducted in June 2020.

RESULTS

Of the 131 patients who repeated the nasopharyngeal swab, 22 patients (16.7%) tested positive again. Some symptoms such as fatigue (51%), dyspnea (44%), and coughing (17%) were still present in a significant percentage of the patients, with no difference between patients with a negative test and those who tested positive. The likelihood of testing positive for SARS-CoV-2 infection was significantly higher among participants with persistent sore throat (prevalence ratio=6.50, 95% CI=1.38, 30.6) and symptoms of rhinitis (prevalence ratio=3.72, 95% CI=1.10, 12.5).

CONCLUSIONS

This study is the first to provide a given rate of patients (16.7%) who test positive on RT-PCR test for SARS-CoV-2 nucleic acid after recovering from COVID-19. These findings suggest that a significant proportion of patients who have recovered from COVID-19 still could be potential carriers of the virus. In particular, if patients continue to have symptoms related to COVID-19, such as sore throat and rhinitis, it is reasonable to be cautious by avoiding close contact, wearing a face mask, and possibly repeating a nasopharyngeal swab.

Lifestyle factors in the prevention of COVID-19

Confinement to the home and psychological distress due to the coronavirus disease 2019 (COVID-19) pandemic may lead to harmful health behaviors, such as overeating, sedentary behavior with reduced physical activity, elevated alcohol and tobacco use and increased screen time causing impaired sleep. All of these behaviors are associated with non-communicable diseases and can interfere with immunity. While no foods, single nutrients or dietary supplements are capable of preventing infection with COVID-19, a balanced diet containing sufficient amounts of macronutrients and diverse micronutrients is a prerequisite of an optimally functioning immune system. High-energy "Western" diets and obesity are major risk factors for a more severe course of COVID-19. Alcohol use and tobacco also have detrimental effects on the immune system. Therefore, population-wide body weight control, reduction of smoking rates and limitation of alcohol consumption are important preventive measures. Furthermore, sufficient restorative sleep is needed for adequate immune functioning. Appropriate lifestyle changes in regard to nutrition, exercise, sleep, smoking and alcohol intake may help shift the population distribution of infection risk and aid in preventing severe COVID-19 disease. Large-scale surveys should explore the effects of lifestyle changes, and the provision of reliable lifestyle information and effective interventions to individuals and communities during the pandemic is a pressing need.

Deployment of a Smart Handwashing Station in a School Setting During the COVID-19 Pandemic: Field Study

Background

Hand hygiene is one of the most effective ways to remove germs, prevent the spread of infectious pathogens, and avoid getting sick. Since the COVID-19 pandemic began, health authorities have been advocating good hand hygiene practices.

Objective

The primary aim of this study is to field test a prototype smart handwashing station deployed in a school setting during the COVID-19 pandemic.

Methods

We deployed a smart handwashing station and examined key technological considerations including connectivity, security, and data management systems, as well as the health and safety of users.

Results

The smart handwashing station was deployed for 10 days in a school setting in Australia during the COVID-19 pandemic. The smart handwashing station’s electrical components remained operational during field testing and underwent robust cleaning protocols each day. The handwashing station was used 1138 times during the field test and there was no COVID-19 transmission at the school during the testing.

Conclusions

This study demonstrates that a personalized feedback approach using technology can successfully be implemented at a school and can provide a platform to improve hand hygiene among school-aged children.