COVID-19: Fear, quackery, false representations and the law

A youth advisory group on health and health research in rural Cambodia

Engaging young people in health research has been promoted globally. We explored the outcomes of youth advisory group on health and research engagement (YAGHRE) in rural Cambodia. In May 2021, the Mahidol Oxford Tropical Medicine Research Unit (MORU) partnered with a local health centre and a secondary school to establish a youth engagement group. Ten students underwent training and led health engagement activities in schools and communities. Activities were documented as field notes and audio-visual materials which underwent content analysis using theory of change supplemented by iterative discussions with YAGHRE members and stakeholders. Five major outcomes were identified: 1. Increased respect. Engagement activities developed based on input from students and stakeholders may have fostered greater respect. 2. Built trust and relationships. Frequent visits to MORU's laboratory and interactions with researchers appeared to contribute to the building of trust and relationship. 3. Improved health and research literacy. Learning new health and research topics, through participatory activities may have improved literacy; 4. Improved uptake of health and research interventions. Health promotional activities and communication with research participants potentially increased the uptake of interventions; 5. Improved community health. YAGHRE's health promotional interventions may have contributed in enhancing community's health.

Strategies to foster community engagement for epidemic and pandemic preparedness and response in sub-Saharan Africa: a scoping review protocol

INTRODUCTION

The surge of public health emergencies over the past decade has disproportionately affected sub-Saharan Africa. These include outbreaks of infectious diseases such as Ebola, Monkeypox and COVID-19. Experience has shown that community participation is key to the successful implementation of infection control activities. Despite the pivotal role community engagement plays in epidemic and pandemic preparedness and response activities, strategies to engage communities have been underexplored to date, particularly in sub-Sahara Africa. Furthermore, reviews conducted have not included evidence from the latest pandemic, COVID-19. This scoping review aims to address these gaps by documenting through available literature, the strategies for community engagement for epidemic and pandemic preparedness and response in sub-Sahara Africa.

METHODS AND ANALYSIS

We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and the methodological framework for scoping reviews from Arksey and O'Malley to guide the review. Two reviewers will develop a systematic search strategy to identify articles published from January 2014 to date. We will retrieve peer-reviewed research published in the English language from databases including Embase, EBSCO-host, PubMed, Global Health, CINAHL, Google Scholar and Web of Science. Additionally, we will search for relevant grey literature from the websites of specific international organisations, public health institutes and Government Ministries of Health in African countries. After the removal of duplicates, the two reviewers will independently screen all titles, abstracts and full articles to establish the relevance of each study for inclusion in the review. We will extract data from the included articles using a data extraction tool and present the findings in tabular form with an accompanying narrative to aid comprehension.

ETHICS AND DISSEMINATION

Ethical approval is not required for the conduct of scoping reviews. We plan to disseminate the findings from this review through publications in a peer-reviewed journal, presentations at conferences and meetings with policy-makers.

Systematic literature review of postponed elections during COVID-19: Campaigns, regulations, and budgets

The postponement of elections during the COVID-19 pandemic reflects a decline in global democracy. The policy of postponing elections due to health concerns, regulatory changes, and economic crises lacks empirical evidence. Several studies suggest that holding elections in countries that proceed with them does not significantly impact the spread of COVID-19. The acceleration of COVID-19 transmission is not limited to countries holding elections; it affects all countries, including those postponing them. Moreover, countries that continue to hold elections have turned this challenge into a COVID-19 mitigation strategy. This study aimed to analyze the findings of original research on election execution during the COVID-19 pandemic, focusing on campaign activities, regulatory changes, and election budgeting. It employed systematic literature review using 12 articles from the Web of Science and Scopus databases. The results show that conducting elections during the COVID-19 pandemic does not contribute to the spread of the virus. This is evident through the adoption of blended campaign strategies by the candidates. Election committees have adjusted voting procedures, including increasing the number of polling stations, tightly scheduling voter arrivals, and visiting red zone lockdown areas to prevent mass mobilization. The increase in election budgets during an economic crisis is not solely for the elections themselves but also for reinforcing health protocols. This research recommends a reconsideration of election postponements and advocates for conducting elections during the COVID-19 pandemic to uphold democracy. Furthermore, future research should explore the social and political implications, as well as the long-term consequences for democracy, which result from the implementation of soft campaign strategies and voting system modifications on a global scale, all in the pursuit of preserving democracy.

Evaluating knowledge, habits, and beliefs regarding dietary supplements as a protective measure against COVID-19 in Malaysia and Iraq: A postsecond wave cross-sectional analysis

Background and Aims

The Corona Virus Disease 2019 (COVID-19) pandemic brought to the forefront various public health approaches, including the consumption of dietary supplements (DS) as a protective measure. With misinformation regarding the virus and the associated benefits of DS prevalent, this study aimed to understand knowledge, habits, and beliefs related to DS usage as a protective measure during the pandemic in Malaysia and Iraq, two countries with deep-rooted traditions in herbal and supplement usage.

Methods

A cross-sectional research study was conducted between September 2021 and March 2022 using a validated online survey. The participants included Malaysians and Iraqis aged 18 years and above who currently consume DS. Using the SurveyMonkey® platform, data were collected from 2425 respondents (response rate = 60.6%), with analysis carried out using SPSS version 28.

Results

Demographically, the sample had an almost equal distribution of Malaysians (51%) and Iraqis (49%), with a mean age of 30.61. The majority had tertiary education (78.6%), and only a fraction had been infected with COVID-19 (26.2%). Concerning knowledge, a significant portion exhibited poor understanding (84.2%) of DS's functioning and implications. Regarding habits, many respondents consumed multivitamins (75.2%), with influence largely coming from peers (23.5%) and product leaflets (46.7%). Belief-wise, about half (49.2%) utilized herbal or supplemental products as a protective measure during the pandemic, with vitamin C with zinc being the most commonly used (45.4%).

Conclusion

The study underlines a significant inclination towards DS usage in Malaysia and Iraq, influenced by societal connections and available information. While many believe in the protective capacities of DS against COVID-19, a substantial knowledge gap persists. It emphasizes the need for evidence-based awareness campaigns and policies to guide public health decisions.

Detecting nuance in conspiracy discourse: Advancing methods in infodemiology and communication science with machine learning and qualitative content coding

The spread of misinformation and conspiracies has been an ongoing issue since the early stages of the internet era, resulting in the emergence of the field of infodemiology (i.e., information epidemiology), which investigates the transmission of health-related information. Due to the high volume of online misinformation in recent years, there is a need to continue advancing methodologies in order to effectively identify narratives and themes. While machine learning models can be used to detect misinformation and conspiracies, these models are limited in their generalizability to other datasets and misinformation phenomenon, and are often unable to detect implicit meanings in text that require contextual knowledge. To rapidly detect evolving conspiracist narratives within high volume online discourse while identifying nuanced themes requiring the comprehension of subtext, this study describes a hybrid methodology that combines natural language processing (i.e., topic modeling and sentiment analysis) with qualitative content coding approaches to characterize conspiracy discourse related to 5G wireless technology and COVID-19 on Twitter (currently known as 'X'). Discourse that focused on correcting 5G conspiracies was also analyzed for comparison. Sentiment analysis shows that conspiracy-related discourse was more likely to use language that was analytic, combative, past-oriented, referenced social status, and expressed negative emotions. Corrections discourse was more likely to use words reflecting cognitive processes, prosocial relations, health-related consequences, and future-oriented language. Inductive coding characterized conspiracist narratives related to global elites, anti-vax sentiment, medical authorities, religious figures, and false correlations between technology advancements and disease outbreaks. Further, the corrections discourse did not address many of the narratives prevalent in conspiracy conversations. This paper aims to further bridge the gap between computational and qualitative methodologies by demonstrating how both approaches can be used in tandem to emphasize the positive aspects of each methodology while minimizing their respective drawbacks.

The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health.

METHODS

An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities.

RESULTS

During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group.

CONCLUSION

The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, healthseeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.

Businesses marketing purported stem cell treatments and exosome therapies for COVID-19: An analysis of direct-to-consumer online advertising claims

We identified 38 businesses advertising purported stem cell interventions and exosome products for COVID-19. These companies operated or facilitated access to 60 clinics. More than 75% of these clinics were based in the United States and Mexico. Thirty-six of the businesses marketed their stem cell and exosome products as treatments for Long COVID, six advertised them as "immune boosters," five claimed to treat patients in the acute infection phase, and two claimed their products were preventive. The least expensive product cost $2,950, the most expensive was $25,000, and the average listed cost for patients was $11,322. The promotion of these products is concerning because they have not been approved by national regulators and do not appear to be supported by convincing safety and efficacy data.

UDHAVI Community Support During India's Second COVID-19 Wave: A Descriptive Study on a Tertiary Care Center's Pandemic Response Helpline

BACKGROUND

In April 2021, during the peak of the second wave of the COVID-19 pandemic in India, hospitals overflowed with COVID-19 patients, and people hesitated to seek necessary care due to fear of contracting the disease. The UDHAVI helpline was set up by a tertiary care hospital in Vellore with the help of district administration, nongovernmental organizations, and various supporting agencies to provide general information, medical advice, counseling, and logistics support to the community.

METHODS

This is a retrospective study of all the phone calls made to the UDHAVI helpline between mid-May and mid-June 2021 during the second wave of the COVID-19 pandemic. The calls were electronically captured as part of the process, and the information was subsequently retrieved and analyzed.

RESULTS

In all, 677 calls were received. The lines for general information, medical advice, counseling, and logistics support received 168 (25%), 377 (56%), 15 (2%), and 117 (17%) calls, respectively. Home care kits, oxygen concentrators, and food were delivered by volunteers from local nongovernmental organizations and hospitals.

CONCLUSION

We believe the details of our experience would be useful in the preparedness and mobilization of resources in the event of any public health emergency. As a result of this initiative, we propose an integrated partnership model for emergency response to any pandemic situation.

Investigating the association of physical and psychological problems with the levels of interleukin-1 and -6 in COVID-19 patients

Introduction

The COVID-19 virus spreads at a high rate, exerting many physical, mental and psychological effects on patients. Patients with COVID-19 have been reported to have high levels of interleukin 1 and interleukin 6. Therefore, this study was conducted to determine the association of physical, mental, and psychological problems with the levels of interleukin-1 and -6 in COVID-19 patients.

Methodology

This is cross-sectional descriptive-analytical research on 121 COVID-19 patients selected using simple random sampling method. The patients were hospitalized in university hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences and Amir al-Momenin Hospital. Data collection tools included the depression anxiety stress scale (DASS), a demographic questionnaire, and a checklist of physical problems. Blood sampling was also done to perform an ELISA test and measure the level of interleukin-1 and -6. Data were analyzed based on independent t-tests, chi-square, regression, and Pearson's correlation coefficient, using SPSS ver. 22.

Results

The average age of the 121 patients participating in this study was 53.31 ± 14.09. A direct and statistically significant correlation was observed between body temperature on the first day and interleukin 1 level. A statistically significant negative correlation was observed between blood oxygen saturation level and interleukin-1 and -6 on the first, third and fifth days. Shortness of breath and coughing had a statistically significant correlation with the level of interleukin 1 on the third and fifth days. A direct and statistically significant correlation was observed between body temperature on the first, third and fifth days and interleukin 6 level. Coughing on the third and fifth days had a statistically significant relationship with interleukin 6 level. No direct and non-significant statistical correlation was found between depression and stress and the serum level of interleukin 1, but a significant correlation was observed between anxiety and serum level of interleukin 1. Finally, the results showed that depression, anxiety and stress had a direct and statistically significant correlation with the serum level of interleukin 6.

Conclusion

Given the relationship between interleukin-1 and -6 and most physical and psychological problems, level of the inflammatory biomarkers interleukin-1 and -6 can be used to estimate the severity of physical and psychological symptoms in COVID-19 patients.

Policy responses to COVID-19 in Sri Lanka and the consideration of Indigenous Peoples

COVID-19 has had uneven impacts on health and well-being, with Indigenous communities in the Global South facing some of the highest risks. Focusing on the experience of Sri Lanka, this study identifies key policy responses to COVID-19, documents how they evolved over two years of the pandemic, and examines if and how government responses have addressed issues pertaining to Indigenous Peoples. Drawing upon an analysis of policy documents (n = 110) and interviews with policymakers (n = 20), we characterize seven key policy responses implemented by the Sri Lankan government: i) testing for and identifying COVID-19; ii) quarantine procedures; iii) provisional clinical treatments; iv) handling other diseases during COVID-19; v) movement; vi) guidelines to be adhered to by the general public; and vii) health and vaccination. The nature of these responses changed as the pandemic progressed. There is no evidence that policy development or implementation incorporated the voices and needs of Indigenous Peoples.

Consumer vulnerability and well-being across contexts: Implications for international businesses

This article assesses the relationship between consumer vulnerability (CV) and well-being (WB) by comparing the effects of ordinary (non-pandemic) and pandemic consumption contexts among Portuguese and Brazilian consumers. Data on pre-and post-pandemic perceived vulnerability and well-being from a cross-cultural sample of 397 consumers were analyzed through structural equations modelling using the PLS-Path. The results revealed an inverse relationship between CV and well-being, which worsened with the emergence of the pandemic. Refund Policies, Product Promotions and Purchase Ability are the dimensions of CV identified as the most affected by the COVID-19 outbreak. Furthermore, fear proved to mediate the effect of vulnerability on well-being partially. The findings allow us to conclude that the most disrupted CV dimensions during COVID-19 are Refund Policy (RP), Purchase Ability (PA), and Product Promotion (PP). Studies comparing consumer vulnerability in international contexts are scarce. By finding the most critical dimensions of CV during a pandemic crisis, this study provides novel insights for companies and public institutions when planning responses and strategies to future disruptive occurrences. The conclusions represent an original contribution by analysing and comparing consumers' vulnerability in an everyday consumption situation and an extreme situation deployed by the COVID-19 pandemic. Valuable insights for governments and policymakers are provided. Firms working in international markets can use the insights to adapt their business strategy as effects on well-being vary across cultures.

Psychosocial Challenges of the Coronavirus Disease-2019 Pandemic Among Frontline Health Care Providers and Their Coping Mechanisms at Mbarara Regional Referral Hospital, Southwestern Uganda

Background

As a novel global health pandemic, Coronavirus Disease-2019 (COVID-2019) has posed various challenges to frontline healthcare providers (FHCPs). This study explored the social and psychological challenges of COVID-19 to the FHCPs at Mbarara Regional Referral Hospital, southwestern Uganda.

Methods

This was a cross-sectional study with a qualitative approach. Participants were purposively selected, consented, and interviewed. Interviews were audio-recorded and transcribed. Data were entered into NVivo 10 software and analyzed using a thematic analysis approach.

Results

Fourteen FHCPs with diverse roles, including 8 men, were interviewed. Participants' median age was 38 years (range: 26-51 years) and eleven of them were married. The subjects' experiences were explored in relation to perceived social and psychological challenges of working during the COVID-19 pandemic, and coping mechanisms in the COVID-19 pandemic situation. The social challenges identified were burnout, domestic violence, and a financially constrained environment. A further, psychological challenge was anxiety, as well as fear and distress. FHCPs responded with a variety of coping mechanisms, including situational acceptance, religious coping, coping through emotional support of others, and bulk purchase of supply-constrained basic necessities.

Conclusion

FHCPs experienced numerous social and psychological challenges, which negatively affected their quality of life amidst a wavering pandemic. As the pandemic rages on, creative and low-cost psychosocial interventions for FHCPs are needed, possibly including more formal peer support, and an improved flow of information about ongoing infectious disease control interventions, so FHCPs feel more knowledgeable about what is ahead.

I trust my immunity more than your vaccines: "Appeal to nature" bias strongly predicts questionable health behaviors in the COVID-19 pandemic

Health care policies often rely on public cooperation, especially during a health crisis. However, a crisis is also a period of uncertainty and proliferation of health-related advice: while some people adhere to the official recommendations, others tend to avoid them and resort to non-evidence based, pseudoscientific practices. People prone to the latter are often the ones endorsing a set of epistemically suspect beliefs, with two being particularly relevant: conspiratorial pandemic-related beliefs, and the appeal to nature bias regarding COVID-19 (i.e., trusting natural immunity to fight the pandemic). These in turn are rooted in trust in different epistemic authorities, seen as mutually exclusive: trust in science and trust in the "wisdom of the common man". Drawing from two nationally representative probability samples, we tested a model in which trust in science/wisdom of the common man predicted COVID-19 vaccination status (Study 1, N = 1001) or vaccination status alongside use of pseudoscientific health practices (Study 2, N = 1010), through COVID-19 conspiratorial beliefs and the appeal to nature bias regarding COVID-19. As expected, epistemically suspect beliefs were interrelated, related to vaccination status, and to both types of trust. Moreover, trust in science had both a direct and indirect effect on vaccination status through both types of epistemically suspect beliefs. Trust in the wisdom of the common man had only an indirect effect on vaccination status. Contrary to the way they are typically portrayed, the two types of trust were unrelated. These results were largely replicated in the second study, in which we added pseudoscientific practices as an outcome; trust in science and the wisdom of the common man contributed to their prediction only indirectly, through epistemically suspect beliefs. We offer recommendations on how to make use of different types of epistemic authorities and how to tackle unfounded beliefs in communication during a health crisis.

Terrorist Attacks Against COVID-19-Related Targets during the Pandemic Year 2020: A Review of 165 Incidents in the Global Terrorism Database

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic enabled a situational type of terrorism with mixed racist, anti-government, anti-science, anti-5G, and conspiracy theorist backgrounds and motives.

OBJECTIVE

The objective of this study was to identify and characterize all documented COVID-19-related terrorist attacks reported to the Global Terrorism Database (GTD) in 2020.

METHODS

The GTD was searched for all COVID-19-related terrorist attacks (aimed at patients, health care workers, and at all actors involved in pandemic containment response) that occurred world-wide in 2020. Analyses were performed on temporal factors, location, target type, attack and weapon type, attacker type, and number of casualties or hostages. Ambiguous incidents were excluded if there was doubt about whether they were exclusively acts of terrorism.

RESULTS

In total, 165 terrorist attacks were identified. With 50% of incidents, Western Europe was the most heavily hit region of the world. Nonetheless, most victims were listed in Southeast Asia (19 fatalities and seven injured). The most frequent but least lethal attack type concerned arson attacks against 5G telephone masts (105 incidents [60.9%] with only one injured). Armed assaults accounted for most fatalities, followed by assassinations. Incendiary and firearms were the most devastating weapon types.

CONCLUSION

This analysis of the GTD, which identified 165 COVID-19-related terrorist attacks in 2020, demonstrates that the COVID-19 pandemic truly resulted in new threats for COVID-19 patients, aid workers, hospitals, and testing and quarantine centers. It is anticipated that vaccination centers have become a new target of COVID-19-related terrorism in 2021 and 2022.

Scientific Misinformation and Mistrust of COVID-19 Preventive Measures among the UK Population: A Pilot Study

The popularisation of complex biomedical concepts brought about by COVID-19 has led to the rapid proliferation and diffusion of scientific misinformation, particularly among individuals with inadequate levels of scientific and digital literacy. A cross-sectional online survey of a UK population sample was conducted to address three key aims: to verify whether there is a correlation between participants' belief in false information around COVID-19 and adherence to preventive measures; to investigate whether participants' scientific misinformation and preventive behaviour are associated with their demographic characteristics; and to evaluate whether participants' scientific misinformation and preventive behaviour can predict their likelihood of having contracted COVID-19. Non-parametric data analysis highlighted a strong negative correlation between participants' belief in misinformation and their trust in preventive measures. Both variables were significantly associated with participants' education levels, but not with their religious beliefs. Remarkably, neither science misinformation levels nor the trust in preventive measures were statistically associated with the likelihood of having contracted COVID-19. Taken together, these findings reinforce the urgency of ensuring that the population is equipped with adequate scientific literacy to enable them to evaluate the reliability of scientific information and recognise the importance of individual preventive behaviours to minimise community spread of infectious diseases.

The Relationship between Fear of COVID-19 and Self-Medication and the Rate of Antibiotic Use in Patients Referred to COVID-19

Introduction. The coronavirus pandemic can cause anxiety and stress among people, which can make them practice self-medication. This study aimed to investigate the relationship between fear of corona and self-medication and antibiotics use. Methods. In a convenience sampling method, 250 people referring to COVID-19 centers including 16-hour comprehensive health services in Kermanshah, Iran, who tested positive and were not hospitalized were extracted from the SIB system. Data collection tools include three questionnaires including corona fear questionnaire, self-medication questionnaire, and self-medication by antibiotic questionnaire and an information form including demographic characteristics. Data were analyzed by SPSS version 25. Results. The prevalence of self-medication was 59.6%. There was a significant correlation between self-medication and gender ( $P$ value <0.05) and education level ( $P$ value <0.05); the most common reason for self-medication was easy access to medicines through pharmacy drug stores. The mean score of fear of corona was higher in women and those who were not in a good financial position due to a lack of suitable economic status to see a doctor. Conclusion. There was a direct and significant relationship between self-medication and self-medication by antibiotics. 59.6% of the participants used medicines themselves, buying over-the-counter in pharmacies. Also, there was a statistically significant difference between the mean score of corona fear in terms of not having a suitable economic status to see a doctor. This indicates that the lack of proper economic status among people with the coronavirus positive test to see a doctor increases the fear of the disease.

Professions and inequality: challenges, controversies, and opportunities

On the basis of the EGOS 2021 sub-plenary on ‘Professions and Inequality: Challenges, Controversies, and Opportunities’, the presenters and panellists wrote four short essays on the relationship between inequality as a grand challenge and professional occupations and organizations, their structures, practices, and strategies. Individually, these essays take an inquisitorial stance on extant understandings of (1) how professions may exacerbate existing inequalities and (2) how professions can be part of the solution and help tackle inequality as a grand challenge. Taken together, the discussion forum aims at advancing scholarly debates on inequality by showing how professions’ scholarship may critically interrogate extant understandings of inequality as a broad, multifaceted concept, whilst providing fruitful directions for research on inequality, their potential solutions, and the role and responsibilities of organization and management scholars.

Exploring the beliefs and experiences with regard to COVID-19 vaccine hesitancy and acceptance in a slum of Karachi, Pakistan

The COVID-19-related misinformation and vaccine hesitancy is a widespread global concern and a recognized public health problem in Pakistan. The current research sought to explore the beliefs and experiences with regard to COVID-19, including vaccine hesitancy and acceptance, in a slum of Karachi, Pakistan. This study used an interpretivist epistemological approach for data collection and employed in-depth interviews (IDIs) and focus group discussions (FGDs) to explore the themes of interest. IDIs and FDGs were conducted in the local language (Pashtu) and Urdu, using semi-structured interview guides. A hybrid thematic analysis approach (use of both inductive and deductive coding) was used to analyze the data. We identified two key themes: the first related to vaccine hesitancy and refusal and included the role of personal belief systems, vaccine mistrust and public perceptions in hesitancy; the second related to vaccine acceptance and included knowledge and awareness about the vaccine and trusted sources of information. Religious beliefs and cultural norms influenced attitudes toward COVID-19 and vaccination. This study also found that awareness about the COVID-19 vaccine in this sample was influenced by sex, educational status and socioeconomic status. Participants with good health literacy and those from healthcare backgrounds were more likely to share views that indicated vaccine acceptance. The findings of this study are being used to co-design a comprehensive intervention to dispel COVID-19 misinformation and vaccine hesitancy across a range of stakeholders such as youths, community leaders, family members, faith leaders, schools and community-based local organizations in Pakistan.

Introduction to Traditional Medicine and Their Role in Prevention and Treatment of Emerging and Re-Emerging Diseases

Infectious diseases have been a threat to human health globally. The relentless efforts and research have enabled us to overcome most of the diseases through the use of antiviral and antibiotic agents discovered and employed. Unfortunately, the microorganisms have the capability to adapt and mutate over time and antibiotic and antiviral resistance ensues. There are many challenges in treating infections such as failure of the microorganisms to respond to the therapeutic agents, which has led to more chronic infections, complications, and preventable loss of life. Thus, a multidisciplinary approach and collaboration is warranted to create more potent, effective, and versatile therapies to prevent and eradicate the old and newly emerging diseases. In the recent past, natural medicine has proven its effectiveness against various illnesses. Most of the pharmaceutical agents currently used can trace their origin to the natural products in one way, shape, or form. The full potential of natural products is yet to be realized, as numerous natural resources have not been explored and analyzed. This merits continuous support in research and analysis of ancient treatment systems to explore their full potential and employ them as an alternative or principal therapy.

Clinical and diagnostic color-coding in ophthalmology - An indispensable educational tool for ophthalmologists

Schematic diagrams have been important tools in Ophthalmology for ages. These are vital tools to document ocular pathologies, assist in the comparison of clinical records on follow-up visits, serve as standardized means of communication between ophthalmologists, educating trainees and postgraduates, and helping in the easy follow-up of disease course over a period. There are standardized color codes for depicting different pathologies in the anterior and posterior segments. The understanding of these guidelines allows proper documentation of findings and helps in standardizing ophthalmic care. This method of documentation is beneficial as this is a less expensive tool, provides immediate records at a glance, allows distinctive marking of clinical findings not possible to document with clinical photographs, and can help in medico-legal cases as well. This article focuses on highlighting the standard guidelines that will be useful for training ophthalmologists. This article primarily focuses on various color-codings for anterior and posterior segment schematic representations, along with a brief touch on the importance of color-coding in glaucoma and standardized eye drop (vials) color codes as per the American Academy of Ophthalmology guidelines. We believe this can be taken as a template for future reference by all trainees, postgraduates, fellows, and clinician ophthalmologists in their day-to-day clinical practice.

Improving the Effectiveness of Anti-COVID Measures in Buildings: Learning from Users’ Perception

The COVID-19 spread abruptly changed the fruition of indoor environments, where necessary adaptive measures have since been implemented. Buildings open to the public were suddenly equipped with physical devices aiming to encourage users’ appropriate behaviors, such as hand sanitizing, social distancing, and temperature monitoring. Through a twofold architectural-psychological perspective, the paper presents a research aiming to understand how users perceive these devices in the Italian context and to identify the design features that could improve their effectiveness in enhancing individuals’ awareness. With an interdisciplinary approach, four methods were adopted: observational field surveys, background and normative framework analysis, survey research through an online questionnaire, and case studies survey research. The results confirm the overall effectiveness of the implemented anti-COVID strategies, their suitability in encouraging individuals’ appropriate behaviors, and the importance of regulating the users’ flow indoors. The research allowed defining the devices (hand-sanitizing devices and temperature-measurement instruments) and wayfinding systems more suited to be included in the prevention strategy and identified their more appropriate design features in relation to the users’ feedback. Operational suggestions are presented as well. The adopted experimental approach can be useful in supporting decision making in managing of the built environment in both the current and future contexts.

COVID-19 and views of imprisonment in a sample of prison tourists

The COVID-19 pandemic has exposed large segments of the global population to the experience of restricted freedoms. In Canada, COVID-19-related measures led to a decrease of mobility within the country, prohibiting access to public and private spaces for prolonged periods of time. This study addresses the effects of the pandemic and related restrictions on views of imprisonment, drawing on a sample of individuals who took part in a tour of the HI Ottawa Jail Hostel (N = 102) in pre- and peri-COVID-19 contexts. The results provide some support for the hypothesis that the uncertainty and existential threat brought about by the pandemic may have contributed to more stringent support for imprisonment and increased punitiveness. However, the results are limited by the small sample size and sample composition. Future directions for research on the impact of the pandemic on public views of imprisonment are discussed.

Antecedents and consequences of COVID-19 conspiracy beliefs: A systematic review

RATIONALE

Belief in COVID-19 conspiracy theories can have severe consequences; it is therefore crucial to understand this phenomenon, in its similarities with general conspiracy belief, but also in how it is context-dependent.

OBJECTIVE

The aim of this systematic review is to provide a comprehensive overview of the available research on COVID-19 conspiracy beliefs and to synthesise this research to make it widely accessible.

METHODS

We present a synthesis of COVID-19 conspiracy belief research from 85 international articles, identified and appraised through a systematic review, in line with contemporary protocols and guidelines for systematic reviews.

RESULTS

We identify a number of potential antecedents of COVID-19 conspiracy beliefs (individual differences, personality traits, demographic variables, attitudes, thinking styles and biases, group identity, trust in authorities, and social media use), their consequences (protective behaviours, self-centred and misguided behaviours such as hoarding and pseudoscientific health practices, vaccination intentions, psychological wellbeing, and other negative social consequences such as discrimination and violence), and the effect sizes of their relations with the conspiracy beliefs.

CONCLUSIONS

We conclude that understanding both the potential antecedents and consequences of conspiracy beliefs and how they are context-dependent is highly important to tackle them, whether in the COVID-19 pandemic or future threats, such as that of climate change.

A taxonomy of risk-associated alternative health practices: A Delphi study

Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify risk-associated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.

Social determinants of panic buying behaviour amidst COVID-19 pandemic: The role of perceived scarcity and anticipated regret

Panic buying behaviour is inherently undesirable due to its detrimental impact on community's resources and disruptions to supply chain systems. The prevailing COVID-19 pandemic has seen a resurgence of this phenomenon across the world, leaving supermarkets in stockout situations. While panic buying is largely reasoned as a psychological reaction to an extreme event, it is also a socially relevant behaviour as our perception of a crisis can be shaped by our observations and interactions within the society. The social determinants of panic buying behaviour, particularly on how these factors heighten one's perception of scarcity, and trigger panic buying behaviour, are studied. A theoretical model is developed to explain panic buying behaviour in a social context by synthesizing various social and behavioural theories, and the inter-relationship among the latent constructs is analysed using the structural equation modelling approach. Accordingly, an online survey was administered and analysis of the data confirmed that non-coercive social influence, social norm and observational learning directly influence one's perception of scarcity. Additionally, perceived scarcity can motivate panic buying behaviour directly or indirectly through feelings of anticipated regret. This study has contributed to the limited literature on panic buying. Understanding the underlying mechanisms of panic buying will aid policymakers and businesses in developing intervention or support strategies to cope with such behaviour.

African Swine Fever-How to Unravel Fake News in Veterinary Medicine

In recent years, fake scientific news has spread much faster through the Internet and social media within the so-called "infodemic". African Swine Fever (ASF) is a perfect case study to prove how fake news can undermine the public health response, even in the veterinary field. ASF is a highly contagious infective disease affecting exclusively domestic and wild pigs such as wild boars. ASF can cause social damage and economic losses both directly (due to the high mortality rate) and indirectly (due to international sanctions). Although ASF is not a threat to human health, since 2018 newspapers have often reported false or misleading news, ranging from misinterpreted findings/data to fake or alarmistic news. In some cases, fake news was spread, such as the use of snipers at the border of nations to kill wild boars, or those reports concerning possible risks to human health. In order to provide real and fact-based news on epidemics, some organizations have created easy-to-read infographic and iconographic materials, available on their websites, to help the readers identifying the fake news. Indeed, it is crucial that governments and scientific organizations work against fear and anxiety, using simple and clear communication.

Can you be Mindful? The Effectiveness of Mindfulness-Driven Interventions in Enhancing the Digital Resilience to Fake News on COVID-19

This study explores the factors that influence the dissemination process of and public susceptibility to fake news amidst COVID-19. By adopting a qualitative approach that draws on 21 interviews with social media users from the standpoint of source credibility and construal level theories, our findings highlight motives of news sharers, platform features, and source credibility/relatedness as major factors influencing the dissemination of and public susceptibility to fake news. The paper further argues that public susceptibility to fake news can be mitigated by building an integrated approach that combines a tripartite strategy from an individual, institutional and platform level. For example, educating the public on digital resilience and enhancing awareness around source credibility can help individuals and institutions reflect on news authenticity and report fake news where possible. This study contributes to fake news literature by integrating concepts from information management, consumer behaviour, influencer marketing and mindfulness to propose a model to help authorities identify and understand the key factors that influence susceptibility to fake news during a public crisis such as COVID-19.

Understanding Factors to COVID-19 Vaccine Adoption in Gujarat, India

The COVID-19 pandemic has posed threats to human life across the globe, including India. Vaccinating is an effective means of addressing the pandemic threat. The government of India has implemented a massive vaccination drive to save its citizens from the deadly virus. However, the effort has faced multiple challenges, including vaccine hesitancy. This research understands respondents' perspectives on factors contributing to the lower vaccination uptake in Gujarat, India. Forty-four semi-structured interviews were conducted through convenience sampling representing different demographic backgrounds. Factors influencing vaccine adoption included religious leadership, political leadership and the government, and fear of side effects, especially among children and those with co-morbidities, resulting primarily from fake news and misinformation circulated through social media. Compared with nine countries from across the world, the study found similarities to vaccine hesitancy from misinformation and the fear of side effects among children. In contrast, the role of government and the influence of religious and political leaders was considered positive. The study recommends strategies to overcome people's apprehensions about the adoption of vaccination. These include offering incentives, providing positive peer-to-peer communication, recruiting influencers such as religious and community leaders and early adopters such as the elderly population to endorse vaccination, targeting youth through social media, and reaching rural sections by involving NGOs and social service groups.

COVID-19 information received by the Peruvian population, during the first phase of the pandemic, and its association with developing psychological distress: Information about COVID-19 and distress in Peru

ABSTRACT

It is suspected that the information the population has about coronavirus disease 2019 (COVID-19) determines both its preventive measures and its effects on mental health. The internet and social media are the sources that have largely replaced the official and traditional channels of information. The objective of this study is to analyse the influence of the sources used by the population in Peru to obtain information on COVID-19 and its association with developing psychological distress (PD) and preventive measures against contagion.1699 questionnaires were analysed. A previously validated instrument adapted to Peru was used. Participants were questioned about the information received regarding COVID-19, its sources, time of exposition, assessment, or beliefs about it. Mental health was measured with the Goldberg General Health Questionnaire. Descriptive and bivariate analysis were performed, developing a classification and regression tree for PD based on beliefs and information about the pandemic.The most used source of information on COVID-19 in Peru was social media and this is associated with developing PD, both in the general population and among health professionals. The quality of the information about treatments for COVID-19 is associated with PD in the general population, whereas prognosis generates more distress among healthcare professionals. The biggest concern is transmitting the virus to family members, close persons, or patients, with more confidence in health professionals than in the health system.The health authorities should use the social media to transmit quality information about COVID-19 and, at the same time, to gather in real time the opinions on the implemented preventive measures. For all, this it is necessary to have higher credibility in the population to increase the confidence in the health system, looking at basic aspects for compliance with prevention measures and improvement of mental health.

Final Year Undergraduate Students’ Representation of the COVID-19 Pandemic and the Lockdown: Adaptability and Responsibility

The COVID-19 pandemic has generated a new reality worldwide and reconfigured identities, behaviors and interests. It has called for heroic representations and highlighted the role of social media in efficient communication. All of the above considered, the current article focuses on the representation of the COVID-19 pandemic generated by the undergraduate students enrolled in the Social Work study program in Transilvania University of Brașov (Romania) by indicating the main connotations of the pandemic and drawing a comparison between students’ representation and the early representations of the same pandemic produced by specialized literature on the topic. The thematic analysis of the essays produced by students highlights their frustration with the havoc brought about by the pandemic to their graduation plans and with the lack of interaction with colleagues and academic staff, as well as their gratitude for the efforts undertaken by their professors to make online education functional, their availability to adapt and support the restrictive measures imposed by authorities, and their optimism about the evolution of the pandemic. The content analysis of 60 bibliographic sources on the topic of COVID-19, indicated by the Anelis+ network as the most relevant in the spring of 2020, highlights a thematic convergence between the aforementioned sources and students’ representation of COVID-19, and thus their responsible attitude toward meeting the challenges of the pandemic.

Pharmaceutical messianism and the COVID-19 pandemic

As part of their populist performances during disease outbreaks, public officials and politicians tend to offer 'miracle cures' or 'wonder drugs' that can supposedly treat or prevent the disease in question. This article analyzes contemporary instances of what we call 'pharmaceutical messianism' and proposes four characteristics for this phenomenon, namely, that it: (1) emerges during times of extraordinary health crisis; (2) builds on pre-existing knowledge, practices, and sentiments; (3) borrows from medical, often heterodox, authority; and (4) involves accessible, affordable, and/or familiar substances. Demonstrating the analytic value of our framework, we present three case studies, constructed using academic and journalistic sources, during the COVID-19 pandemic: hydroxychloroquine in France, ivermectin in the Philippines, and Covid-Organics in Madagascar. We conclude by identifying some implications of our findings on public health and avenues for future research.

A critical review on the availability of substandard and falsified medicines online: Incidence, challenges and perspectives

Simultaneous expansion of the Internet and increased globalisation of the pharmaceutical industry have meant medication can be accessed transnationally from both legal and illicit sources. This has coincided with the rise of substandard and falsified medicines (SFMs) online. These products fail to meet regulatory or quality standards and/or are constituted with substandard ingredients, causing undesired pharmacological effects, including possible injury and death. This review aimed to identify original research studies that examined characteristics of SFM online sales, attitudes towards purchasing medicines online and strategies to address this drug safety challenge. Keywords of ‘Substandard’ and ‘Falsified’/‘Counterfeit’ and ‘Medicines’/‘Drugs’ and ‘Online’/‘Internet’ were searched using Web of Knowledge and PubMed databases. Resulting literature, which satisfied the study’s inclusion criteria, was included in the review, and the findings from each paper were assessed. From an initial 185 literature articles, 7 were eligible according to the inclusion criteria to be reviewed. These articles identified studies testing SFMs purchased online, surveys of attitudes and knowledge about SFMs online, and website content analysis to detect illegal online sales. Challenges identified were lack of knowledge and awareness among consumers and physicians, in addition to the use of direct-to-consumer-advertising, via Internet platforms and social media, providing easy access to SFMs. Despite this, medicine authentication technology, website verification approaches and new detection methods were identified as potential solutions specific to online SFM sales. To address online sales of SFMs, more robust research, greater awareness/educational programmes, analytical detection methods and more stringent online global governance are required.

Associations of Delay in Doctor Consultation With COVID-19 Related Fear, Attention to Information, and Fact-Checking

Background: Delaying doctor consultation is harmful. Fear of COVID-19 leads to delays in seeking medical care at a time when pandemic information overflows. However, little is known about the role of COVID-19 related fear, attention to information, and fact-checking in such delay.

Objective: Under the Hong Kong Jockey Club SMART Family-Link Project, we examined the associations of delay in doctor consultation amidst the pandemic with sociodemographic characteristics, COVID-19 related fear, attention to information, and fact-checking.

Methods: We conducted a population-based online cross-sectional survey in May 2020 on Hong Kong Chinese adults. Respondents reported whether the pandemic caused any delay in doctor consultation (yes/no), level of COVID-19 related fear, attention to information and fact-checking (all on a scale of 0 to 10 and recoded into tertiles of low, moderate, high). Regression analyses were used to examine the associations of delay and fear with sociodemographic characteristics, attention and fact-checking, adjusting for covariates. Data were weighted by sex, age and education level of the population.

Results: Of 4,551 respondents (46.5% male, 59.7% aged over 45 years), 10.1% reported delay in doctor consultation. The mean score was 6.4 for fear, 8.0 for attention and 7.4 for fact-checking. Delay was more common in males and increased with age and fear. High vs. low level of fear was associated with delay [adjusted odd ratios (AOR) 2.68, 95% confidence interval (CI) 2.08, 3.47]. Moderate level of fact-checking was negatively associated with delay (AOR 0.72, 95% CI 0.56, 0.92). Females reported greater fear and fear decreased with age. Fear increased with attention to information and decreased with fact-checking. Fear substantially mediated the association of delay with attention (96%) and fact-checking (30%).

Conclusions: We have first shown that delay in doctor consultation increased with fear of COVID-19 and decreased with fact-checking amidst the pandemic. Fear also increased with attention to COVID-19 related information and decreased with fact-checking. Understanding these associations can help policymakers develop targeted communication and support to the public to reduce delayed doctor consultations and the associated COVID-19-related or unrelated morbidity and mortality in the community.

The Assessment of Fear of COVID-19 among the Elderly Population: A Cross-Sectional Study

The prevailing COVID-19 pandemic has dramatically affected the mental health and well-being of individuals. This cross-sectional study aimed to assess the perceived fear of COVID-19 among older adults in Poland and identify subpopulations with the highest risk of potential mental health disorders. The study was conducted in November–December 2020 on 500 people aged ≥60 years (mean M = 67.9, standard deviation SD = 4.2). In order to collect information on participants’ characteristics and COVID-19-related information, they were asked to complete a questionnaire based on recorded telephone calls. Perceived fear of COVID-19 was measured using Fear of COVID-19 Scale (FCV-19S), which ranges from 7 to 35. Multiple linear regression was performed to identify factors associated with the perceived fear of COVID-19. Our results showed that the highest level of fear of COVID-19 infection was observed among women (p = 0.025) and patients taking anticoagulants (p = 0.004). Moreover, older adults with higher anxiety levels were more likely to be fearful of COVID-19 (according to the GAS-10 scale; p < 0.001). These findings may help policy makers and healthcare workers to adapt and implement better mental health strategies to help the elderly fight fear and anxiety during the prevailing pandemic.

Utilization of complementary and alternative medicine for the prevention of COVID-19 infection in Ghana: A national cross-sectional online survey

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82.5% of all participants reported CAM use during the COVID-19 pandemic period.

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69.1% of CAM users intended it for COVID-19 infection prevention.

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Commonly used CAM include vitamins, spiritual healing/prayer, minerals and herbals.

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Age, sex and COVID-19 illness perception significantly predicted CAM use.

Complementary and alternative medicine (CAM) use is widespread and has played critical roles in preventing infections, including previous coronaviruses. This study sought to document current practices in the use of CAM for the prevention of COVID-19 disease in Ghana. An anonymous electronic survey was conducted from February 1, 2021 to April 30, 2021. Data on demographic characteristics, basic clinical information, illness perceptions about COVID-19, and CAM use during the pandemic period were generated. While about 82.5% (986/1195) of the participants used CAM during the COVID-19 period, 69.1% (681/986) of CAM users intented it for COVID-19 infection prevention. Vitamin supplements (88.1%, 869/986), spiritual healing/prayer (23.3%, 230/986), mineral supplements (22.3%, 220/986), botanical/herbal medicines (22.2%, 219/986), and diet therapy (19.4%, 191/986) were the main types of CAM used. From the adjusted binary logistic regression model, current age (aOR: 1.03, 95%CI: 1.01–1.05), sex (aOR: 1.41, 95%CI: 1.02–1.95), participants’ perceptions of consequences (aOR: 1.10, 95%CI: 1.04–1.17), identity (aOR: 1.15, 95%CI: 1.06–1.25) and concerns about COVID-19 (aOR: 0.91, 95%CI: 0.85–0.97) were statistically significant predictors of CAM use. These results suggest the need for appropriate public health policy on COVID-19 and CAM use in addition to directing further research initiatives toward an optimized COVID-19 prevention scheme using clinically validated CAM treatments. Research to validate the clinical efficacy of these products, especially the herbs, for COVID-19 prevention while isolating lead compounds that could be optimized and used for the treatment and prevention of COVID-19 is also recommended.

Validation of the COVID-19 Transmission Misinformation Scale and Conditional Indirect Negative Effects on Wearing a Mask in Public

The SARS-CoV-2 (COVID-19) pandemic devastated the world economy. Global infections and deaths altered the behaviors of generations. The Internet acted as an incredible vehicle for communication but was also a source of unfounded rumors. Unfortunately, this freedom of information sharing and fear of COVID-19 fostered unfounded claims about transmission (e.g., 5G networks spread the disease). With negligible enforcement to stop the spread of rumors and government officials spouting unfounded claims, falsities became ubiquitous. Organizations, public health officials, researchers, and businesses spent limited resources addressing rumors instead of implementing policies to overcome challenges (e.g., speaking to defiant mask wearers versus safe reopening actions). The researchers defined COVID-19 transmission misinformation as false beliefs about the spread and prevention of contracting the disease. Design and validation of the 12-item COVID-19 Transmission Misinformation Scale (CTMS) provides a measure to identify transmission misinformation believers. Indirect COVID-19 transmission misinformation beliefs with a fear of COVID-19 decreased wearing a mask in public intentions. Callousness exacerbated COVID-19 transmission misinformation beliefs as a moderator.

Twitter discourse on nicotine as potential prophylactic or therapeutic for COVID-19

Background

An unproven “nicotine hypothesis” that indicates nicotine's therapeutic potential for COVID-19 has been proposed in recent literature. This study is about Twitter posts that misinterpret this hypothesis to make baseless claims about benefits of smoking and vaping in the context of COVID-19. We quantify the presence of such misinformation and characterize the tweeters who post such messages.

Methods

Twitter premium API was used to download tweets (n = 17,533) that match terms indicating (a) nicotine or vaping themes, (b) a prophylactic or therapeutic effect, and (c) COVID-19 (January-July 2020) as a conjunctive query. A constraint on the length of the span of text containing the terms in the tweets allowed us to focus on those that convey the therapeutic intent. We hand-annotated these filtered tweets and built a classifier that identifies tweets that extrapolate the nicotine hypothesis to smoking/vaping with a positive predictive value of 85%. We analyzed the frequently used terms in author bios, top Web links, and hashtags of such tweets.

Results

21% of our filtered COVID-19 tweets indicate a vaping or smoking-based prevention/treatment narrative. Qualitative analyses show a variety of ways therapeutic claims are being made and tweeter bios reveal pre-existing notions of positive stances toward vaping.

Conclusion

The social media landscape is a double-edged sword in tobacco communication. Although it increases information reach, consumers can also be subject to confirmation bias when exposed to inadvertent or deliberate framing of scientific discourse that may border on misinformation. This calls for circumspection and additional planning in countering such narratives as the COVID-19 pandemic continues to ravage our world. Our results also serve as a cautionary tale in how social media can be leveraged to spread misleading information about tobacco products in the wake of pandemics.

Twitter Discourse on Nicotine as Potential Prophylactic or Therapeutic for COVID-19

Background:

An unproven “nicotine hypothesis” that indicates nicotine’s therapeutic potential for COVID-19 has been proposed in recent literature. This study is about Twitter posts that misinterpret this hypothesis to make baseless claims about benefits of smoking and vaping in the context of COVID-19. We quantify the presence of such misinformation and characterize the tweeters who post such messages.

Methods:

Twitter premium API was used to download tweets (n = 17,533) that match terms indicating (a) nicotine or vaping themes, (b) a prophylactic or therapeutic effect, and (c) COVID-19 (January-July 2020) as a conjunctive query. A constraint on the length of the span of text containing the terms in the tweets allowed us to focus on those that convey the therapeutic intent. We hand-annotated these filtered tweets and built a classifier that identifies tweets that extrapolate the nicotine hypothesis to smoking/vaping with a positive predictive value of 85%. We analyzed the frequently used terms in author bios, top Web links, and hashtags of such tweets.

Results:

21% of our filtered COVID-19 tweets indicate a vaping or smoking-based prevention/treatment narrative. Qualitative analyses show a variety of ways therapeutic claims are being made and tweeter bios reveal pre-existing notions of positive stances toward vaping.

Conclusion:

The social media landscape is a double-edged sword in tobacco communication. Although it increases information reach, consumers can also be subject to confirmation bias when exposed to inadvertent or deliberate framing of scientific discourse that may border on misinformation. This calls for circumspection and additional planning in countering such narratives as the COVID-19 pandemic continues to ravage our world. Our results also serve as a cautionary tale in how social media can be leveraged to spread misleading information about tobacco products in the wake of pandemics.

Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal: A cross-sectional study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal.

METHODS

A cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear.

RESULTS

The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear.

CONCLUSION

Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them.

The effect of COVID-19 lockdown on psychiatric admissions: role of gender

BACKGROUND

The UK went into nationwide lockdown on 24 March 2020, in response to COVID-19. The direct psychiatric effects of this are relatively unknown.

AIMS

We examined whether the first UK lockdown changed the demographics of patients admitted to psychiatric hospitals (to include gender, legality, route of admission and diagnoses), independent of seasonal variation..

METHOD

We conducted an anonymous review of psychiatric admissions aged ≥18 years in the 6-month period after the announcement of the first UK lockdown (March to August 2020), and in the previous year (March to August 2019), in Kent and Medway NHS and Social Care Partnership Trust in-patient facilities. The number of admissions were compared, along with factors that may help to explain the psychological effects of national lockdown.

RESULTS

There was no significant increase in total number of admissions or the gender percentage. However, there was a 11.8% increase in formal sectioning under the Mental Health Act 1983. This increase was sustained and statistically significant across all 6 months. A sustained decrease in admissions via the crisis team was also observed as being statistically significant. Separate diagnoses saw changes in percentage of admissions between March and May. The most statistically significant was schizophrenia admissions for men in April (18.7%), and women in March (18.4%).

CONCLUSIONS

Our findings highlight the effect of COVID-19 on the legal status of psychiatric admissions, and emphasise the importance of having a robust, adaptable and open psychiatric service that caters to the ongoing needs of patients, regardless of government restrictions.

Immune Responses to SARS-CoV2 Mirror Societal Responses to COVID-19: Identifying Factors Underlying a Successful Viral Response

Simple Summary

The immune system was sculpted in numerous evolutionary battles to protect individuals, societies, and species from novel pathogens. During that time, it had developed highly effective strategies to cope with novel pathogenic challenges and retain immune “memory” following pathogen clearance. We found surprising parallels between person-level immune responses to the virus causing COVID-19 and the society-level responses to the COVID-19 pandemic. Similarly, the events which lead to a life-endangering immune cytokine storm, parallel those leading to a devastating socioeconomic crisis we termed a “social cytokine storm”. This new understanding may help explain why COVID-19, caused by a virus with no “exceptional” epidemiological capabilities, had inflicted such profound social and global toll. Understanding the set of events leading to an immunological and societal cytokine storms may aid scientists and policymakers to adopt more effective strategies that could reduce future disease morbidity and mortality, avert avoidable social cytokine storms, and minimize the socioeconomic toll.

Abstract

The adaptive immune system was sculpted to protect individuals, societies, and species since its inception, developing effective strategies to cope with emerging pathogens. Here, we show that similar successful or failed dynamics govern personal and societal responses to a pathogen as SARS-CoV2. Understanding the self-similarity between the health-protective measures taken to protect the individual or the society, help identify critical factors underlying the effectiveness of societal response to a pathogenic challenge. These include (1) the quick employment of adaptive-like, pathogen-specific strategies to cope with the threat including the development of “memory-like responses”; (2) enabling productive coaction and interaction within the society by employing effective decision-making processes; and (3) the quick inhibition of positive feedback loops generated by hazardous or false information. Learning from adaptive anti-pathogen immune responses, policymakers and scientists could reduce the direct damages associated with COVID-19 and avert an avoidable “social cytokine storm” with its ensuing socioeconomic damage.

Exploring fear of COVID-19 and its correlates among older adults in Bangladesh

OBJECTIVE

This study was aimed to assess the perceived fear of COVID-19 and its associated factors among older adults in Bangladesh.

METHODS

This cross-sectional study was conducted in October 2020 among 1032 older Bangladeshi adults aged ≥60 years. A semi-structured questionnaire was used to collect information on participants' characteristics and COVID-19 related information. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S), where the cumulative score ranged from 7 to 35. Multiple linear regression was performed to identify factors associated with perceived fear of COVID-19.

RESULTS

The mean fear score was 19.4. Participants who were concerned about COVID-19 (β: 2.75, 95% CI: 1.71 to 3.78) and overwhelmed by COVID-19 (β: 3.31, 95% CI: 2.33 to 4.29) were significantly more likely to be fearful of COVID-19. Moreover, older adults who felt themselves isolated from others and whose close friends and family members were diagnosed with COVID-19 were more fearful. However, the participants who received COVID-19 related information from the health workers had a lower level of fear (β: -1.90, 95% CI: - 3.06 to - 0.73).

CONCLUSIONS

The presence of overwhelming fear of COVID-19 among the older adults of Bangladesh underlines the psychological needs of these vulnerable groups. Health workers have a key role in addressing these needs and further research is needed to identify the effective strategies for them to use.

Acceptance of a Covid-19 vaccine is associated with ability to detect fake news and health literacy

Background

During the Covid-19 pandemic fake news has been circulating impacting on the general population’s opinion about a vaccine against the SARS-CoV-2. Health literacy measures the capacity of navigating health information.

Methods

We used data from a prospective national online cohort of 1647 participants. Descriptive statistics, Chi2 and ANOVA independence tests and two multivariable multinomial regression models were performed. Interactions between each variable were tested.

Results

Detection of fake news and health literacy scores were associated with intention to get vaccinated against SARS-CoV-2 (p < 0.01). The risk of being “anti-vaccination” or “hesitant”, rather than “pro-vaccination”, was higher among individuals reporting bad detection of fake news, respectively OR = 1.93 (95%CI = [1.30;2.87]) and OR = 1.80 (95%CI = [1.29;2.52]). The risk of being in “hesitant”, rather than “pro-vaccination” was higher among individuals having a bad health literacy score (OR = 1.44; 95%CI = [1.04;2.00]). No interaction was found between detection of fake news and health literacy.

Conclusions

To promote acceptance of a vaccine against SARS-CoV-2, it is recommended to increase individuals’ ability to detect fake news and health literacy through education and communication programs.

Response to the COVID-19 Outbreak in Urban Settings in China

The COVID-19 outbreak in China was devastating and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2-11, 2020, 4607 individuals were recruited from 11 provinces with varying numbers of COVID-19 cases using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, the recommended public health practices significantly (p < 0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR = 1.58, p < 0.01), living in regions with a higher density of COVID-19 cases (aOR = 2.13, p < 0.01), having completed college (aOR = 1.38, p = 0.03), meeting screening criteria for depression (aOR = 6.03, p < 0.01), and poorer perceived health status (aOR = 1.54, p < 0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.

Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis

BACKGROUND

During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions.

OBJECTIVE

This study aimed to uncover the emerging themes in Twitter users' perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak.

METHODS

This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, "COVID" AND "vaccine") to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms.

RESULTS

In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9% (12,882/100,209) as Financial Concerns, 12.7% (12,696/100,209) as Venting Negative Emotions, 9.9% (9908/100,209) as Prayers and Calls for Positivity, 8.1% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level-the extent to which a tweet being retweeted, quoted, liked, or replied by other users-was similar among different themes, but tweets venting negative emotions yielded the lowest engagement.

CONCLUSIONS

This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence.

Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Healthcare Workers: Results of a Cross Sectional Survey

PURPOSE

To compare COVID-19 related knowledge, perceptions, and preferred information sources between healthcare workers and non-healthcare workers.

DESIGN

Cross-sectional survey.

SETTING

Web-based.

SUBJECTS

Convenience sample of Pennsylvanian adults.

MEASURES

Primary outcomes were binary responses to 15 COVID-19 knowledge questions weighted by a Likert scale assessing response confidence.

ANALYSIS

Generalized linear mixed-effects models to assess comparisons between clinical decision makers (CDM), non-clinical decision makers working in healthcare (non-CDM) and non-healthcare workers (non-HCW).

RESULTS

CDMs (n = 91) had higher overall knowledge than non-CDMs (n = 854; OR 1.81 [1.51, 2.17], p < .05). Overall knowledge scores were not significantly different between non-CDMs (n = 854) and non-HCW (n = 4,966; OR 1.03 [0.97, 1.09], p > .05).

CONCLUSION

The findings suggest a need for improved education about COVID-19 for healthcare workers who are not clinical decision makers, as they play key roles in patient perceptions and compliance with preventive medicine during primary care visits.

WITHDRAWN: COVID-19, its novel vaccination and fake news - What a brew

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