Middle East respiratory syndrome coronavirus (MERS-CoV): what lessons can we learn?

Healthcare workers' knowledge and risk perception regarding the first wave of COVID-19 in Khyber Pakhtunkhwa, Pakistan: an online cross-sectional survey

Background

Increased COVID-19 transmission among the populace may be caused by healthcare workers (HCWs) who lack knowledge, awareness, and good preventive practices. Additionally, it may cause elevated stress levels, anxiety, poor medical judgement, and situational overestimation.

Objectives

The present survey aimed to assess knowledge and risk perception regarding COVID-19 among HCWs in Khyber Pakhtunkhwa (KP), Pakistan.

Methodology

A web-based online, pre-tested questionnaire comprising 26 items was circulated via social media in April 2020 amongst HCWs in major tertiary care facilities in KP.

Results

The study's results, revealing both the commendable knowledge levels among HCWs about COVID-19 and their heightened risk perception, highlight the critical need for targeted interventions to address the potential impact on self-protective behaviour and mental health within this vital workforce. This insight is important for designing strategies that not only enhance HCWs' well-being but also ensure the continued effectiveness of healthcare delivery during pandemics. The percentage mean score (PMS) of COVID-19 knowledge was 85.14±10.82. Male HCWs and those with an age older than or equal to 32 years demonstrated a higher knowledge score (85.62±11.08; P=0.032 and 87.59±7.33, P=0.021, respectively). About 76% of HCWs feared contracting COVID-19. Nearly 82% of respondents were mentally preoccupied with the pandemic and also terrified of it. 'Of these, 81% were nurses, 87% had a job experience of 6-8 years and 54.45% were frontline workers. Feelings of panic and concern about the pandemic were found to be more in HCWs who were physicians above the age of 32, and who had 3-5 years of work experience. HCWs' overall risk perception was found to be significantly different between males (7.04±2.26) and females (8.01±1.97), job experience of 6-10 years (8.04±177) with 3-5 years and younger than or equal to 2 years job experience (7.18±2.43,6.93±2.22), respectively, and between frontline HCWs (7.50±2.10) and non-frontline HCWs (6.84±2.40).

Conclusion

HCWs demonstrated good knowledge about COVID-19. As the risk perception of COVID-19 among HCWs is high, it can raise concerns about their self-protective behaviour, and mental health. These issues need to be addressed.

Sustaining Preparedness in Hospitals

PURPOSE

The years following the 9/11/2001 terrorists attacks saw a marked increase in community and hospital emergency preparedness, from communications across community networks, development of policies and procedures, to attainment and training in the use of biological warfare resources. Regular drills ensured emergency and health care personnel were trained and prepared to address the next large-scale crisis, especially from terrorist and bioterrorist attacks. This chapter looks at some of the more familiar global health issues over the past two decades and the lessons learned from hospital responses to inform hospital management in preparation for future incidents.

SEARCH METHODS

This study is a narrative review of the literature related to lessons learned from four major events in the time period from 2002 to 2023 - SARS, MERS, Ebola, and COVID-19.

SEARCH RESULTS

The initial search yielded 25,913 articles; 57 articles were selected for inclusion in the study.

DISCUSSION AND CONCLUSIONS

Comparison of key issues and lessons learned among the four major events described in this article - SARS, MERS, Ebola, and COVID-19 - highlight that several lessons are "relearned" with each event. Other key issues, such as supply shortages, staffing availability, and hospital capacity to simultaneously provide care to noninfectious patients came to the forefront during the COVID-19 pandemic. A primary, ongoing concern for hospitals is how to maintain their preparedness given competing priorities, resources, and staff time. This concern remains post-COVID-19.

Knowledge, Attitudes, and Willingness of Healthcare Workers in Iraq's Kurdistan Region to Vaccinate against Human Monkeypox: A Nationwide Cross-Sectional Study

Although human monkeypox infections had not been recorded in the Kurdistan region of Iraq as of August 2023, the rapid growth of cases worldwide and the detection of monkeypox in neighboring Middle Eastern nations call for careful planning and timely response measures. Educating and empowering frontline healthcare workers (HCWs) so that they can act to curb the spread of monkeypox infections are core elements of primary prevention and protecting public health. Therefore, this study aimed to assess HCWs' knowledge and attitudes about monkeypox and their willingness to vaccinate against monkeypox. By employing a convenience sampling method, an online survey was disseminated via Google Forms between 1 November 2022 and 15 January 2023. The researchers utilized regression analyses to ascertain the factors associated with the three parameters: knowledge, attitude, and the willingness to vaccinate. A total of 637 HCWs were included in the analysis (ages ranged between 21 and 51 years). The mean overall scores were 8.18 of a max score of 16 (SD 3.37), 3.4 of 5 (SD 1.37), and 2.41 of 5 (SD 1.25) for knowledge, attitude, and willingness to vaccinate, respectively. A multivariate logistic regression analysis demonstrated that HCWs who had heard about monkeypox before 2022 rather than later had a higher level of knowledge (AOR: 4.85; 95% CI: 2.81-8.36; p < 0.001). In addition, those who had newly joined the workforce or had less than 1 year experience in practice had more positive attitudes about curbing monkeypox (AOR: 0.35; 95% CI: 0.20-0.59; p < 0.01) than those who practiced for longer. No significant predictors of willingness to vaccinate against monkeypox were identified. The research revealed that HCWs exhibited a relatively low level of monkeypox knowledge. They also had poor attitudes towards monkeypox vaccination and were therefore reluctant to receive the vaccines. Imparting knowledge about the infectious disease can cultivate better awareness and attitudes among HCWs as to their roles in mitigating the spread of an epidemic in the foreseeable future.

Symptomatic MERS-CoV infection reduces the risk of future COVID-19 disease; a retrospective cohort study

BACKGROUND

The general human immune responses similarity against different coronaviruses may reflect some degree of cross-immunity, whereby exposure to one coronavirus may confer partial immunity to another. The aim was to determine whether previous MERS-CoV infection was associated with a lower risk of subsequent COVID-19 disease and its related outcomes.

METHODS

We conducted a retrospective cohort study among all patients screened for MERS-CoV at a tertiary care hospital in Saudi Arabia between 2012 and early 2020. Both MERS-CoV positive and negative patients were followed up from early 2020 to September 2021 for developing COVID-19 infection confirmed by RT-PCR testing.

RESULTS

A total of 397 participants followed for an average 15 months during COVID-19 pandemic (4.9 years from MERS-CoV infection). Of the 397 participants, 93 (23.4%) were positive for MERS-CoV at baseline; 61 (65.6%) of the positive cases were symptomatic. Out of 397, 48 (12.1%) participants developed COVID-19 by the end of the follow-up period. Cox regression analysis adjusted for age, gender, and major comorbidity showed a marginally significant lower risk of COVID-19 disease (hazard ratio = 0.533, p = 0.085) and hospital admission (hazard ratio = 0.411, p = 0.061) in patients with positive MERS-CoV. Additionally, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV infection (hazard ratio = 0.324, p = 0.034) and hospital admission (hazard ratio = 0.317, p = 0.042).

CONCLUSIONS

The current findings may indicate a partial cross-immunity, where patients with symptomatic MERS-CoV have a lower risk of future COVID-19 infection and related hospitalization. The present results may need further examination nationally using immunity markers.

Heating, ventilation, and air-conditioning systems in healthcare: a scoping review

Guidelines for heating, ventilation, and air-conditioning systems have been developed for different settings. However, there is a lack of up-to-date evidence providing concrete recommendations for the heating, ventilation, and air-conditioning systems of an isolation room, which is essential to appropriately guide infection control policies. To highlight the guidelines for heating, ventilation, and air-conditioning systems in isolation rooms to inform relevant stakeholders and policymakers. A systematic search was performed based on Joanna Briggs Methodology using five databases (CINAHL, Embase, Joanna Briggs Institute, Medline, and Web of Science) and websites. Eight articles published by government departments were included in this review. Most studies recommended controlled airflow without recirculation, 12 air changes per hour, high-efficiency particulate air filtrate to exhaust contaminated air from the airborne isolation room, humidity ≤60%, and temperature in the range of 18-30 °C. This review provides further evidence that there is a need for interdisciplinary collaborative research to quantify the optimum range for heating, ventilation, and air conditioning system parameters, considering door types, anterooms, and bed management, to effectively reduce the transmission of infection in isolation rooms.

Level of Knowledge Regarding Mpox among Peruvian Physicians during the 2022 Outbreak: A Cross-Sectional Study

Introduction: Due to the high incidence of mpox in Peru and the poor knowledge about this disease among healthcare workers in non-endemic countries, it is crucial to determine the knowledge status of Peruvian physicians. Methodology: We conducted an analytical cross-sectional study based on an online survey from August to September 2022. Physicians who had a medical license and lived and practiced medicine in Peru were included. To evaluate the factors associated with a higher level of knowledge, we used crude (cPR) and adjusted (aPR) prevalence ratios with 95% confidence intervals (95% CI) using Poisson regression. Results: We included 463 physicians. The mean age was 36.6 (SD: 10.3) years, and most were male (58.1%). Regarding knowledge, the median knowledge score was 14 [IQR: 13 to 15] out of 17 points. In terms of knowledge gaps, only 60.7% of the participants knew that there was an FDA-approved vaccine for mpox, 49.0% of participants knew about mpox proctitis and 33.3% acknowledged that it could be transmitted by the bite of an infected rodent. We found that taking care of patients with mpox (aPR: 1.39; 95% CI: 1.13 to 1.72) was associated with higher knowledge (>p50), while living in the eastern macro-region (aPR: 0.62; 95% CI: 0.42 to 0.93) was associated with lower knowledge (≤p50). Conclusions: Our study showed a high level of knowledge about mpox among Peruvian physicians. However, educational campaigns may be necessary, especially for physicians from the eastern region and those who do not have clinical experience with mpox.

Perception of COVID-19 and Vaccine Acceptance among Healthcare Workers

Background

COVID-19 infection is more likely to be acquired and transmitted by healthcare workers (HCWs). Furthermore, they serve as role models for communities in terms of COVID-19 vaccination attitudes. As a result, HCWs' reluctance to vaccinate could have a significant impact on pandemic containment efforts.

Aim

To characterize the current COVID-19 vaccine approval situation among healthcare workers and to determine the most likely reason for agreement or disagreement with COVID-19 vaccination.

Methods

This cross-sectional design included 451 HCWs from COVID-19 treatment institutions, with COVID-19 exposure risk changing depending on job function and working location.

Results

The study recruited 156 physicians and 295 nurses, of whom 58.1% were female and 41.9% were male. Physicians had a significantly higher rate of participation in COVID-19 pandemic prevention and control, with a rate of 69.9% versus 55.3% of nurses. Acceptance of COVID-19 vaccination was reported by 40.8% of HCWs. The rate of acceptance was significantly higher among physicians (55.1%) than among nurses (33.2%) (p < 0.001). Most HCWs (67.8%) believed the vaccine was not effective. Physicians showed more significant trust in the effectiveness of the vaccine than nurses (41% and 27.5, respectively) (p=0.003). Concerning vaccine safety, only 32.8% of HCWs believed it was safe. This was significantly higher in physicians (41.7%) than in nurses (28.1%) (p=0.004).

Conclusion

Vaccination uncertainty is common among healthcare personnel in Egypt, and this could be a significant barrier to vaccine uptake among the public. Campaigns to raise vaccine knowledge are critically needed.

Knowledge of COVID-19 among Brazilian health care professionals and associated factors

Health care professional's knowledge is essential to contain epidemics. This research aimed to evaluate the knowledge of Brazilian health care professionals regarding COVID-19 to analyze whether there is a difference in knowledge between professionals in Primary Health Care and those in other levels of care or not; and to identify factors associated with knowledge. This is a cross-sectional study, including 716 participants who answered an online questionnaire between April and May 2020. Descriptive statistics, difference tests between groups, and logistic regression models were used to analyze the data. The average knowledge score was 12.42 points (out of a possible total of 15). There was no significant difference between professionals in Primary Health Care and those in other levels of care. Knowledge was associated with age, profession, perception regarding media's information quality, and hours exposed to information on COVID-19. Participants showed adequate knowledge, despite some specific gaps. Continuing education actions should prioritize younger nonmedical professionals.

Awareness, Knowledge, and Perceptions of COVID-19 Precautions Among Employees of Al-Imam Abdulrahman Al Faisal Hospital in Riyadh, KSA

Background

The global pandemic of coronavirus disease-19 (COVID-19) was announced by the World Health Organization (WHO) in early 2020. The consequences of the pandemic were vast, where healthcare systems, education, and the economy of many countries were greatly affected. As such, extraordinary precautions and measures were implemented to the public as well as to the healthcare systems in order to counter the spread of the disease. However, the success of these measures depends largely on the individual's adherence to them as well as their awareness about COVID-19. Indeed, healthcare workers and their non-medical co-workers play a crucial role in that, as they are considered the front line in fighting the infection.

Objectives

To assess the knowledge, awareness and perceptions of the healthcare workers (HCWs) regarding COVID-19 in Al-Imam Abdulrahman Al Faisal Hospital in Riyadh, Saudi Arabia.

Methods

Using a cross-sectional study design, a previously validated questionnaire was used as an online survey to assess the knowledge, awareness and perceptions (KAP) of HCWs regarding COVID-19. The targeted population of this study was all the healthcare workers in Al-Imam Abdulrahman Al Faisal Hospital, including their non-medical co-workers.

Results

The study included 274 respondents consisting of 53.65% males and 46.45% females with an average age between 30-39 years. The majority of the respondents were paramedics with a percentage of 30.66%. The governmental references were the main source of information regarding COVID-19 for 69% of the respondents. Questions with accurate responses that exceeded 90% were about the COVID-19 complications, transmission, and measures to reduce its transmission. In this study, overall knowledge was significantly associated with the gender of the participants (P=0.01).

Conclusion

There was a good level of knowledge and perception in health care professionals and co-workers regarding SARS-CoV-2.

Alveolar macrophages protect mice from MERS-CoV-induced pneumonia and severe disease

Emerging and re-emerging human coronaviruses (hCoVs) cause severe respiratory illness in humans, but the basis for lethal pneumonia in these diseases is not well understood. Alveolar macrophages (AMs) are key orchestrators of host antiviral defense and tissue tolerance during a variety of respiratory infections, and AM dysfunction is associated with severe COVID-19. In this study, using a mouse model of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, we examined the role of AMs in MERS pathogenesis. Our results show that depletion of AMs using clodronate (CL) liposomes significantly increased morbidity and mortality in human dipeptidyl peptidase 4 knock-in (hDPP4-KI) mice. Detailed examination of control and AM-depleted lungs at different days postinfection revealed increased neutrophil activity but a significantly reduced MERS-CoV-specific CD4 T-cell response in AM-deficient lungs during later stages of infection. Furthermore, enhanced MERS severity in AM-depleted mice correlated with lung inflammation and lesions. Collectively, these data demonstrate that AMs are critical for the development of an optimal virus-specific T-cell response and controlling excessive inflammation during MERS-CoV infection.

Multisectoral actions of mental health during the COVID‐19 pandemic in Mazandaran province of Iran

Aim

A widespread outbreak of COVID‐19 is followed by adverse effects on the mental health of the general population. Therefore, this study is an audit to investigate the activities of various organizations during the COVID‐19 pandemic in Mazandaran Province, Iran.

Methods

The aim of the study was to collect the data, the relevant officials in various organizations and units were contacted to collect the statistics of actions taken in psychology and psychiatry wards. Moreover, databases such as Google Scholar and Iranian resources were searched.

Results

According to the results, different healthcare systems worked in parallel during the peak of the COVID‐19 pandemic. For example, Mazandaran University of Medical Science [MAZUMS] Health Vice‐Chancellor performed the following activities during this crisis: establishing a virtual crisis management working group, holding a provincial educational committee to train the crisis management teams, organizing virtual psychological intervention teams in the healthcare systems, and so forth. In addition, the mental health activities by Mazandaran Welfare Organization during the COVID‐19 outbreak included providing hostelry free psychological counseling, quarantine boarding and rehabilitation centers, and providing harm prevention protocols of COVID‐19, especially for marginalized regions. In the third level of medical centers, including hospitals, consultation‐liaison psychiatry or psychiatrists and clinical psychologists, therapeutic interventions for comorbid psychiatric disorders with COVID‐19 disease, and online workshops for mental health were conducted to reduce burnout of medical staff and nurses.

Conclusion

This study can provide a good guideline for different service providers by using the experiences of other centers to achieve better results.

Different healthcare systems worked in parallel during the peak of the COVID‐19 pandemic. Mazandaran University of Medical Science [MAZUMS] Health Vice‐Chancellor and Mazandaran Welfare Organization performed different activities during this crisis. In the third level of medical centers, including hospitals, consultation‐liaison psychiatry, or psychiatrists performed therapeutic interventions for comorbid psychiatric disorders with the COVID‐19 disease.

Assessment of front-line healthcare workers' Knowledge, Attitude and Practice after several months of COVID-19 pandemic

BACKGROUND

Frontline healthcare workers (F-HCWs) are at the forefront of medical care providers against the novel coronavirus 2019 (COVID-19) pandemic which has life-threatening potentials. Inadequate knowledge and incorrect attitudes among HCWs can directly influence practices and lead to delayed diagnosis, poor infection control practices, and spread of disease.

OBJECTIVES

The aim of this study was to assess the knowledge, attitude and practice (KAP) regarding the COVID-19 pandemic among the frontline healthcare workers (F-HCWs) working at a tertiary care hospital situated in eastern Uttar Pradesh and to identify the factors significantly associated with KAP.

METHODS

A cross-sectional study was conducted among 260 health care providers across eastern Uttar Pradesh including Basti city during December 2020. Data was collected using a self-primed pretested questionnaire from the FHCWs working at a tertiary care hospital of eastern Uttar Pradesh. In this survey, a convenience sampling method was adopted. 12 items on knowledge, 10 items on attitude, and 5 items on practices related to COVID-19. The other variables consisted of 4 items on socio-demographic attributes, p-value and 95% confidence intervals (CIs) were performed to assess the attitude and practices in relation to knowledge.

RESULTS

Of the total 260 study population, 228 were interviewed online, 32 were self-administered. Knowledge and attitude of the nursing staff were highest but practice score was best for residents. Among different age groups knowledge, attitude and practices scores were highest for 35-45, 45-60 and 25-35 age groups respectively. Respondents having 5-10 years of experience had the best knowledge and the attitude score was highest for HCWs having 10-20 years' experience but the practice score was higher for HCWs having more than 20 years' work experience. Overall knowledge score of respondents having strong correlation with attitude (p<0.05) and to the practice (p<0.05).

CONCLUSION

In this survey many F-HCWs reported adequate overall knowledge with a positive attitude and adopted appropriate practices. The F-HCWs with a higher level of education and more years of experience in health care facilities had better KAP towards COVID-19.

Assessment of knowledge, attitude and practice toward COVID-19 and associated factors among health care workers in Silte Zone, Southern Ethiopia

INTRODUCTION

COVID-19 is a pandemic respiratory disease caused by the highly contagious novel coronavirus (SARS-CoV 2). The disease is now quickly spreading around the world, resulting in ongoing coronavirus pandemic. Healthcare workers are more susceptible to COVID-19 infection than the general population due to frequent contact with infected individuals.

OBJECTIVE

This study was aimed to assess knowledge, attitude and practice towards COVID-19 and associated factors among health care workers.

METHODS

Facility-based cross-sectional study design was conducted among health care workers in Silte Zone. A total of 379 health professionals were selected using multistage stratified sampling technique. Self-administered questionnaire was used to collect data. Binary logistic regression model was used to see association between outcome and independent variables.

RESULTS

This study found 74.9%, 84.2% and 68.9% prevalence of adequate knowledge, positive attitude and good practice respectively. Working in comprehensive specialized hospital (AOR = 4.46, 95% CI = 1.46-13.62).having MSC degree (AOR = 10.26, 95% CI = 2.27-46.44), and training on COVID-19 (AOR = 6.59, 95% CI = 2.97-14.65) were strongly associated with knowledge of health care workers. On the other hand, older age (AOR = 3.35, 95% CI = 1.07-10.50), training on COVID-19 (AOR = 3.73, 95% CI = 1.82-7.63), Work experience (AOR = 3.78, 95% CI = 1.46-9.80) and Knowledge (AOR = 5.45, 95% CI = 2.60-11.43) were significantly associated with attitude, whereas source of information from friends or colleagues (AOR = 3.13, 95% CI = 1.28-7.66), working in primary hospital (AOR = 0.36, 95% CI = 0.21-0.620) and having good knowledge (AOR = 1.80, 95% CI = 1.03-3.14) were strongly associated with good practice of health care workers.

CONCLUSION

This study found majority of health care workers had good level of knowledge and positive attitude toward COVID-19, but lower proportion of health care workers practices sufficiently in the study area. Type of health facilities, level of education, training on COVID-19, work experience, type of source of information were significantly associated with knowledge, attitude and practice of health care workers. Stakeholders need to focus on interventions that increase preventive practices of health care workers.

Nurses' knowledge, concerns, perceived impact and preparedness toward COVID-19 pandemic: A cross-sectional survey

Aim

This study aimed to assess the nurses' knowledge, concerns, perceived impact and preparedness toward the COVID‐19 pandemic.

Background

As COVID‐19 is a new disease, its spread and emergence cause fear, anxiety and confusion among the general population. Nurses are in close contact with infected persons, and their knowledge plays an important role in preventing the transmission chain.

Methods

In this cross‐sectional study, 207 nurses were selected using convenience sampling from 29 March to 19 April 2020. The study used a questionnaire assessing the nurses' baseline characteristics, their source of information, knowledge, concerns, the perceived impact and their preparedness for the COVID‐19 pandemic.

Results

Around half of the surveyed nurses (51.2%) reported that the Ministry of Health's and World Health Organization's websites and official pages were their main sources of information. The majority of nurses (81.6%) knew the nature of the virus, 83.6% agreed that their job puts them at risk of infection with COVID‐19 and 72% felt personally prepared for the pandemic.

Conclusion

The majority of nurses had an acceptable level of knowledge regarding COVID‐19. However, psychological interventions are needed to be addressed in the planning stage before any pandemic.

What is already known about this topic?

It is well established that COVID‐19 is a highly infectious disease with a fatality rate of about 6.48% in Egypt.

Studies about nursing and COVID‐19 are relatively few.

There is a lack of data regarding the nurses' knowledge, concerns, perceived impact and preparedness toward COVID‐19.

What does this paper add?

Nurses prefer gaining their knowledge regarding COVID‐19 from the Ministry of Health's and the World Health Organization's websites and official pages rather than the social media websites.

Nurses have an acceptable level of knowledge regarding COVID‐19. The majority of surveyed nurses knew the nature of the virus along with its signs and symptoms.

The majority of surveyed nurses feel that their job puts them at the risk of infection with COVID‐19, and they are quite afraid of being infected.

The implications of this paper:

Psychological interventions are needed in the planning stage before any pandemic to enhance the protection of nurses and health care workers and to reduce the psychological impact.

Sustainable awareness programmes are required for health care workers, keeping them up to date with the most recent information regarding prevention and management methods from the World Health Organization's guidelines and other instructional materials.

Hospitals can hold meetings and organize regular psychological support groups to allow nurses to manage their fears and acquire stress reduction strategies.

Knowledge, attitude, practice and clinical recommendations of health care workers towards COVID-19: a systematic review

OBJECTIVES

This study aimed to evaluate the knowledge, attitude, practice, and clinical recommendations of health care workers (HCWs) towards COVID-19.

METHODS

In this systematic review study, international databases (Web of Science, PubMed, and Scopus) were searched for the relevant studies published in English from the inception of databases until July 30, 2020. Hoy et al.'s tool was used to evaluate the quality of studies. All search steps, screening, selection of studies, quality assessment, and data extraction were performed separately by two researchers.

RESULTS

Out of 3460 articles searched, 28 articles conducted on 16,427 HCWs were included in the study. Most of the HCWs had good knowledge (72.2%), a positive attitude (70.9%), and good practice (78.8%) towards COVID-19. The most important clinical recommendation to improve knowledge, attitude, and practice (KAP) was to provide HCWs with a periodic training program regarding COVID-19. The most important source of information for HCWs on COVID-19 was social networks.

CONCLUSIONS

Despite HCWs' good knowledge, attitude, and practice (KAP), it is recommended to periodically review KAP and carry out further studies in different countries as well. It is also recommended to use social media to improve KAP.

Knowledge, attitude, and associated factors towards COVID-19 among nurses who work in South Gondar Zone, hospitals, Northwest Ethiopia 2020. A multi-central institution-based cross-sectional study

Coronavirus disease 2019 is an emerging respiratory disease that is caused by a novel coronavirus and was first detected in December 2019 in Wuhan, China. The world was affected by the Coronavirus Disease in 2019. In sub-Saharan Africa, including Ethiopia, there is no study conducted on the level of Knowledge, Attitude, and Associated Factors towards Coronavirus disease 2019 among Health care workers, specifically Nurses. This study aims to assess the level of Knowledge, Attitude, and Associated Factors towards Coronavirus disease 2019 among Nurses who work in South Gondar Zone, Hospitals, Northwest Ethiopia, 2020. An Institution based cross-sectional study was conducted among 166 Nurses in South Gondar Zone, Ethiopia, From 1 June to 30 June 2020. For selecting the study participants after proportional allocation of study subjects to each hospital, simple random sampling techniques were to be used. Data were entered into Epi info version 7.2.0.1, and exported to Statistical Package for Social Sciences window version 24 for analysis. Binary and multivariable logistic regression was used to see the association between dependent and independent variables. Adjusted odds ratio with 95% confidence interval was computed. P-value < 0.05 was used to declare association. Finally, the result is presented in the form of texts, tables, and graphs. Of 166 Nurses, 166 (100% response rate) responded to the online interview questionnaire. Of the participating 166 nurses, 57.2% were females and 42.8% were males; 41.6 % of the respondents were between the ages of 20 and 29 years. About 84.9 % had good knowledge and 63.3% favourable attitude of COVID-19. Wearing general medical masks can prevent one from acquiring infection by the COVID-19 virus. AOR = 0.44, 95% CI = 0.005-0.362 were factors of knowledge about COVID-19, whereas, 'I strongly agree' Medical staff were ready to participate in anti-epidemic in the community, AOR = 0.08, 95% CI = 0.003-1.76 were factors of attitude about COVID-19. Where factors of attitude about COVID-19. In this study, most of the nurses had good knowledge and a favourable attitude regarding of COVID-19. Wearing general medical masks that can prevent one from acquiring infection by the COVID-19 virus were factors in association with the knowledge of nurses on COVID-19. Similarly, Medical staff were ready to participate in anti-epidemic community factors associated with the attitudes of nurses on COVID-19.

Interferon therapy in patients with SARS, MERS, and COVID-19: A systematic review and meta-analysis of clinical studies

Concern regarding coronavirus (CoV) outbreaks has stayed relevant to global health in the last decades. Emerging COVID-19 infection, caused by the novel SARS-CoV2, is now a pandemic, bringing a substantial burden to human health. Interferon (IFN), combined with other antivirals and various treatments, has been used to treat and prevent MERS-CoV, SARS-CoV, and SARS-CoV2 infections. We aimed to assess the clinical efficacy of IFN-based treatments and combinational therapy with antivirals, corticosteroids, traditional medicine, and other treatments. Major healthcare databases and grey literature were investigated. A three-stage screening was utilized, and included studies were checked against the protocol eligibility criteria. Risk of bias assessment and data extraction were performed, followed by narrative data synthesis. Fifty-five distinct studies of SARS-CoV2, MERS-CoV, and SARS-CoV were spotted. Our narrative synthesis showed a possible benefit in the use of IFN. A good quality cohort showed lower CRP levels in Arbidol (ARB) + IFN group vs. IFN only group. Another study reported a significantly shorter chest X-ray (CXR) resolution in IFN-Alfacon-1 + corticosteroid group compared with the corticosteroid only group in SARS-CoV patients. In a COVID-19 trial, total adverse drug events (ADEs) were much lower in the Favipiravir (FPV) + IFN-α group compared with the LPV/RTV arm (P = 0.001). Also, nausea in patients receiving FPV + IFN-α regimen was significantly lower (P = 0.03). Quantitative analysis of mortality did not show a conclusive effect for IFN/RBV treatment in six moderately heterogeneous MERS-CoV studies (log OR = −0.05, 95% CI: (−0.71,0.62), I² = 44.71%). A meta-analysis of three COVID-19 studies did not show a conclusive nor meaningful relation between receiving IFN and COVID-19 severity (log OR = −0.44, 95% CI: (−1.13,0.25), I² = 31.42%). A lack of high-quality cohorts and controlled trials was observed. Evidence suggests the potential efficacy of several combination IFN therapies such as lower ADEs, quicker resolution of CXR, or a decrease in inflammatory cytokines; Still, these options must possibly be further explored before being recommended in public guidelines. For all major CoVs, our results may indicate a lack of a definitive effect of IFN treatment on mortality. We recommend such therapeutics be administered with extreme caution until further investigation uncovers high-quality evidence in favor of IFN or combination therapy with IFN.

Middle East Respiratory Syndrome (MERS) Virus-Pathophysiological Axis and the Current Treatment Strategies

Middle East respiratory syndrome (MERS) is a lethal respiratory disease with its first case reported back in 2012 (Jeddah, Saudi Arabia). It is a novel, single-stranded, positive-sense RNA beta coronavirus (MERS-CoV) that was isolated from a patient who died from a severe respiratory illness. Later, it was found that this patient was infected with MERS. MERS is endemic to countries in the Middle East regions, such as Saudi Arabia, Jordan, Qatar, Oman, Kuwait and the United Arab Emirates. It has been reported that the MERS virus originated from bats and dromedary camels, the natural hosts of MERS-CoV. The transmission of the virus to humans has been thought to be either direct or indirect. Few camel-to-human transmissions were reported earlier. However, the mode of transmission of how the virus affects humans remains unanswered. Moreover, outbreaks in either family-based or hospital-based settings were observed with high mortality rates, especially in individuals who did not receive proper management or those with underlying comorbidities, such as diabetes and renal failure. Since then, there have been numerous reports hypothesising complications in fatal cases of MERS. Over the years, various diagnostic methods, treatment strategies and preventive measures have been strategised in containing the MERS infection. Evidence from multiple sources implicated that no treatment options and vaccines have been developed in specific, for the direct management of MERS-CoV infection. Nevertheless, there are supportive measures outlined in response to symptom-related management. Health authorities should stress more on infection and prevention control measures, to ensure that MERS remains as a low-level threat to public health.

Knowledge and Perceptions of COVID-19 Among Health Care Professionals, Medical Students, and Dental Students in the GCC Region: A Cross-Sectional Correlational Study

Purpose

The aim of this study was to assess the levels of awareness and knowledge regarding COVID-19 among healthcare professionals and students in Kuwait and the Gulf Cooperation Council (GCC) region.

Materials and Methods

An online cross-sectional survey using a previously validated questionnaire was used to assess the awareness and knowledge levels of COVID-19 in this study, which was distributed via various online platforms to include as many participants as possible. The study targeted medical doctors, dentists, medical students, and dental students from the GCC region. Participants were at least 18 years old, voluntarily consented to complete the questionnaire, and were assured that their responses would remain anonymous. Permission was obtained using a previously validated and applied questionnaire to assess their level of awareness and knowledge regarding COVID-19. To compare the proportional responses between groups in descriptive statistics, a proportion Z-test was used to find any significant differences, with a statistical significance set at p < 0.05.

Results

A total of 1621 participants responded to our questionnaire. Almost two-thirds of the respondents were female (64.4%), and the majority were less than 25 years old (67.2%). Dentists accounted for 12.6% of the total population, and their clinical experience ranged from 0.25 to 52 years (median: 3 years, IQR: 1–10 years). Meanwhile, medical doctors accounted for 24.5% of the responses, and their clinical experience ranged from 0 to 50 years (median: 13 years, IQR: 3–23 years). Among the dental students, 42.3% were in the pre-clinical years, while 57.7% were in the clinical years of study. However, among medical students, 57.5% were in the pre-clinical years, while 42.5% were in the clinical years of study.

Conclusion

Our results demonstrated that dental students, medical doctors, and medical students exhibited higher odds of having satisfactory COVID-19 perception scores than dentists.

Innate and Adaptive Immune Genes Associated with MERS-CoV Infection in Dromedaries

The recent SARS-CoV-2 pandemic has refocused attention to the betacoronaviruses, only eight years after the emergence of another zoonotic betacoronavirus, the Middle East respiratory syndrome coronavirus (MERS-CoV). While the wild source of SARS-CoV-2 may be disputed, for MERS-CoV, dromedaries are considered as source of zoonotic human infections. Testing 100 immune-response genes in 121 dromedaries from United Arab Emirates (UAE) for potential association with present MERS-CoV infection, we identified candidate genes with important functions in the adaptive, MHC-class I (HLA-A-24-like) and II (HLA-DPB1-like), and innate immune response (PTPN4, MAGOHB), and in cilia coating the respiratory tract (DNAH7). Some of these genes previously have been associated with viral replication in SARS-CoV-1/-2 in humans, others have an important role in the movement of bronchial cilia. These results suggest similar host genetic pathways associated with these betacoronaviruses, although further work is required to better understand the MERS-CoV disease dynamics in both dromedaries and humans.

Middle East respiratory syndrome coronavirus infection profile in Qatar: An 8-year experience

The Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012. The objective of the study was to describe the epidemiology, risk factors, clinical characteristics, and outcome of MERS-CoV in Qatar. A total of 28 cases of MERS-CoV were identified, corresponding to an incidence of 1.7 per 1,000,000 population. Most patients had a history of contact with camels 15, travel to Kingdom of Saudi Arabia 7 or known contact with individuals with confirmed MERS-CoV infection 7. Majority of patients had acute kidney injury (AKI) 17 and 9 needed renal replacement therapy. All patients were hospitalized, 14 required critical care support. Overall, total of 10 died. The immediate cause of death was multiorgan failure with acute respiratory syndrome (ARDS) 9. MERS-CoV is a rare infection in the State of Qatar. There was no hospital outbreaks or healthcare worker reported infection. The infection causes severe respiratory failure and acute renal failure. Patients with AKI and on ventilator support carry higher risk of mortality.

University students' perceptions of airborne infection control: exploratory study using Q methodology

Background

International cooperation for infection control is important to prevent global pandemics. University students were difficult groups to manage of infection control measures. They often had overconfidence to their health, ineffective personal hygiene, and active social activities. Their misperceptions and inappropriate preventive behaviors increase the infection risks to university and community. Understanding university students’ perceptions of airborne infection management will contribute to the establishment of relevant policies and health education programs.

Method

This study explored subjective perceptions of airborne infection among university students in South Korea using Q-methodology. Forty university students representing different majors ranked a set of 33 statements reflecting their perceptions of airborne infection. They sorted the statements into a distribution on seven scales ranging from “strongly disagree” to “strongly agree.” Collected data were analyzed by the PC-QUANL program. The subjective perception types were extracted by using the principal component analysis.

Results

Four type are derived regardingperception of airborne infection: Type I (Government responsibility), Type II (Personal responsibility in self-management), Type III (Strict external management) and Type IV (Comprehensive countermeasures management). Thesefour types accounted for 45.6% of the total variance, and the individual contributions of Types I, II, III, and IV were 27.7, 7.6, 6.2, and 4.1%, respectively.

Conclusion

The major contribution of this study is to clarify university students’ perceptions of airborne infection. These findings can be used in formulating effective strategies for health education, media reporting, and public health policy to improve airborne infection management.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09909-6.

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.

Knowledge of COVID-19 infection control among healthcare workers in radiology departments in Saudi Arabia

Radiological examinations have played a crucial role in the identification and management of COVID-19 patients. Therefore, knowledge and awareness of infection control among healthcare workers in radiology departments are important to prevent disease transmission. This study aimed to assess the knowledge and practice of infection control for COVID-19 among healthcare workers in radiology departments in Saudi Arabia. A cross-sectional, online questionnaire was administered among healthcare workers in radiology departments in Saudi Arabia in May 2020. The questionnaire consisted of demographic characteristics, profession, knowledge of infection control for COVID-19, and good practice of infection control measures for COVID-19 in radiology departments. A descriptive statistical analysis and chi-square test were performed using SPSS software. A total of 234 (91%) of healthcare workers replied that they have good knowledge about the precautions needed during the examination of positive COVID-19 cases in radiology departments, and 216 (84%) replied that they knew the necessary precautions when using portable X-ray machine. Moreover, 191 (>74%) of those surveyed agreed that wearing personal protective equipment and following the CDC sequence. There was significant association between profession and good clinical practices in radiology departments regarding COVID-19. Such knowledge could limit the spread of COVID-19 among the healthcare workers in radiology departments.

COVID-19: What should health professionals know? Assessment of Knowledge, attitude, and practice of community pharmacists in a developing country

BACKGROUND

Healthcare professionals are the primary frontiers of the fight against every public health threat. These had made them vulnerable to various infectious agents, with many reports of morbidity and mortality also being evident.

OBJECTIVES

The current study aimed to assess the knowledge, attitude, and practice toward COVID-19 among community pharmacists in Gondar town, Ethiopia.

METHODS

A cross-sectional study was conducted. A structured, self-administered questionnaire was used for data collection, and the collected data were coded, validated, and analyzed using SPSS version 26. Quantitative data were summarized using means and standard deviations, while frequencies and proportions were used to summarize categorical data. A chi-square test was used to assess an association between the different variables, and a P-value of less than 0.05 was considered to declare statistical significance at a 95% confidence interval.

RESULTS

A total of 46 community pharmacy professionals had participated in the study. The main sources of information about COVID-19 were news media 29 (63%), followed by social media 24 (52.2%). The mean knowledge score was 8.15 (standard deviation: 1.86), and among the total study participants, 29 (63%) were found to have good knowledge about COVID-19. The mean attitude score was 31.52 (standard deviation: 4.288). Only 30.4% of the study participants were found to have a good practice toward the prevention of COVID-19. Chi-square results showed that having a good knowledge of COVID-19 was significantly associated with practice (P = 0.035).

CONCLUSION

Significant gaps were identified concerning community pharmacy professional's knowledge of COVID-19 and their practice toward prevention of the disease. Strategies should be implemented to equip community pharmacy professionals with all necessary information about COVID-19 through continuous training programs and other virtual platforms.

Assessment of Knowledge, Attitudes, and Perception of Health Care Workers Regarding COVID-19, A Cross-Sectional Study from Egypt

Healthcare workers (HCWs) are at the frontline defense against the coronavirus disease 2019 (COVID-19) pandemic. Inadequate knowledge and incorrect attitudes among HCWs can directly influence practices and lead to delayed diagnosis, poor infection control practice, and spread of disease. This study aimed to assess the knowledge, perception, and attitude of the Egyptian HCWs towards the COVID-19 disease. A descriptive cross-sectional study was conducted in Egypt, among 407 HCWs using a self-administered questionnaire. The mean correct answer rate was 80.4% with a mean knowledge score of 18.5 ± 2.7 out of 24. A positive correlation between knowledge and attitude scores was detected (r = 0.215, p < 0.001). About 83.1% of our participants reported that they were afraid of being infected with COVID-19, and 89.2% stated that they were more susceptible to COVID-19 infection as compared to others. Unavailability of personal protective equipment (PPE), fear of transmitting the disease to their families, and social stigma were the most frequently reported reasons for increased risk perception. The overall knowledge level of HCWs was generally good especially among physicians. A positive attitude was detected among allied health professionals more than physicians. Risk perception was high among HCWs. Causes of increased risk perception need to considered by the government and the Egyptian Ministry of Health.

Knowledge, attitude and practice towards COVID-19 among workers of a tertiary hospital in Bayelsa State, Nigeria

INTRODUCTION

coronavirus disease (COVID-19) has since assumed pandemic dimensions with over 14million persons affected in 213 countries and territories worldwide as at mid-July 2020. The level of awareness and knowledge of the disease as well as the related attitude and practice amongst hospital workers could determine its extent of control. The aim of this study was to determine the knowledge, attitude and practices amongst hospital staff regarding COVID-19.

METHODS

this cross-sectional study was conducted among staff of the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria. A self-administered semi-structured questionnaire was adapted in assessing their knowledge, attitude and practice towards COVID-19.

RESULTS

one hundred and twenty four respondents completed the study with a mean age of 30.9 ± 6.5 years. Up to 90% of them demonstrated good knowledge of COVID-19 with regard to preventive and control measures. Approximately 90% of them practiced good hand hygiene though a lesser proportion wore face masks (51.6%) and practiced crowd avoidance (58.1%). Medical doctors had a marginally higher practice score compared with "others" (p = 0,047). Up to 98(79.0%) of respondents were scared of self-infection and 99(79.8%) were not motivated to work due to inadequate facilities, equipment and resources in 50% of cases. Knowledge of COVID-19 was positively correlated with the practices of the participants (p = 0.023).

CONCLUSION

the hospital staff lacked adequate motivation towards management of COVID-19 and were constrained for the fear of self- infection, inadequate equipment, resources and equipment despite possessing a good knowledge of the disease. There is need for concerted efforts by stakeholders in the health care industry to ensure hospital workers are adequately motivated and provided with the needed risk protection devices and resources during this pandemic.

Respiratory viruses in individuals with a high frequency of animal exposure in southern and highland Vietnam

Active surveillance for zoonotic respiratory viruses is essential to inform the development of appropriate interventions and outbreak responses. Here we target individuals with a high frequency of animal exposure in Vietnam. Three-year community-based surveillance was conducted in Vietnam during 2013-2016. We enrolled a total of 581 individuals (animal-raising farmers, slaughterers, animal-health workers, and rat traders), and utilized reverse transcription-polymerase chain reaction to detect 15 common respiratory viruses in pooled nasal-throat swabs collected at baseline or acute respiratory disease episodes. A respiratory virus was detected in 7.9% (58 of 732) of baseline samples, and 17.7% (136 of 770) of disease episode samples (P < .001), with enteroviruses (EVs), rhinoviruses and influenza A virus being the predominant viruses detected. There were temporal and spatial fluctuations in the frequencies of the detected viruses over the study period, for example, EVs and influenza A viruses were more often detected during rainy seasons. We reported the detection of common respiratory viruses in individuals with a high frequency of animal exposure in Vietnam, an emerging infectious disease hotspot. The results show the value of baseline/control sampling in delineating the causative relationships and have revealed important insights into the ecological aspects of EVs, rhinoviruses and influenza A and their contributions to the burden posed by respiratory infections in Vietnam.

Knowledge of Health Care Professionals and Medical Students Regarding Covid-19 in a Tertiary Care Hospital in Nepal

INTRODUCTION

The lack of knowledge among health care professionals leads to diagnostic delays, further spread of disease, and poor infection control practices. Health care professionals must be updated knowledge regarding COVID-19. This study aims to assess the knowledge of health care professionals regarding COVID -19 in a medical college in Chitwan.

METHODS

A Knowledge, Attitude and Practice Study was carried out in a tertiary care hospital in Chitwan, Nepal from April 22, 2020, to April 28, 2020. The institutional review committee of Chitwan Medical College provided ethical approval for the research. Data were collected with an online questionnaire using Google forms. The questionnaire was sent out to 724 potential responders who included health care professionals from medical, dental, nursing, and allied health sciences in Chitwan Medical College. A convenient sampling method was used for data collection. Data were analyzed using Statistical Package of Social Sciences.

RESULTS

A total of 181 respondents completed the web survey. Overall, a total of 35 (19.3%) respondents were found to have "Good" knowledge; 105 (58%) respondents had "Fair" knowledge and 41 (22.7%) respondents had "Poor" knowledge regarding various aspects of COVID-19. There was no significant difference among the various health professional groups in their knowledge scores under the four knowledge domains.

CONCLUSIONS

The study of knowledge of health care professionals could act as a reference for the prevention and better management of COVID-19. This study shows that there is a need to implement periodic educational interventions and training programs on infection control practices for COVID-19 across all healthcare professions.

Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence

The transmission behaviour of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still being defined. It is likely that it is transmitted predominantly by droplets and direct contact and it is possible that there is at least opportunistic airborne transmission. In order to protect healthcare staff adequately it is necessary that we establish whether aerosol-generating procedures (AGPs) increase the risk of transmission of SARS-CoV-2. Where we do not have evidence relating to SARS-CoV-2, guidelines for safely conducting these procedures should consider the risk of transmitting related pathogens. Currently there is very little evidence detailing the transmission of SARS-CoV-2 associated with any specific procedures. Regarding AGPs and respiratory pathogens in general, there is still a large knowledge gap that will leave clinicians unsure of the risk to themselves when offering these procedures. This review aimed to summarize the evidence (and gaps in evidence) around AGPs and SARS-CoV-2.

Knowledge, Awareness and Practice of Health care Professionals amid SARS-CoV-2, Corona Virus Disease Outbreak

OBJECTIVE

To assess the knowledge, awareness and practice level of health care workers towards Corona Virus disease - 2019 (COVID-19).

METHODS

A cross sectional study was conducted by administering a well-structured questionnaire comprising of three sections including knowledge, attitude and practice amongst health care professionals in various hospitals and clinics, over a duration of two months 'Feb-March' 2020. The data from 810 participants were collected manually as well as through online survey registered on www.surveys.google.com, using a validated questionnaire. The questionnaire comprised of three sections assessing knowledge, awareness and practice of participants. The descriptive analysis was carried out for demographics and dependent variables with statistical program for social sciences. Spearman test was used to detect any relationship between the health care professional response with respect to their gender and level of education. A p value of < 0.05 was considered statistically significant.

RESULTS

More than half (57.2%) of the health care professionals were working in a hospital setting. Fifty two percent of health care professionals had awareness and 72% were practicing adequate measures to combat COVID-19. The majority (81.9%) believed that the sign and symptoms are similar to a common flu and the main strata of population that could be affected by COVID-19 are elderly (79%). Seventy three percent of participants did not attend any lecture, workshop or seminar on COVID-19 for awareness purpose. Sixty seven percent of health care professionals were practicing universal precaution for infection control and 57.4% were using sodium hypochlorite as a surface disinfectant in dental surgeries. There was no significant relationship (p > 0.05) between the health care professionals' responses with gender and their education level.

CONCLUSION

The study suggests that the vast majority of the health care professionals have adequate knowledge and awareness related to COVID-19. However some aspects of practice of health care professionals were found to be deficient including, following CDC guidelines during patient care, acquiring verified knowledge related to COVID-19, disinfection protocol and the use of N-95 mask. Mandatory Continued professional development programs including lectures and workshops on COVID-19 for all health care professionals are the need of the hour, to manage the pandemic and limiting the morbidity and mortality related to it.

Trustworthy Health-Related Tweets on Social Media in Saudi Arabia: Tweet Metadata Analysis

Background

Social media platforms play a vital role in the dissemination of health information. However, evidence suggests that a high proportion of Twitter posts (ie, tweets) are not necessarily accurate, and many studies suggest that tweets do not need to be accurate, or at least evidence based, to receive traction. This is a dangerous combination in the sphere of health information.

Objective

The first objective of this study is to examine health-related tweets originating from Saudi Arabia in terms of their accuracy. The second objective is to find factors that relate to the accuracy and dissemination of these tweets, thereby enabling the identification of ways to enhance the dissemination of accurate tweets. The initial findings from this study and methodological improvements will then be employed in a larger-scale study that will address these issues in more detail.

Methods

A health lexicon was used to extract health-related tweets using the Twitter application programming interface and the results were further filtered manually. A total of 300 tweets were each labeled by two medical doctors; the doctors agreed that 109 tweets were either accurate or inaccurate. Other measures were taken from these tweets’ metadata to see if there was any relationship between the measures and either the accuracy or the dissemination of the tweets. The entire range of this metadata was analyzed using Python, version 3.6.5 (Python Software Foundation), to answer the research questions posed.

Results

A total of 34 out of 109 tweets (31.2%) in the dataset used in this study were classified as untrustworthy health information. These came mainly from users with a non-health care background and social media accounts that had no corresponding physical (ie, organization) manifestation. Unsurprisingly, we found that traditionally trusted health sources were more likely to tweet accurate health information than other users. Likewise, these provisional results suggest that tweets posted in the morning are more trustworthy than tweets posted at night, possibly corresponding to official and casual posts, respectively. Our results also suggest that the crowd was quite good at identifying trustworthy information sources, as evidenced by the number of times a tweet’s author was tagged as favorited by the community.

Conclusions

The results indicate some initially surprising factors that might correlate with the accuracy of tweets and their dissemination. For example, the time a tweet was posted correlated with its accuracy, which may reflect a difference between professional (ie, morning) and hobbyist (ie, evening) tweets. More surprisingly, tweets containing a kashida—a decorative element in Arabic writing used to justify the text within lines—were more likely to be disseminated through retweets. These findings will be further assessed using data analysis techniques on a much larger dataset in future work.

Overview of Current Therapeutics and Novel Candidates Against Influenza, Respiratory Syncytial Virus, and Middle East Respiratory Syndrome Coronavirus Infections

Emergence and re-emergence of respiratory virus infections represent a significant threat to global public health, as they occur seasonally and less frequently (such as in the case of influenza virus) as pandemic infections. Some of these viruses have been in the human population for centuries and others had recently emerged as a public health problem. Influenza viruses have been affecting the human population for a long time now; however, their ability to rapidly evolve through antigenic drift and antigenic shift causes the emergence of new strains. A recent example of these events is the avian-origin H7N9 influenza virus outbreak currently undergoing in China. Human H7N9 influenza viruses are resistant to amantadines and some strains are also resistant to neuraminidase inhibitors greatly limiting the options for treatment. Respiratory syncytial virus (RSV) may cause a lower respiratory tract infection characterized by bronchiolitis and pneumonia mainly in children and the elderly. Infection with RSV can cause severe disease and even death, imposing a severe burden for pediatric and geriatric health systems worldwide. Treatment for RSV is mainly supportive since the only approved therapy, a monoclonal antibody, is recommended for prophylactic use in high-risk patients. The Middle East respiratory syndrome coronavirus (MERS-CoV) is a newly emerging respiratory virus. The virus was first recognized in 2012 and it is associated with a lower respiratory tract disease that is more severe in patients with comorbidities. No licensed vaccines or antivirals have been yet approved for the treatment of MERS-CoV in humans. It is clear that the discovery and development of novel antivirals that can be used alone or in combination with existing therapies to treat these important respiratory viral infections are critical. In this review, we will describe some of the novel therapeutics currently under development for the treatment of these infections.

A Review of Zoonotic Pathogens of Dromedary Camels

Dromedary, or one-humped, camels Camelus dromedarius are an almost exclusively domesticated species that are common in arid areas as both beasts of burden and production animals for meat and milk. Currently, there are approximately 30 million dromedary camels, with highest numbers in Africa and the Middle East. The hardiness of camels in arid regions has made humans more dependent on them, especially as a stable protein source. Camels also carry and may transmit disease-causing agents to humans and other animals. The ability for camels to act as a point source or vector for disease is a concern due to increasing human demands for meat, lack of biosafety and biosecurity protocols in many regions, and a growth in the interface with wildlife as camel herds become sympatric with non-domestic species. We conducted a literature review of camel-borne zoonotic diseases and found that the majority of publications (65%) focused on Middle East respiratory syndrome (MERS), brucellosis, Echinococcus granulosus, and Rift Valley fever. The high fatality from MERS outbreaks during 2012-2016 elicited an immediate response from the research community as demonstrated by a surge of MERS-related publications. However, we contend that other camel-borne diseases such as Yersinia pestis, Coxiella burnetii, and Crimean-Congo hemorrhagic fever are just as important to include in surveillance efforts. Camel populations, particularly in sub-Saharan Africa, are increasing exponentially in response to prolonged droughts, and thus, the risk of zoonoses increases as well. In this review, we provide an overview of the major zoonotic diseases present in dromedary camels, their risk to humans, and recommendations to minimize spillover events.

Diagnostic delays in Middle East respiratory syndrome coronavirus patients and health systems

BACKGROUND

Although Middle East respiratory syndrome coronavirus (MERS-CoV) diagnostic delays remain a major challenge in health systems, the source of delays has not been recognized in the literature. The aim of this study is to quantify patient and health-system delays and to identify their associated factors.

METHODS

The study of 266 patients was based on public source data from the World Health Organization (WHO) (January 2, 2017-May 16, 2018). The diagnostic delays, patient delays, and health-system delays were calculated and modelled using a Poisson regression analysis.

RESULTS

In 266 MERS-CoV patients reported during the study period, the median diagnostic delays, patient delays, and health-system delays were 5 days (interquartile [IQR] range: 3-8 days), 4 days (IQR range: 2-7 days), and 2 days (IQR range: 1-2 days), respectively. Both patient delay (r = 0.894, P = 0.001) and health-system delay (r = 0.163, P = 0.025) were positively correlated with diagnostic delay. Older age was associated with longer health-system delay (adjusted relative ratios (aRR), 1.011; 95% confidence intervals (CI), 1.004-1.017). Diagnostic delay (aRR, 1.137; 95% CI, 1.006-1.285) and health-system delays (aRR, 1.217; 95% CI, 1.003-1.476) were significantly longer in patients who died.

CONCLUSION

Delays in MERS-CoV diagnosis exist and may be attributable to patient delay and health-system delay as both were significantly correlated with longer diagnosis delay. Early MERS-CoV diagnosis may require more sensitive risk assessment tools to reduce avoidable delays, specifically those related to patients and health system.

Dynamics of scientific publications on the MERS-CoV outbreaks in Saudi Arabia

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging disease with a relatively high case fatality rate. Most cases have been reported from Saudi Arabia, and the disease epidemic potential is considered to be limited. However, human-human transmission has occurred, usually in the context of healthcare facility-associated outbreaks. The scientific and medical community depends on timely publication of epidemiological information on emerging diseases during outbreaks to appropriately target public health responses. In this review, we considered the academic response to four MERS CoV outbreaks that occurred in Al-Hasa in 2013, Jeddah in 2014 and Riyadh in 2014 and 2015. We analysed 68 relevant epidemiology articles. For articles for which submission dates were available, six articles were submitted during the course of an outbreak. One article was published within a month of the Al-Hasa outbreak, and one each was accepted during the Jeddah and Riyadh outbreaks. MERS-CoV epidemiology articles were cited more frequently than articles on other subjects in the same journal issues. Thus, most epidemiology articles on MERS-CoV were published with no preferential advantage over other articles. Collaboration of the research community and the scientific publishing industry is needed to facilitate timely publication of emerging infectious diseases.

Host resilience to emerging coronaviruses

Recently, two coronaviruses, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus, have emerged to cause unusually severe respiratory disease in humans. Currently, there is a lack of effective antiviral treatment options or vaccine available. Given the severity of these outbreaks, and the possibility of additional zoonotic coronaviruses emerging in the near future, the exploration of different treatment strategies is necessary. Disease resilience is the ability of a given host to tolerate an infection, and to return to a state of health. This review focuses on exploring various host resilience mechanisms that could be exploited for treatment of severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus and other respiratory viruses that cause acute lung injury and acute respiratory distress syndrome.

Middle East respiratory syndrome coronavirus in Al-Madinah City, Saudi Arabia: Demographic, clinical and survival data

BACKGROUND

Middle East respiratory syndrome coronavirus (MERS-CoV), is an emerging virus respiratory infection. It has a high mortality rate and a wide spectrum of clinical features. This study describes the clinical characteristics and outcome of MERS infected patients.

METHODS

A retrospective study was conducted of all confirmed MERS-CoV infections from March 2014 to May 2014 at two tertiary care hospitals in Al-Madinah region (Saudi Arabia). We gathered data about demographic, clinical presentation, and factors associated with severity and mortality.

RESULTS

A total of 29 cases were identified; 20 males (69%) and nine females (31%), age 45±12years. The death rate was higher for men (52%) than for women (23%). Initial presentation was fever in 22 (75%) cases, cough in 20 (69%) cases, and shortness of breath in 20 (69%) cases. Associated comorbidities were diabetes mellitus in nine (31%) patients and chronic kidney disease (CKD) in eight (27%) patients. Duration of symptoms before hospitalization ranged from 2.9days to 5days. Elevated liver enzymes were present in 14 (50%) patients and impaired renal profile present in eight (27%) patients. We also describe in this study radiological patterns and factors associated with mortality.

CONCLUSION

MERS-CoV infection transmission continues to occur as clusters in healthcare facilities. The frequency of cases and deaths is higher among men than women and among patients with comorbidities.

Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients

BACKGROUND

Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection.

METHODS

Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples.

RESULTS

During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04).

CONCLUSIONS

MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients.