Lessons learned from three Southeast Asian countries during the COVID-19 pandemic

Perceptions of risk and coping strategies during the COVID-19 pandemic among women and older adults

The world's health, economic, and social systems have been adversely impacted by the COVID-19 pandemic. With lockdown measures being a common response strategy in most countries, many individuals were faced with financial and mental health challenges. The current study explored the effect of the COVID-19 pandemic on the psychological well-being, perception of risk factors and coping strategies of two vulnerable groups in Malaysia, namely women and older adults from low-income households (USD592). A purposive sample of 30 women and 30 older adults was interviewed via telephone during Malaysia's Movement Control Order (MCO) regarding the challenges they faced throughout the pandemic. Thematic analysis was subsequently conducted to identify key themes. The themes identified from the thematic analysis indicated a degree of overlap between both groups. For women, seven themes emerged: 1) Psychological challenges due to COVID-19 pandemic, 2) Family violence, 3) Finance and employment related stress and anxiety, 4) Women's inequality and prejudice, 5) Coping strategies, 6) Professional support, and 7) Women's empowerment. Similarly, there were six themes for the older adults: 1) Adverse emotional experiences from COVID-19, 2) Threats to health security, 3) Loss of social connections, 4) Government aid to improve older adults' psychological well-being, 5) Psychological support from family members and pets, and 6) Self-reliance, religion, and spirituality. The findings provide valuable information on the specific burdens faced by these groups, and support psychological interventions and mitigations that would be appropriate to improve well-being during the recovery phase.

Unlocking the importance of perceived governance: The impact on COVID-19 in NUTS-2 European regions

In the immediate aftermath of the pandemic, governments implemented non-pharmaceutical interventions (NPIs). Previous literature suggests that NPI effectiveness is influenced by governance quality. The acceptance and perceived necessity of these measures by the public are crucial to their success, as NPIs cannot be easily enforced without public support. Does regional governance also play a role? This study examines the correlation between the quality of governance in European NUTS-2 regions and the spread of COVID-19. The findings indicate that overall perceived governance, and its perceived quality and corruption pillars, significantly impact the effectiveness of these interventions. This effect was pronounced during the first wave and then diminished in importance, disappearing before vaccines were available, suggesting that regional governance matters especially in the immediate aftermath of an exogenous shock.

Barriers and facilitators to the provision of maternal health services at community health centers during the COVID-19 pandemic: Experiences of midwives in Indonesia

OBJECTIVE

To explore the experiences of midwives in Indonesia on the provision of maternal health services during the COVID-19 pandemic.

DESIGN AND METHODS

A qualitative descriptive study using focus group discussions was undertaken. A conventional content analysis was used to analyze the data. Coding categories were generated from the transcripts.

SETTING AND PARTICIPANTS

Twenty-two midwives from five community health centers of three regions in the Province of Jambi, Indonesia were included.

FINDINGS

The interviewees shared similar barriers and facilitators in delivering the services, including the unavailability of adequate protective equipment, the limitation of the number of services, and dealing with the new public health measures related to the COVID-19. Overall, midwives demonstrated a continued commitment to provide maternal health services during the pandemic.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Significant changes in service delivery have been made to comply with pandemic related restrictions. Despite the unprecedentedly difficult working environment, the midwives continue to provide adequate services to the community by implementing a strict health protocol. Findings from this study contribute to a better understanding of how the quality of the services changed, as well as how new challenges can be addressed and positive changes can be reinforced.

An appraisal of peer-reviewed published literature on Influenza, 2000-2021 from countries in South-East Asia Region

Background

Influenza poses a major public health challenge in South-East Asia Region (SEAR). To address the challenge, there is a need to generate contextual evidence that could inform policy makers and program managers for response preparedness and impact mitigation. The World Health Organization has identified priority areas across five streams for research evidence generation at a global level (WHO Public Health Research Agenda). Stream 1 focuses on research for reducing the risk of emergence, Stream 2 on limiting the spread, Stream 3 on minimizing the impact, Stream 4 on optimizing the treatment and Stream 5 on promoting public health tools and technologies for Influenza. However, evidence generation from SEAR has been arguably low and needs a relook for alignment with priorities. This study aimed to undertake a bibliometric analysis of medical literature on Influenza over the past 21 years to identify gaps in research evidence and for identifying major areas for focusing with a view to provide recommendations to member states and SEAR office for prioritizing avenues for future research.

Methods

We searched Scopus, PubMed, Embase, and Cochrane databases in August 2021. We identified studies on influenza published from the 11 countries in WHO SEAR in the date range of 1 January 2000-31 December 2021. Data was retrieved, tagged and analyzed based on the WHO priority streams for Influenza, member states, study design and type of research. Bibliometric analysis was done on Vosviewer.

Findings

We included a total of 1,641 articles (Stream 1: n = 307; Stream 2: n = 516; Stream 3: n = 470; Stream 4: n = 309; Stream 5: n = 227). Maximum number of publications were seen in Stream 2, i.e., limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza which majorly included transmission, spread of virus at global and local levels and public health measures to limit the transmission. The highest number of publications was from India (n = 524) followed by Thailand (n = 407), Indonesia (n = 214) and Bangladesh (n = 158). Bhutan (n = 10), Maldives (n = 1), Democratic People's Republic of Korea (n = 1), and Timor-Leste (n = 3) had the least contribution in Influenza research. The top-most journal was PloS One which had the maximum number of influenza articles (n = 94) published from SEAR countries. Research that generated actionable evidence, i.e., implementation and intervention related topics were less common. Similarly, research on pharmaceutical interventions and on innovations was low. SEAR member states had inconsistent output across the five priority research streams, and there was a much higher scope and need for collaborative research. Basic science research showed declining trends and needed reprioritization.

Interpretation

While a priority research agenda has been set for influenza at the global level through the WHO Global Influenza Program since 2009, and subsequently revisited in 2011 and again in 2016-2017, a structured contextualized approach to guide actionable evidence generation activities in SEAR has been lacking. In the backset of the Global Influenza Strategy 2019-2030 and the COVID-19 pandemic, attuning research endeavors in SEAR could help in improved pandemic influenza preparedness planning. There is a need to prioritize contextually relevant research themes within priority streams. Member states must inculcate a culture of within and inter-country collaboration to produce evidence that has regional as well as global value.

The effect of self-esteem on the spread of a pandemic. A cross-country analysis of the role played by self-esteem in the spread of the COVID-19 pandemic

Extant research on COVID-19 suggests that many socio-economic determinants, by affecting personal behavior, have influenced the evolution of the pandemic. In this paper we study the role played in this regard by average levels of self-esteem in the public. There are reasons to believe that both low and very levels of self-esteem may have an effect on the spread of COVID-19, for opposite reasons. On the one hand, people with low self-esteem may not worry enough to behave in the way recommended (and prescribed, through non-pharmaceutical interventions) by the authorities; people with very high self-esteem, on the other hand, may be over-confident and fail to follow the prescriptions, believing that they do not need them. In this study we test this hypothesis by means of a quantitative cross-country analysis, using a hybrid model and the Rosenberg self-esteem scale. Our results suggest the existence of a U-shaped relationship between the trend of COVID-19 and average levels of self-esteem in a country.

Assessing the effectiveness of the intervention measures of COVID-19 in China based on dynamical method

Normalized interventions were implemented in different cities in China to contain the outbreak of COVID-19 before December 2022. However, the differences in the intensity and timeliness of the implementations lead to differences in final size of the infections. Taking the outbreak of COVID-19 in three representative cities Xi'an, Zhengzhou and Yuzhou in January 2022, as examples, we develop a compartmental model to describe the spread of novel coronavirus and implementation of interventions to assess concretely the effectiveness of Chinese interventions and explore their impact on epidemic patterns. After applying reported human confirmed cases to verify the rationality of the model, we apply the model to speculate transmission trend and length of concealed period at the initial spread phase of the epidemic (they are estimated as 10.5, 7.8, 8.2 days, respectively), to estimate the range of basic reproduction number (2.9, 0.7, 1.6), and to define two indexes (transmission rate v _t and controlled rate v _c ) to evaluate the overall effect of the interventions. It is shown that for Zhengzhou, v _c is always more than v _t with regular interventions, and Xi'an take 8 days to achieve v _c  > v _t twice as long as Yuzhou, which can interpret the fact that the epidemic situation in Xi'an was more severe. By carrying out parameter values, it is concluded that in the early stage, strengthening the precision of close contact tracking and frequency of large-scale nucleic acid testing of non-quarantined population are the most effective on controlling the outbreaks and reducing final size. And, if the close contact tracking strategy is sufficiently implemented, at the late stage large-scale nucleic acid testing of non-quarantined population is not essential.

The SEIR model incorporating asymptomatic cases, behavioral measures, and lockdowns: Lesson learned from the COVID-19 flow in Sweden

The Sweden approach is unique in handling the COVID-19 flow, compared to other European countries. While other countries have practiced the full lockdowns, Sweden has practiced the lighter lockdowns or the partial lockdowns as public spaces such as cafes and restaurants are allowed to serve their customers subject to government recommendations. This study aims to develop an SEIR model for Sweden capturing important issues such as the roles of behavioral measures, partial lockdowns, and undocumented cases. The suggested SEIR model is probably the first SEIR model capturing the roles of behavioral measures, partial lockdowns, hospital preparedness, and asymptomatic cases for Sweden. The SEIR model can successfully reproduce similar main observed outputs, namely documented infected cases and documented death cases. This study finds that the effects of partial lockdowns effectively start 52 days after the first confirmed case. Again, behavioral measures and partial lockdowns reduce possible infected cases about 22% and 70% respectively. This study also suggests that the Sweden government should step up to the full lockdowns by conducting public closures so COVID-19 flow can be curtailed significantly. Likewise, owing to airborne transmission, protecting vulnerable people such as senior citizens should be prioritised.

Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method

Background

The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA.

Objective

The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19.

Methods

We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages.

Results

We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between –0.05 and –1.46 due to the assistance of continuous restrictions. However, 58.6% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic.

Conclusions

The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19.

The optimality of age-based lockdown policies

This paper studies an age-based lockdown that keeps over-60 workers at home as policy response to COVID-19 pandemic in a sample of thirty countries of the European single market. Three main policy issues are addressed, and the results can be summarized as follows. First, age-based lockdown policies are associated with limited output losses and, therefore, are an efficient strategy to limit the spread of the virus in a pandemic, especially in presence of strong age-dependent fatality rates. Second, lockdown policies generate substantial spillover effects; hence, international policy coordination avoiding that too many countries are in lockdown contemporaneously or that such coordination takes place across the countries with the highest integration of over-60 workers along GVCs may be helpful in reducing disruptions. Third, non-targeted lockdowns are much more costly than age-based ones; therefore, other things equal, age-based policies should always be preferred to non-targeted ones. Our analysis also suggests that, in our sample, the over-60 workers are relatively more numerous in sectors where the value added and the integration in GVCs is lower; this feature should be kept in mind in the design of other policies as it might play an important role.

Policy responses to COVID-19 pandemic waves: Cross-region and cross-sector economic impact

This paper proposes a modelling approach to assess the cross-region and cross-sector economic impacts of the restrictions imposed by governments to contain the COVID-19 pandemic. The nationwide lockdown imposed in Italy during the first wave of the pandemic is used as a benchmark. However, the adopted approach allows an ex-ante assessment of alternative policy responses, in the event of successive pandemic waves, in order to rationalise the policy intervention and reach the best possible compromise between containing the risk of contagion and reducing economic losses. The used approach consists of a non-linear programming model based on a multiregional Input-Output (I-O) table, which guarantees greater flexibility than traditional I-O analysis. It is applied to estimate both direct and indirect losses of GDP and employment produced by alternative policy responses represented by general and differentiated lockdowns. The evidence deriving from the Italian experience shows a sort of learning process through successive waves based on the introduction of increasingly flexible and tailored policy responses to the pandemic.

Classification Schemes of COVID-19 High Risk Areas and Resulting Policies: A Rapid Review

The COVID-19 pandemic has posed a significant global health threat since January 2020. Policies to reduce human mobility have been recognized to effectively control the spread of COVID-19; although the relationship between mobility, policy implementation, and virus spread remains contentious, with no clear pattern for how countries classify each other, and determine the destinations to- and from which to restrict travel. In this rapid review, we identified country classification schemes for high-risk COVID-19 areas and associated policies which mirrored the dynamic situation in 2020, with the aim of identifying any patterns that could indicate the effectiveness of such policies. We searched academic databases, including PubMed, Scopus, medRxiv, Google Scholar, and EMBASE. We also consulted web pages of the relevant government institutions in all countries. This rapid review's searches were conducted between October 2020 and December 2021. Web scraping of policy documents yielded additional 43 country reports on high-risk area classification schemes. In 43 countries from which relevant reports were identified, six issued domestic classification schemes. International classification schemes were issued by the remaining 38 countries, and these mainly used case incidence per 100,000 inhabitants as key indicator. The case incidence cut-off also varied across the countries, ranging from 20 cases per 100,000 inhabitants in the past 7 days to more than 100 cases per 100,000 inhabitants in the past 28 days. The criteria used for defining high-risk areas varied across countries, including case count, positivity rate, composite risk scores, community transmission and satisfactory laboratory testing. Countries either used case incidence in the past 7, 14 or 28 days. The resulting policies included restrictions on internal movement and international travel. The quarantine policies can be summarized into three categories: (1) 14 days self-isolation, (2) 10 days self-isolation and (3) 14 days compulsory isolation.

Fighting the COVID pandemic: National policy choices in non-pharmaceutical interventions

The COVID-19 pandemic pushed countries to adopt various non-pharmaceutical interventions (NPIs). Due to the features of the pandemic, which spread over time and space, governments could decide whether or not to follow policy choices made by leaders of countries affected by the virus before them. In this study, we aim to empirically model the adoption of NPIs during the first wave of COVID-19 in the 14 European countries with more than 10 million inhabitants, in order to detect whether a policy diffusion mechanism occurred. By means of a multivariate approach based on Principal Component Analysis and Cluster Analysis, we manage to derive three clusters representing different behaviour models to which the different European countries belong in the different periods of the first wave: pre-pandemic, summer relaxation and deep-lockdown scenarios. These results bring a two-fold contribution: on the one hand, they may help us to understand differences and similarities among European countries during the first wave of the COVID-19 outbreak and guide future quantitative or qualitative studies; on the other, our findings suggest that with minor exceptions (such as Sweden and Poland), different countries adopted very similar policy strategies, which are likely to be due more to the unfolding of the pandemic than to specific governmental strategies.