The SARS-CoV-2 pandemic: A syndemic perspective

A Unique mRNA Vaccine Elicits Protective Efficacy against the SARS-CoV-2 Omicron Variant and SARS-CoV

The highly pathogenic coronaviruses SARS-CoV-2 and SARS-CoV have led to the COVID-19 pandemic and SARS outbreak, respectively. The receptor-binding domain (RBD) of the spike (S) protein of SARS-CoV-2, particularly the Omicron variant, has frequent mutations, resulting in the reduced efficiency of current COVID-19 vaccines against new variants. Here, we designed two lipid nanoparticle-encapsulated mRNA vaccines by deleting the mutant RBD of the SARS-CoV-2 Omicron variant (SARS2-S (RBD-del)) or by replacing this mutant RBD with the conserved and potent RBD of SARS-CoV (SARS2-S (SARS-RBD)). Both mRNA vaccines were stable at various temperatures for different time periods. Unlike SARS2-S (RBD-del) mRNA, SARS2-S (SARS-RBD) mRNA elicited effective T-cell responses and potent antibodies specific to both SARS-CoV-2 S and SARS-CoV RBD proteins. It induced strong neutralizing antibodies against pseudotyped SARS-CoV-2 and SARS-CoV infections and protected immunized mice from the challenge of the SARS-CoV-2 Omicron variant and SARS-CoV by significantly reducing the viral titers in the lungs after Omicron challenge and by completely preventing SARS-CoV-induced weight loss and death. SARS2-S (SARS-RBD)-immunized serum antibodies protected naïve mice from the SARS-CoV challenge, with its protective efficacy positively correlating with the neutralizing antibody titers. These findings indicate that this mRNA vaccine has the potential for development as an effective vaccine against current and future SARS-CoV-2 variants and SARS-CoV.

The COVID-19 quandemic

BACKGROUND

The terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic - a portmanteau of "quantification" and "pandemic".

MAIN TEXT

The use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management. Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking.

CONCLUSION

A quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities.

The Integrated Health Monitor COVID-19: A Protocol for a Comprehensive Assessment of the Short- and Long-Term Health Impact of the Pandemic in the Netherlands

BACKGROUND

The global COVID-19 pandemic has profoundly affected public health. Directly, the pandemic resulted in over 6.6 million deaths, numerous hospitalizations, and widespread illness. The pandemic has also affected health indirectly through government-imposed protective measures, causing decline in mental well-being and increasing social isolation. Unlike previous disasters or crises, the pandemic's worldwide and enduring impact necessitates a unique research approach. The Network for Health Research in Disasters in the Netherlands responded by initiating a longitudinal, extensive research project called the Integrated Health Monitor COVID-19. The Integrated Health Monitor COVID-19 explores both the direct and indirect health effects of the pandemic at the population level.

METHODS

The Integrated Health Monitor COVID-19 employs a dual-pronged monitoring strategy alongside an annual literature review. This strategy comprises short-cycle monitoring (conducted quarterly) and long-cycle monitoring (conducted once every one or two years). This comprehensive approach enables the evaluation of health trends during the pandemic, facilitating comparisons with pre-pandemic levels and identification of risk and protective factors. Both monitoring methods incorporate data from surveys and general practice registries. The integration of annual literature reviews with these measurements enables iterative research, while dialogues on policy and practice improvements enhance the knowledge-to-action process.

DISCUSSION

Much of the existing knowledge about the potential impact of the COVID-19 pandemic is derived from research on sudden-onset disasters limited to specific geographical areas. This study is anticipated to provide valuable fresh insights into the evolving dynamics of population health and specific vulnerabilities within the ongoing pandemic context.

Years of life lost to COVID-19 in 49 countries: A gender- and life cycle-based analysis of the first two years of the pandemic

Specific mortality rates have been widely used to monitor the main impacts of the COVID-19 pandemic; however, a more meaningful measure is the Years of Life Lost (YLL) due to the disease, considering it takes into account the premature nature of each death. We estimated the YLL due to COVID-19 between January 2020 and December 2021 in 49 countries for which information was available, developing an analytical method that mathematically refines that proposed by the World Health Organization. We then calculated YLL rates overall, as well as by sex and life cycle. Additionally, we estimated the national cost-effective budgets required to manage COVID-19 from a health system perspective. During the two years of analysis, we estimated that 85.6 million years of life were lost due to COVID-19 in the 49 countries studied. However, due to a lack of data, we were unable to analyze the burden of COVID-19 in about 75% of the countries in the world. We found no difference in the magnitude of YLL rates by gender but did find differences according to life cycle, with older adults contributing the greatest burden of YLL. The COVID-19 pandemic has posed a significant burden of disease, which has varied between countries. However, due to the lack of quality and disaggregated data, it has been difficult to monitor and compare the pandemic internationally. Therefore, it is imperative to strengthen health information systems in order to prepare for future pandemics as well as to evaluate their impacts.

SARS-CoV-2 RNA in Wastewater and Bivalve Mollusk Samples of Campania, Southern Italy

SARS-CoV-2 can be detected in the feces of infected people, consequently in wastewater, and in bivalve mollusks, that are able to accumulate viruses due to their ability to filter large amounts of water. This study aimed to monitor SARS-CoV-2 RNA presence in 168 raw wastewater samples collected from six wastewater treatment plants (WWTPs) and 57 mollusk samples obtained from eight harvesting sites in Campania, Italy. The monitoring period spanned from October 2021 to April 2022, and the results were compared and correlated with the epidemiological situation. In sewage, the ORF1b region of SARS-CoV-2 was detected using RT-qPCR, while in mollusks, three targets-RdRp, ORF1b, and E-were identified via RT-dPCR. Results showed a 92.3% rate of positive wastewater samples with increased genomic copies (g.c.)/(day*inhabitant) in December-January and March-April 2022. In the entire observation period, 54.4% of mollusks tested positive for at least one SARS-CoV-2 target, and the rate of positive samples showed a trend similar to that of the wastewater samples. The lower SARS-CoV-2 positivity rate in bivalve mollusks compared to sewages is a direct consequence of the seawater dilution effect. Our data confirm that both sample types can be used as sentinels to detect SARS-CoV-2 in the environment and suggest their potential use in obtaining complementary information on SARS-CoV-2.

Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study

Introduction

Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study.

Methods

An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics.

Results

Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers.

Conclusions

COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.

Health inequalities and social determinants of health: The role of syndemics in rheumatic disease

A syndemic is the co-existence of two or more health problems (including both social and biological features) that adversely influence each other with negative consequences on disease outcomes and perpetuation of inequalities. The syndemic approach can be applied to better understand the course of rheumatic musculoskeletal diseases (RMD) involving the study of adverse biological pathways and social determinants of health (SDH) all under the same framework. Identifying if a syndemic exists within RMDs may include investigating the synergic interactions between comorbidity (e.g., diabetes, obesity, chronic kidney diseases) and the concomitant of other adverse conditions (e.g., drug non-adherence, substance abuse), along with SDHs such as low household income, unemployment, low education, limited access to health care, as well as racial/ethnic discrimination. For decades, the understanding of RMDs progression has been based on causality, rather than investigating the kaleidoscopic web of connections that can potentially influence a disease course. The co-existence of health burdens in vulnerable populations, including those with RMD, specifically in certain socioeconomic groups, calls for new ways and strategies of thinking to improve our understanding of risk factors and co-morbidities to offer tailored interventions for clinical medicine and public health policy.

Purity, Danger, and Patriotism: The Struggle for a Veteran Home during the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic rendered congregate shelter settings high risk, creating vulnerability for people experiencing homelessness (PEH). This study employed participant observation and interviews over 16 months in two Veteran encampments, one located on the grounds of the West Los Angeles Veteran Affairs Medical Center (WLAVA) serving as an emergency COVID-19 mitigation measure, and the other outside the WLAVA gates protesting the lack of onsite VA housing. Study participants included Veterans and VA personnel. Data were analyzed using grounded theory, accompanied by social theories of syndemics, purity, danger, and home. The study reveals that Veterans conceptualized home not merely as physical shelter but as encompassing a sense of inclusion and belonging. They sought a Veteran-run collective with a harm reduction approach to substance use, onsite healthcare, and inclusive terms (e.g., no sobriety requirements, curfews, mandatory treatment, or limited lengths of stay). The twin encampments created distinct forms of community and care that protected Veterans from COVID-19 infection and bolstered collective survival. The study concludes that PEH constitute and belong to communities that provide substantial benefits even while amplifying certain harms. Housing interventions must consider how unhoused individuals become, or fail to become, integrate into various communities, and foster therapeutic community connections.

In the Shadow of COVID-19: The Well-Being and Rights of People Living with Dementia in Finland During the Pandemic

BACKGROUND

Exceptional circumstances such as the COVID-19 pandemic increase the risk for vulnerability among people living with dementia.

OBJECTIVE

This article discusses the well-being and rights of people living with dementia in Finland during the pandemic and analyses the legal framework covering the restrictions of their rights during that period.

METHODS

The empirical research comprises a survey of persons with dementia (n = 31) and their family members (n = 168). The participants completed a total of 13 survey items involving questions about their well-being during the pandemic, restrictions on freedom, access to services, information on pandemic regulations and guidelines as well as possible problems with authorities. The survey included both multiple choice and open-ended questions.

RESULTS

According to people with dementia and their family members, by spring 2021, the pandemic had reduced meaningful activities available to people living with dementia in Finland and decreased the number of meetings between them and other people. Many reported a decline in their physical and/or mental well-being or greater difficulty or delays in accessing social and health services. Over a third of respondents found that the right to meet people was restricted among people with dementia, and almost half of the respondents took the view that their freedom of movement was restricted. There were also major shortcomings in terms of information on restrictions.

CONCLUSION

The results highlight the importance of bearing in mind the negative effects that restrictions on mobility, meeting other people and meaningful activities can have on the well-being of people living with dementia. This should be considered, for example, when reforming legislation.

Multimorbidity and SARS-CoV-2-Related Outcomes: Analysis of a Cohort of Italian Patients

BACKGROUND

Since the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples.

OBJECTIVE

The objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab.

METHODS

Data were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years).

RESULTS

Of 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes.

CONCLUSIONS

Our study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions.

Environment and COVID-19 incidence: A critical review

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented worldwide health crisis. Many previous research studies have found and investigated its links with one or some natural or human environmental factors. However, a review on the relationship between COVID-19 incidence and both the natural and human environment is still lacking. This review summarizes the inter-correlation between COVID-19 incidence and environmental factors. Based on keyword searching, we reviewed 100 relevant peer-reviewed articles and other research literature published since January 2020. This review is focused on three main findings. One, we found that individual environmental factors have impacts on COVID-19 incidence, but with spatial heterogeneity and uncertainty. Two, environmental factors exert interactive effects on COVID-19 incidence. In particular, the interactions of natural factors can affect COVID-19 transmission in micro- and macro- ways by impacting SARS-CoV-2 survival, as well as human mobility and behaviors. Three, the impact of COVID-19 incidence on the environment lies in the fact that COVID-19-induced lockdowns caused air quality improvement, wildlife shifts and socio-economic depression. The additional value of this review is that we recommend future research perspectives and adaptation strategies regarding the interactions of the environment and COVID-19. Future research should be extended to cover both the effects of the environment on the COVID-19 pandemic and COVID-19-induced impacts on the environment. Future adaptation strategies should focus on sustainable environmental and public policy responses.

Incidence and characterisation of post-COVID-19 symptoms in hospitalized COVID-19 survivors: A single centre, prospective observational cohort study to recognize the syndemic connotations in India

BACKGROUND

Long COVID or post-COVID-19 syndrome is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to pre pandemic states, post-COVID-19 state tends to be less recognised from low middle income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of the COVID 19, it is important to characterise post-COVID-19 syndrome.

OBJECTIVE

We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February 2021 to July 2021 from a tertiary care centre in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in non-ICU and ICU patients, assessing the persistence, severity and characteristics of post-COVID-19 manifestations and elucidating the risk factors associated with the presence of post-COVID-19 manifestations.

METHODS

120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after informed written consent. The cohort included 50 patients requiring Intensive care unit and 70 patients with non-intensive care. The follow-up was conducted on the second and sixth week after discharge with a structured questionnaire. The questionnaire was filled by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow up at 6 weeks.

RESULTS

: Mean age of the cohort was 55 years and 55% were males. Only (5%) of the cohort had taken the first dose of COVID-19 vaccination.58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. 60.8% (n=73) of patients had at least one persistent symptom at sixth week of discharge. 50 (41.7%) patients required intensive care during their inpatient stay. Presence of persistent symptoms at 6 weeks was not associated with severity of illness, age or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8% followed by dyspnoea (20%) and weight loss (16.7%). Female sex (OR 2.4, 95% CI: 1.03-5.58, P=.04) and steroid administration during hospital stay (OR: 4.43; 95% CI: 1.9-10.28, P=.001), were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis.

CONCLUSIONS

60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 week's post- discharge from hospital. Incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate and severe COVID-19 severity categories. Female sex and steroid administration during hospital stay were identified as predictors of persistence of post-COVID-19 symptoms at 6 weeks.

CLINICALTRIAL

The ecosyndemic framework of the global environmental change and the COVID-19 pandemic

The ecosyndemic theory combines the concept of 'synergy' with 'epidemic' and the term "eco" implies the role of the environmental changes. Each of the conditions enhances the negative impacts of the other in an additive way making our society more vulnerable and heightening individual risk factors. In this study, we analyze the mutually reinforcing links between the environment and health from the complexity angle of the ecosyndemic theory and propose the characterization of the COVID-19 pandemic as ecosyndemic. We use the term 'ecosyndemic' because the global environmental change contributes to local-scale, regional-scale and global-scale alterations of the Earth's systems. These changes have their root causes in the way that people interact with the physical, chemical, and biotic factors of the environment. These interactions disturb nature and the consequences have feedbacks in every living organism.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

BACKGROUND

Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes.

METHODS

A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included.

RESULTS

Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes.

CONCLUSIONS

Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

Adequação dos serviços odontológicos do Paraná no enfrentamento da Covid-19: um estudo transversal

RESUMO O objetivo deste estudo transversal foi identificar adequações quanto à utilização de Equipamentos de Proteção Individual e organização do processo de trabalho no atendimento odontológico ambulatorial no Paraná durante o primeiro ano da pandemia da Covid-19. A amostra de conveniência incluiu 1.105 profissionais de saúde bucal (cirurgiões-dentistas, técnicos e auxiliares em saúde bucal) durante o primeiro ano da pandemia (agosto a outubro de 2020). Formulário on-line (Google Formulários®) foi enviado por e-mail pelo Conselho Regional de Odontologia. As medidas de enfrentamento da Covid-19 foram comparadas entre os tipos de serviços odontológicos: ambulatorial do Sistema Único de Saúde – SUS (Atenção Primária, Centro de Especialidades Odontológicos e Pronto Atendimento), clínica privada, e outros (Sistema S, forças de segurança, sindicatos, hospitais públicos e privados e clínicas de ensino). Os profissionais dos serviços ambulatoriais do SUS relataram com maior frequência que: suspenderam atendimentos eletivos, evitavam gerar aerossóis e trabalhavam a quatro mãos. Nas clínicas privadas, utilizavam frequentemente teleorientação e telemonitoramento. Nos ‘outros serviços’, houve maior proporção de redução das horas de trabalho e autoclavagem de peças de mão após cada atendimento. Conclui-se que, apesar da alta adequação às medidas de enfrentamento da Covid-19, houve diferença na prática profissional nos diferentes tipos de serviços odontológicos.

Viral Neoliberalism: The Road to Herd Immunity Still A Rocky One

The objective of this article is to assess the dominant global economic system and the resulting power relations from the perspective of the strategies used worldwide against the SARS-CoV-2 pandemic. The predominantly biomedical approach has not sufficiently taken into account the actual dimension of COVID-19 as a syndemic. While the much longer-term pandemic caused by the neoliberalism virus has not been systematically considered by public and global health scholars in the context of COVID-19, it exhibits essential characteristics of an infectious pathogen, and the symptoms can be described and detected according to biomedical criteria. Even more, the severity of leading symptoms of neoliberalism such as growing inequities calls for immunization campaigns and ultimately herd immunity from viral neoliberalism. However, achieving worldwide immunity would require an anti-neoliberal vaccine, which is extremely challenging to develop vis-à-vis the power relations in global health.

Emerging from the global syndemic crucible: Finding belonging in a post corona future

The covid-19 global syndemic has upended societies worldwide and concomitantly united the world in a shared experience of lockdowns, social distancing, and economic upheaval. In the face of great uncertainty, dystopian realities, and binding government edicts, people's everyday lives, sense of agency, actions, and interactions changed forcibly. Importantly, it has disrupted many practices and routines essential for (re)constituting a sense of belonging, an important element of personhood and individual wellbeing. Using the "Letters from the Future" method, we investigate how individuals imagine and present themselves in the future to navigate this social change. We ask "How do letter writers construct a sense of belonging in a future of their own imagining?" To answer this question, we combine discourse- and text analysis with network analysis to examine 47 letters that Greek participants wrote during the Spring 2020 lockdown. We explore how individuals present and introduce their future self, what topos this self inhabits and what expressions, values, and practices they perform and negotiate as they reflect on and navigate their relational worlds. By and large, Greek letter writers recognize that inequities and injustices paved the way for the syndemic and express a pressing need for societal transformation.

[Social determinants associated with self-reporting of symptoms and access to COVID-19 testing and diagnosis in the Plurinational State of BoliviaDeterminantes sociais associados ao autorrelato de sintomas, acesso a testagem e diagnóstico de COVID-19 no Estado Plurinacional da Bolívia]

Objective

To identify the prevalence of self-reporting of symptoms and access to testing and diagnosis of coronavirus-19 disease (COVID-19), as well as its association with social determinants of health (SDH).

Methods

Cross-sectional study with a sample of 11 728 men and 12 612 women over the age of 17, based on the National Household Survey 2020. The dependent variables were the self-reporting of symptoms, access to testing, and a positive COVID-19 test. The independent variables were age, educational level, area of residence and geographic area, ethnicity, type of household, income per capita, occupation, and health insurance. Prevalences, bivariate associations, and binomial logistical regression models (odds ratio (OR), and 95% confidence interval (CI95%) were calculated.

Results

Of the total individuals included, 16% reported symptoms, 10% a test, and 4.2% a positive COVID-19 test. Inequalities were observed in the reporting of COVID-19 symptoms, with a higher probability in women whose income had fallen (OR: 1.7; CI95%: 1.2-2.4) and unemployed persons (OR: 1.2; CI95%: 1.1-1.4 for men and OR: 1.3; CI95%: 1.5-1.5 for women). In contrast, with respect to access to diagnostic tests, the highest probability was observed in people with higher education (OR: 2.4; CI95%: 1.9-2.9 for men and OR: 2.7; CI95%: 2.2-3.4 for women), whose income was maintained (OR: 1.5; CI95%: 1.3-1.9 for men and OR: 1.7; CI95%: 1.4-2.0 for women) and those in the highest quartile of per capita household income (OR: 2.0; CI95%: 1.6-2.5 for men and OR: 1.6; CI95%: 1.3-2.0 for women). The probability of reporting symptoms and getting tested, and being diagnosed with COVID-19 increased with age for people with health insurance and those living in the llanos region; however, it decreased for residents of rural areas.

Conclusions

There are inequalities in access to testing and the reporting of COVID-19 symptoms.

Tuberculosis in the Russian Federation: Dynamics of the Epidemic Indicators before and after COVID-19 Pandemic

The measures taken against tuberculosis (TB) in recent years in the Russian Federation have been highly effective. Unfortunately, the COVID-19 pandemic may seriously undermine the progress that has been made in the fight against TB. The aim of this study was to assess changes in the epidemiological rates of tuberculosis in the Russian Federation before and after the COVID-19 pandemic. Materials and methods. The analysis was conducted by considering the main epidemiological indicators of tuberculosis, according to the federal statistics for the period from 2017 to 2021. The parameters were estimated according to the data received from 11 areas in the North-Western region. Statistical analysis was carried out using the free software computing environment R (v.3.5.1) and the commercial software package Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 24.0, IBM Corp., 2016). Research results. We found a positive correlation between the incidence among the overall population and the incidence among children aged 0–17, inclusively (r = 0.55 in 2017, r = 0.60 in 2020, and r = 0.53 in 2021). Along with the received regularities, a different trend is shown in the data analysis of general incidence and health X-ray examination for tuberculosis among the general population. The correlation has decreased threefold from 2017 (r = 0.72) to 2020 (r = 0.32); this negative trend might be the result of factors such as the quality of X-ray screening examinations among the general population, and the reduced assessment objectivity of the tuberculosis incidence rate. Conclusions. In assessing the correlation between general incidence and incidence in children under 17 years of age, as well as between incidence and mortality in the Russian Federation, a positive correlation was found with an increasing trend. Such a discrepancy might be due to decreases in the occupational health examination coverage among the general population. Therefore, in the years ahead, we can expect epidemiological indicators to increase incidence and mortality, including child mortality, associated with the insufficient detection of tuberculosis among the population during the COVID-19 pandemic.

Covid-19 pandemic and Brazilian Nursing: unveiling meanings of work

The objective of this study was to reflect on the meanings of the work of Brazilian nursing care in the context of the Covid-19 pandemic. This is a theoretical study anchored in the definition of meanings of work, according to Estelle Morin's perspective. The work developed by nursing professionals became even more evident in pandemic times, with the precarious conditions of health services in Brazil coming to light. During the pandemic, the incorporation of meanings of work became more important, given that the society recognized the relevance of these professionals in dealing with the pandemic, and this allowed the discussion about their social, political, and economic recognition. The impacts of nursing performance during the Covid-19 pandemic are related to the economic issue, social values, autonomy in the exercise of the profession, recognition, and safety, reflecting on the sense of purpose of work. Thus, the work that makes sense for nursing professionals is related to professional appreciation, specifically, to salary recognition, while what makes no sense is what hinders intellectual, cognitive, and financial progress. Thus, conditions were imposed that give directions to ambivalent meanings to work.

COVID-19's impact on type 1 diabetes management: A mixed-methods study exploring the Peruvian experience

INTRODUCTION

The COVID-19 pandemic has negatively impacted health services, especially in low-and-middle-income countries, where care for chronic conditions such as diabetes was disrupted. Our study aims to describe the challenges faced by people living with Type 1 diabetes mellitus (T1DM) to access care during the COVID-19 pandemic in Peru.

METHODS

A sequential explanatory mixed-method study was conducted between May and September 2020 including health professionals involved in T1DM care, people with T1DM and their caregivers. The study consisted of a quantitative strand to gather general information through electronic surveys and a qualitative strand that involved in-depth interviews.

RESULTS

For the quantitative study, we included 105 people with T1DM, 50 caregivers and 76 health professionals. The qualitative study included a total of 31 interviews; 16 people with T1DM, 14 health care professionals, and one representative from the Peruvian Ministry of Health (MoH). People with T1DM faced difficulties accessing consultations, insulin, monitoring devices and laboratory testing during the pandemic. Different phases of the Peruvian health system response were found. Firstly, an initial informal response to addressing T1DM care during the pandemic characterised by local initiatives to ensure continuity of care for people with T1DM. Following from this, a formal response was implemented by the MoH which focussed on reinforcing the primary level of care. Measures included teleconsultations and delivery of medicines, although these were not implemented in all health care establishments. Throughout the pandemic patient associations played an important role in organising and helping to counteract the impact of COVID-19 on people with T1DM.

CONCLUSIONS

The Peruvian health care system slowly adapted to the COVID-19 pandemic to provide care for people with T1DM. However, people with T1DM had difficulties to access care. Thus, reinforcement of interventions such as communication between levels of care, teleconsultations and delivery of medicines was urgently needed. Patient associations' capacity to respond should be considered by local authorities and civil society should be part of the health system response.

Advances in diagnostic tools for respiratory tract infections. From tuberculosis to COVID19: changing paradigms?

Respiratory tract infections (RTI) are one of the commonest reasons for seeking healthcare, but are amongst the most challenging diseases in terms of clinical decision making. Proper and timely diagnosis is critical in order to optimize management and prevent further emergence of antimicrobial resistance by misuse, or overuse of antibiotics. Diagnostic tools for RTI include those involving syndromic and etiological diagnosis: from clinical and radiological features to laboratory methods targeting both pathogen detection and host biomarkers, as well as their combinations in terms of clinical algorithms. They also include tools for predicting severity and monitoring treatment response. Unprecedented milestones have been achieved in the context of the COVID-19 pandemic, involving the most recent applications of diagnostic technologies both at genotypic and phenotypic level, which have changed paradigms in infectious respiratory diseases in terms of why, how and where diagnostics are performed. The aim of this review is to discuss advances in diagnostic tools that impact clinical decision making, surveillance and follow-up of RTI and tuberculosis. If properly harnessed, recent advances in diagnostic technologies, including omics and digital transformation emerge as an unprecedented opportunity to tackle ongoing and future epidemics while handling antimicrobial resistance from a One Health perspective.

Diversity regained: Precautionary approaches to COVID-19 as a phenomenon of the total environment

As COVID-19 emerged as a phenomenon of the total environment, and despite the intertwined and complex relationships that make humanity an organic part of the Bio- and Geospheres, the majority of our responses to it have been corrective in character, with few or no consideration for unintended consequences which bring about further vulnerability to unanticipated global events. Tackling COVID-19 entails a systemic and precautionary approach to human-nature relations, which we frame as regaining diversity in the Geo-, Bio-, and Anthropospheres. Its implementation requires nothing short of an overhaul in the way we interact with and build knowledge from natural and social environments. Hence, we discuss the urgency of shifting from current to precautionary approaches to COVID-19 and look, through the lens of diversity, at the anticipated benefits in four systems crucially affecting and affected by the pandemic: health, land, knowledge and innovation. Our reflections offer a glimpse of the sort of changes needed, from pursuing planetary health and creating more harmonious forms of land use to providing a multi-level platform for other ways of knowing/understanding and turning innovation into a source of global public goods. These exemplary initiatives introduce and solidify systemic thinking in policymaking and move priorities from reaction-based strategies to precautionary frameworks.

Surveillance and Control of African Swine Fever in the Early Phase of the COVID-19 Pandemic, March-May 2020: A Multi-Country E-Survey

Stringent COVID-19 public health and social measures (PHSMs) have challenged the work of animal health professionals, especially in the early phase of the pandemic. We aimed to qualitatively describe how COVID-19 PHSMs have affected the surveillance and control of African swine fever (ASF) in Europe, assess how professionals engaged in these activities perceived the impact of the COVID-19 crisis, and identify potential areas of improvement. An online questionnaire was proposed via email between 9 December 2020 and 22 January 2021 to professionals engaged in ASF-related activities in Europe and Eastern neighboring countries. The questionnaire contained questions pertaining to ASF surveillance and control activities between March and May 2020, respondent's perception of the impact of COVID-19 PHSMs on these activities, and respondent's opinion on potential improvements to prepare for future crises. Economic and sanitary variables were used to describe the national contexts over the study period. Twenty-seven respondents from 24 countries participated to the study. Essential activities related to surveillance and management of ASF were reduced and/or adapted but maintained in most surveyed countries. Communication was mentioned as the first area of improvement during crisis while maintenance of efficient veterinary services and surveillance activities were cited second and third top priorities. The need for the development of remote procedures was also recognized. Some respondents highlighted difficulties in ensuring biosecurity and biosafety of the field actors due to shortage in protective equipment. Only a small majority (52%) of the survey participants agreed that their institution/working group is better prepared to future lockdown-type situations. Our study emphasizes that short-term measures were globally successful to tackle the immediate impacts of the COVID-19 crisis on the routine duties of professionals involved in ASF surveillance and control. Our findings suggest that country-specific improvements are necessary to support and advance the preparedness of the actors involved in infectious animal disease surveillance and control in case lockdown-like measures are implemented. Overall, our results highlight the crucial importance of recognizing animal health services as essential activities during crisis.

The COVID-19/Tuberculosis Syndemic and Potential Antibody Therapy for TB Based on the Lessons Learnt From the Pandemic

2020 will be marked in history for the dreadful implications of the COVID-19 pandemic that shook the world globally. The pandemic has reshaped the normality of life and affected mankind in the aspects of mental and physical health, financial, economy, growth, and development. The focus shift to COVID-19 has indirectly impacted an existing air-borne disease, Tuberculosis. In addition to the decrease in TB diagnosis, the emergence of the TB/COVID-19 syndemic and its serious implications (possible reactivation of latent TB post-COVID-19, aggravation of an existing active TB condition, or escalation of the severity of a COVID-19 during TB-COVID-19 coinfection), serve as primary reasons to equally prioritize TB. On a different note, the valuable lessons learnt for the COVID-19 pandemic provide useful knowledge for enhancing TB diagnostics and therapeutics. In this review, the crucial need to focus on TB amid the COVID-19 pandemic has been discussed. Besides, a general comparison between COVID-19 and TB in the aspects of pathogenesis, diagnostics, symptoms, and treatment options with importance given to antibody therapy were presented. Lastly, the lessons learnt from the COVID-19 pandemic and how it is applicable to enhance the antibody-based immunotherapy for TB have been presented.

Emergence of epidemic diseases: zoonoses and other origins

Infectious diseases emerge via many routes and may need to overcome stepwise bottlenecks to burgeon into epidemics and pandemics. About 60% of human infections have animal origins, whereas 40% either co-evolved with humans or emerged from non-zoonotic environmental sources. Although the dynamic interaction between wildlife, domestic animals, and humans is important for the surveillance of zoonotic potential, exotic origins tend to be overemphasized since many zoonoses come from anthropophilic wild species (for example, rats and bats). We examine the equivocal evidence of whether the appearance of novel infections is accelerating and relate technological developments to the risk of novel disease outbreaks. Then we briefly compare selected epidemics, ancient and modern, from the Plague of Athens to COVID-19.

Promoting a Syndemic Approach for Cardiometabolic Disease Management During COVID-19: The CAPISCO International Expert Panel

Efforts in the fight against COVID-19 are achieving success in many parts of the world, although progress remains slow in other regions. We believe that a syndemic approach needs to be adopted to address this pandemic given the strong apparent interplay between COVID-19, its related complications, and the socio-structural environment. We have assembled an international, multidisciplinary group of researchers and clinical practitioners to promote a novel syndemic approach to COVID-19: the CArdiometabolic Panel of International experts on Syndemic COvid-19 (CAPISCO). This geographically diverse group aims to facilitate collaborative-networking and scientific exchanges between researchers and clinicians facing a multitude of challenges on different continents during the pandemic. In the present article we present our “manifesto”, with the intent to provide evidence-based guidance to the global medical and scientific community for better management of patients both during and after the current pandemic.

Syndemic: tautology and dichotomy in a new-old concept

ABSTRACT In the wake of the decade’s most severe pandemic, the term ‘syndemic’ reemerged as an alternative to better designate the nature assumed by COVID-19. The authors who advocate for this concept argue that it gives greater analytical breadth, which allows an understanding of the synergistic interactions between diseases and their social origins. This essay aims to analyze this concept in the light of historical-dialectical materialism. In particular, it dialogues with the Collective Health current devel- oped under the influence of Marxism. Thus, the category of social determination of the health-disease process is called to the debate when its greater breadth is revealed before the syndemic concept. We found that the concept under analysis is tautological and reproduces old dichotomies of the biomedical model while criticizing it.

Prevalence and predictors of hypertension: Evidence from a study of rural India

Background:

Raised blood pressure (BP) is the leading global risk factor for cardiovascular diseases and a major cause of premature death. Worldwide, one in four men and one in five women are hypertensive. For effective preventive strategy, understanding of predictors of hypertension is necessary.

Objective:

To assess prevalence and predictors of hypertension in the rural adult Indian population.

Material and Methods:

This cross-sectional study was carried out on 425 rural subjects (25–64 years) of the Varanasi district in India selected through multistage sampling. Blood pressure of each subject was measured using a standard technique. Sociodemographic data and predictors of hypertension were assessed by interviewing subjects with help of a predesigned and pretested proforma.

Results:

Prevalence of hypertension was 31.5% (95% CI: 27.1–35.9). There existed a significant (P < 0.05) association of BP with age, educational status, occupation, socioeconomic class, tobacco consumption, waist circumference, waist-hip ratio, and nutritional status. No significant association was found with gender, religion, caste, marital status, type and size of family, family without NCDs, awareness of screening camps for NCDs and national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke, and alcohol consumption. Significant association of education, nutritional, and occupational status obtained in univariate analysis got eliminated in the logistic model. Risk of hypertension was higher in the 45–64 years age group (AOR: 3.06; 95% CI: 1.75–5.35) and in socioeconomic class IV and V (AOR: 2.24; 95% CI: 1.17–4.31).

Conclusion:

Prevalence of hypertension in the rural population was high and most of the observed predictors were modifiable.

Sindemia: tautologia e dicotomia em um novo-velho conceito

RESUMO No bojo da mais grave pandemia em décadas, o termo ‘sindemia’ ressurgiu como uma alternativa para melhor denominar o caráter assumido pela Covid-19. Os autores que defendem esse conceito argumentam que ele confere maior amplitude analítica, o que permite apreender as interações sinérgicas entre doenças e as suas origens sociais. O objetivo deste ensaio consistiu em analisar esse conceito à luz do materialismo histórico-dialético. Para tal, dialoga-se, sobremodo, com a corrente da saúde coletiva que se desenvolveu sob influência do marxismo. Assim, a categoria determinação social do processo saúde-doença é chamada ao debate quando se revela a sua maior amplitude ante o conceito de sindemia. Constatou-se que o conceito ora em análise é tautológico e reproduz velhas dicotomias do modelo biomédico, mesmo querendo criticá-lo.

The Syndemic Theory, the COVID-19 Pandemic, and The Epidemics of Non-Communicable Diseases (NCDs)

Background: The syndemic theory is based on the interaction of two or more epidemics. This phenomenon is important in the current COVID-19 pandemic. Results: This pandemic affects all aspects of human life, including the management of non-communicable diseases (NCDs) such as cancer, diabetes, hypertension, and so on. This effect may have an impact not only on the management of the underlying NCDs but also on the infection and prognosis of COVID-19. Another aspect of this syndemic is that the health policies in each country have been revolutionized as a result of this pandemic, and the association of COVID-19 with other NCDs necessitates the implementation of new policies to properly manage this syndemic. Conclusion: In this paper, we review the syndemic theory, how the COVID-19 pandemic could be classified as a syndemic with other NCDs, and how this pandemic changes circumstances for policymakers in any country, particularly the Islamic Republic of Iran.

Mental health in the Austrian general population during COVID-19: Cross-sectional study on the association with sociodemographic factors

INTRODUCTION

The impact of the Coronavirus disease (COVID-19) pandemic and the associated governmental restrictions on mental health have been reported in different countries. This cross-sectional study evaluated mental health during the COVID-19 pandemic in Austria and the association with sociodemographic factors (i.e., age, sex, education, income, employment status, partnership status, and migration background).

METHODS

A representative sample (N = 1,031) of the Austrian general population was surveyed online end of April 2022. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), alcohol abuse (CAGE), eating disorders (SCOFF), and stress (PSS-10).

RESULTS

1,031 participants completed the online survey (50.3% women; mean age: 45.6 ± 17.23 years). Cut-offs for clinically relevant depression were exceeded by 28%. 16% scored above the cut-off for clinically relevant anxiety symptoms, 15% for clinical insomnia, 18% for alcohol abuse, 26% for eating disorders, and 65% for moderate to high stress. Comparisons with another cross-sectional representative Austrian sample recruited during the first weeks of the COVID-19 pandemic in Austria (April 2020) revealed increases in depression (from 21 to 28%) but no significant changes in anxiety, insomnia, and moderate to high stress. Multivariable logistic regression showed the strongest associations of mental health indicators with age, income, and sex. Increasing age and income were associated with lower odds of mental health symptoms. Being female compared to male increased the odds of depressive symptoms while decreasing the odds of alcohol abuse.

DISCUSSION

The COVID-19 crisis seems particularly stressful for younger adults (<35 years) and people with low income (<€2,000 net household income per month). Policymakers need to consider the high social and economic costs of lockdowns and think of optimal intervention methods for mental disorders among young and low-income individuals.

Pandemia da Covid-19 e a Enfermagem brasileira: desvelando sentidos do trabalho

RESUMO Objetivou-se refletir sobre os sentidos do trabalho da Enfermagem assistencial brasileira no contexto da pandemia da Covid-19. Estudo teórico ancorado na definição de sentidos do trabalho, segundo a perspectiva de Estelle Morin. O trabalho desenvolvido pelos profissionais de Enfermagem ficou ainda mais evidenciado em tempos pandêmicos, vindo à tona as condições precárias dos serviços de saúde no Brasil. Durante a pandemia, a incorporação de sentidos ao trabalho passou a ter importância maior, tendo em vista que a sociedade reconheceu a relevância desses profissionais no enfrentamento da pandemia, e isso possibilitou a discussão acerca do seu reconhecimento social, político e econômico. Os impactos da atuação da Enfermagem durante a pandemia de Covid-19 têm relação com a questão econômica, valores sociais, autonomia no exercício da profissão, reconhecimento e segurança, refletindo na razão de ser do trabalho. Assim, o trabalho que faz sentido para os profissionais de Enfermagem relaciona-se à valorização profissional, especificamente, ao reconhecimento salarial, enquanto o que não faz sentido é aquele que impossibilita avanços do ponto de vista intelectual, cognitivo e financeiro. Dessarte, foram impostas condições que dão rumos para sentidos ambivalentes ao trabalho.

Challenges and Opportunities for Public Health Service in Oman From the COVID-19 Pandemic: Learning Lessons for a Better Future

Despite the apparent challenges inflicted by COVID-19 globally, the pandemic provided an opportunity to utilize and expand existing public health capacities for a more adaptive and resilient system during and after each wave of the disease. This paper provides a narrative review of Oman's public health response to the COVID-19 pandemic from January 2020 to July 2021, and the challenges it faced for a more rapid and efficient response. The review demonstrates that the three main pillars influencing the direction of the pandemic and aiding the control are Oman's unified governmental leadership, the move to expand the capacity of the health care system at all levels, and community partnership in all stages of the response including the COVID-19 vaccination campaign. The opportunities identified during response stages in the harmonization of the multisectoral response, streamlining communication channels, addressing vulnerable communities (dormitories, residences at border regions), and providing professional technical leadership provide an excellent precursor for expediting the transformation of Oman's health care system to one with a multisectoral holistic approach. Some of the major challenges faced are the shortage of the public health cadre, lack of a fully integrated digital platform for surveillance, and the scarcity of experts in risk communication and community engagement. A future health system where the center for diseases surveillance and control acts as a nucleus for multisectoral expertise and leadership, which includes community representatives, is crucial to attain optimum health. The destruction inflicted by this prolong COVID-19 pandemic at all levels of human life had valued the importance of investing on preventive and preparedness strategies.

Interacting Epidemics in Amazonian Brazil: Prior Dengue Infection Associated With Increased Coronavirus Disease 2019 (COVID-19) Risk in a Population-Based Cohort Study

BACKGROUND

Immunity after dengue virus (DENV) infection has been suggested to cross-protect from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mortality.

METHODS

We tested whether serologically proven prior DENV infection diagnosed in September-October 2019, before the coronavirus disease 2019 (COVID-19) pandemic, reduced the risk of SARS-CoV-2 infection and clinically apparent COVID-19 over the next 13 months in a population-based cohort in Amazonian Brazil. Mixed-effects multiple logistic regression analysis was used to identify predictors of infection and disease, adjusting for potential individual and household-level confounders. Virus genomes from 14 local SARS-CoV-2 isolates were obtained using whole-genome sequencing.

RESULTS

Anti-DENV immunoglobulin G (IgG) was found in 37.0% of 1285 cohort participants (95% confidence interval [CI]: 34.3% to 39.7%) in 2019, with 10.4 (95% CI: 6.7-15.5) seroconversion events per 100 person-years during the follow-up. In 2020, 35.2% of the participants (95% CI: 32.6% to 37.8%) had anti-SARS-CoV-2 IgG and 57.1% of the 448 SARS-CoV-2 seropositives (95% CI: 52.4% to 61.8%) reported clinical manifestations at the time of infection. Participants aged >60 years were twice more likely to have symptomatic COVID-19 than children under 5 years. Locally circulating SARS-CoV-2 isolates were assigned to the B.1.1.33 lineage. Contrary to the cross-protection hypothesis, prior DENV infection was associated with twice the risk of clinically apparent COVID-19 upon SARS-CoV-2 infection, with P values between .025 and .039 after adjustment for identified confounders.

CONCLUSIONS

Higher risk of clinically apparent COVID-19 among individuals with prior dengue has important public health implications for communities sequentially exposed to DENV and SARS-CoV-2 epidemics.

COVID-19 severity determinants inferred through ecological and epidemiological modeling

Understanding variations in the severity of infectious diseases is essential for planning proper mitigation strategies. Determinants of COVID-19 clinical severity are commonly assessed by transverse or longitudinal studies of the fatality counts. However, the fatality counts depend both on disease clinical severity and transmissibility, as more infected also lead to more deaths. Instead, we use epidemiological modeling to propose a disease severity measure that accounts for the underlying disease dynamics. The measure corresponds to the ratio of population-averaged mortality and recovery rates (m/r), is independent of the disease transmission dynamics (i.e., the basic reproduction number), and has a direct mechanistic interpretation. We use this measure to assess demographic, medical, meteorological, and environmental factors associated with the disease severity. For this, we employ an ecological regression study design and analyze different US states during the first disease outbreak. Principal Component Analysis, followed by univariate, and multivariate analyses based on machine learning techniques, is used for selecting important predictors. The usefulness of the introduced severity measure and the validity of the approach are confirmed by the fact that, without using prior knowledge from clinical studies, we recover the main significant predictors known to influence disease severity, in particular age, chronic diseases, and racial factors. Additionally, we identify long-term pollution exposure and population density as not widely recognized (though for the pollution previously hypothesized) significant predictors. The proposed measure is applicable for inferring severity determinants not only of COVID-19 but also of other infectious diseases, and the obtained results may aid a better understanding of the present and future epidemics. Our holistic, systematic investigation of disease severity at the human-environment intersection by epidemiological dynamical modeling and machine learning ecological regressions is aligned with the One Health approach. The obtained results emphasize a syndemic nature of COVID-19 risks.

The Covid-19 pandemic reinforces the need for sustainable health planning

The 2030 Agenda for Sustainable Development highlighted the growing attention to the adequacy of health planning models to sustainable development. A re-reading of the results of a round table debate on "sustainable planning", which took place at the 5th National Congress of Tropical Medicine (Portugal, 2019) under a participant observation strategy, framed by the findings of a "synthesis of better evidence" literature review and cross-referenced with the reflections of different authors and experts about the momentum created by the COVID-19 pandemic, underlined the challenges to sustainable health planning that have emerged and are projected beyond the current pandemic context. Variable perceptions of the term "sustainable health development", leading to the potential loss of their relevance in guiding the elaboration of policies and strategic plans, and the potential higher effectiveness of the participatory approaches of health planning in achieving sustainable health were highlighted in the debate and literature, in general and in public health emergency contexts. Those results gained new relevance during the current COVID-19 pandemic, bringing back to the forefront a reflection of the inadequate planning framework that has usually been used to understand and respond to global health challenges, despite the already existing experience, evidence and support instruments.

Community-Level Experiences, Understandings, and Responses to COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Qualitative and Ethnographic Studies

(1) Background: COVID-19 disruptions offer researchers insight into how pandemics are at once biological and social threats, as communities struggle to construct meaning from novel challenges to their ontological status quo. Multiple epistemes, in which public health imperatives confront and negotiate locally derived knowledge and traditions, vie for legitimacy and agency, resulting in new cultural forms. (2) Methods: To investigate the context and construction of community responses, a systematic review of qualitative literature was conducted with the aim of evaluating those insights provided by empirical, social field research in low- and middle-income countries since the onset of COVID-19. Six scholarly databases were searched for empirical, qualitative, field-based, or participatory research that was published in peer-reviewed journals between December 2019 and August 2021. (3) Results: Twenty-five studies were selected for data extraction, following critical appraisal for methodological rigor by two independent reviewers, and were then analyzed thematically. Faced with unprecedented social ruptures, restrictions in social and physical mobility, and ever-looming uncertainties of infection, financial insecurity, stigma, and loss, communities worldwide reacted in multiple and complex ways. Pervasive misinformation and fear of social rejection resulted in noncompliance with pandemic sanctions, resistance, and increased isolation, allowing the spread of the disease. The meaning of, and understandings about, COVID-19 were constructed using traditional, religious, and biomedical epistemologies, which were occasionally in conflict with each other. Innovations and adaptations, through syntheses of traditional and biomedical discourses and practice, illustrated community resilience and provided models for successful engagement to improve public health outcomes. (4) Conclusion: Local context and community engagement were indispensable considerations when enacting effective public health interventions to meet the challenges of the pandemic.

Protecting vulnerable groups from tobacco-related harm during and following the COVID-19 pandemic

Marginalized populations are being disproportionally affected by the current pandemic. Direct effects include higher infection rates with greater morbidity and mortality; indirect effects stem from the societal response to limit the spread of the virus. These same groups also have smoking rates that are significantly higher than the general population. In this commentary, we discuss how the pandemic has been acting to further increase the harm from tobacco endured by these groups by applying the syndemic framework. Using this approach, we elaborate on the factors that promote clustering of harms from tobacco with harms from COVID-19. These include the worsening of psychological distress, a potential increase in smoking behaviour, greater exposure to second-hand smoke and less access to smoking cessation services. Then, we offer mitigation strategies to protect disadvantaged groups from tobacco-related harm during and following the COVID-19 pandemic. These strategies include affordable smoking cessation services, a proactive approach for smoking treatment using information technology, opportunistic screening and treatment of tobacco dependence among individuals presenting for COVID-19 vaccination, policy interventions for universal coverage of cessation pharmacotherapy, comprehensive smoke-free policies and regulation of tobacco retail density. Now more than ever, coordinated action between clinicians, health care systems, public health organizations and health policy makers is needed to protect vulnerable groups from the harm of tobacco.

[COVID-19 as a syndemic: a theoretical model and foundations for a comprehensive approach in health]

This essay aims to present and discuss the theoretical framework for the COVID-19 syndemic. The first part presents the foundations and principles of syndemic theory. For the purposes of this essay, syndemic was defined as a process of synergic interaction between two or more diseases, in which the effects are mutually enhanced. We discussed the three principal typologies of syndemic interaction: mutually causal epidemics; epidemics interacting synergically; and serial causal epidemics. In the second part, COVID-19 is analyzed as a syndemic resulting from the interaction between various groups of diseases and the socioeconomic context. The theoretical model considered the interaction between COVID-19 and chronic noncommunicable diseases, infectious and parasitic diseases, and mental health problems. The essay addressed how social iniquities and conditions of vulnerability act at various levels to increase the effect of COVID-19 and other pandemics. The last section discusses the need for comprehensive, multisector, and integrated responses to COVID-19. A model for intervention was presented that involves the patient care and socioeconomic dimensions. In the sphere of patient care, the authors defend the structuring of strong and responsive health systems, accessible to the entire population. The economic and social dimension addressed the issue of reclaiming the ideals of solidarity, the health promotion strategy, and emphasis on social determinants of health. In conclusion, the lessons learned from the syndemic approach to COVID-19 call on government and society to develop policies that link clinical, sanitary, socioeconomic, and environmental interventions.

Causes of multidrug-resistant tuberculosis from the perspectives of health providers: challenges and strategies for adherence to treatment during the COVID-19 pandemic in Brazil

BACKGROUND

Multidrug-resistant tuberculosis (MDR-TB) is a serious phenomenon on a global scale that can worsen with the COVID-19 pandemic. The study aimed to understand the perceptions of health professionals about MDR-TB, their strategies to ensure adherence to treatment and their challenges in the context of the COVID-19 pandemic in a priority municipality for disease control.

METHODS

We conducted a qualitative study and recruited 14 health providers (four doctors, three nurses, three nursing technicians, three nursing assistants and a social worker) working in a city in the state of São Paulo, Brazil. Remote semi-structured interviews were conducted with the participants. For data analysis, the thematic content analysis technique was applied according to the study's theoretical framework.

RESULTS

The study revealed the causes of MDR-TB are associated with poverty, vulnerability, and social risk. A pre-judgement from the providers was observed, namely, all patients do not adhere due their resistance and association with drug abuse or alcoholism. The study also observed difficulty among health providers in helping patients reconstruct and reframe their life projects under a care perspective, which would strengthen adherence. Other issues that weakened adherence were the cuts in social protection and the benefits really necessary to the patients and a challenge for the providers manage that. The participants revealed that their actions were impacted by the pandemic and insecurity and fear manifested by patients after acquiring COVID-19. For alleviating this, medical appointments by telephone, delivery of medicine in the homes of patients and visits by health professionals once per week were provided.

CONCLUSION

The study advances knowledge by highlighting the challenges faced by the health system with the adherence of patients with MDR-TB in a context aggravated by the pandemic. An improvement in DOT is really necessary to help the patients reframe their lives without prejudices, face their fears and insecurity, recover their self-esteem and motivate in concluding their treatment.