COVID-19 - the role of mass gatherings

Risk-based management of international sporting events during the COVID-19 pandemic

Mass gatherings include a diverse range of events such as sporting competitions, religious ceremonies, entertainment activities, political rallies and cultural celebrations, which have important implications for population well-being. However, if not managed properly, these events can amplify health risks including those related to communicable diseases, and place undue strain on health systems in host countries and potentially in attendees' home countries, upon their return. The coronavirus disease 2019 (COVID-19) pandemic has provided a unique opportunity to evaluate the risk factors associated with mass gatherings and the effectiveness of applying mitigation measures during infectious disease emergencies. The pandemic has also allowed event organizers and health officials to identify best practices for mass gathering planning in host countries. To guide decisions about whether to hold, postpone, modify or cancel a mass gathering during the COVID-19 pandemic, the World Health Organization and its partners developed normative guidance and derivative tools promoting a risk-based approach to mass gathering planning. This approach involves three steps to guide decision-making around mass gatherings: risk evaluation, risk mitigation and risk communication. The approach was applied in the planning and execution of several mass gathering events, including the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games. Lessons identified from these large-scale international events offer insights into the planning and implementation of mass gathering events during a pandemic, and the broader impacts of such events on society. These lessons may also further inform and refine planning for future mass gatherings.

Recommendations for management of diabetes and its complications during Hajj (Muslim Pilgrimage) - 2024 update

Hajj is an obligatory duty for all healthy adult Muslims once in the lifetime subjected to the ability. Considering the 10.5 % global prevalence of diabetes coupled with the numbers of Muslims performing the Hajj, ∼ 1.8 million in 2023, it is estimated that Muslims with diabetes performing Hajj may exceed 340,000 this year. During Hajj the pattern and amount of their meal, fluid intake and physical activity are markedly altered. Many people with diabetes insist on doing the Hajj duty, thereby creating a medical challenge for themselves and their health care providers. It is therefore important that medical professionals be aware of the potential risks that may be associated with Hajj. People with diabetes may face many health hazards during Hajj including but not limited to the killer triad which might occur during Hajj: Hypoglycemia, Foot injury and Infections. Many precautions should be taken to prevent and treat these potentially serious complications. Risk stratification, medication adjustments, proper clinical assessment, and education before doing Hajj are crucial.

Managing risk of infectious disease transmission at religious mass gatherings: Insights from survey, COVID-19 PCR, and antibody tests from Arbaeen walkers in 2020

BACKGROUND

Arbaeen in Iraq has been one of the largest mass gatherings during the COVID-19 pandemic with 14.5 million attendees in 2020. We set out to assess the prevalence of current or past COVID-19 among 2020 Arbaeen participants, and establish associations between COVID-19 test results, symptoms, and known recent exposure.

METHODS

This was a cross-sectional study involving participants who joined Arbaeen walk in Iraq in October 2020. COVID-19 PCR and/or rapid antibody test were conducted among consented participants. A short questionnaire was administered. Rapid antibody testing was done onsite. Nasal and throat swab samples were transferred to the laboratory for PCR testing.

RESULTS

A total of 835 (88.3% male; 11.7% female) participants were recruited. The most common symptom overall was cough (9.6%) followed by sore throat, fever, and loss of taste/smell (6.6%, 5.5%, and 5.0%, respectively). One in five (20.3%) participants reported close contact with a confirmed COVID-19 case in the past 14 days. Of the 237 participants with a PCR test, 18 (7.6%) were positive. Of the 765 participants with rapid antibody test, 19.3% tested positive for IgM, 39.3% for IgG, and 16.4% for both. Approximately 40% of the participants had evidence of current or past COVID-19 infection based on antibody and PCR.

CONCLUSIONS

The almost 1 in 10 COVID-19 cases within such a multimillion person gathering, illustrates the difficulty in limiting the participation of infectious individuals in religious mass gatherings. There is a pressing need to explore measures to reduce the risk of transmission of infectious diseases at major mass gathering events.

Healthcare policies, precautionary measures and outcomes of mass gathering events in the era of COVID-19 pandemic: Expedited review

With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.

Investigating Crimean-Congo haemorrhagic fever virus seropositivity in camels and human behavioural risks in an abattoir in Nigeria

Crimean-Congo haemorrhagic fever virus (CCHFV) is an emerging viral pathogen with pandemic potential that is often misdiagnosed. Case fatality in low-resource settings could be up to 40% due to close contact between animals and humans. A two-year cross-sectional study was conducted in Fagge abattoir, Kano State, Nigeria, to estimate the seropositivity of CCHFV in camels using a commercial multi-species competitive enzyme-linked immunosorbent assay (ELISA). A closed-ended questionnaire was administered to the abattoir workers to assess their awareness, mitigation, and behavioural practices associated with CCHF. Of the 184 camels tested, 179 (97%) were seropositive for CCHFV (95% confidence interval (CI): 93.77, 99.11). The median (interquartile range (IQR)) age of respondents was 41 (35-52), with 62% having no education. Respondents had little knowledge about CCHFV and the concept of zoonotic disease. In this study, the high estimated prevalence of antibodies to CCHFV in camels highlights the heightened risk of transmission of CCHFV in Nigeria. Similarly, a concerning lack of knowledge and inadequate preventive practices, alongside a prevalence of high-risk behaviours associated with CCHF among abattoir workers, were noted in this study. Thus, there is an urgent need for comprehensive public health education and collaborative One Health strategies to avert the threats of spillover events.

Syndromic surveillance during 2022 Uganda Martyrs' commemoration

Mass gatherings frequently include close, prolonged interactions between people, which presents opportunities for infectious disease transmission. Over 20,000 pilgrims gathered at Namugongo Catholic and Protestant shrines to commemorate 2022 Uganda Martyr's Day. We described syndromes suggestive of key priority diseases particularly COVID-19 and viral hemorrhagic fever (VHF) among visiting pilgrims during May 25-June 5, 2022. We conducted a survey among pilgrims at the catholic and protestant shrines based on signs and symptoms for key priority diseases: COVID-19 and VHF. A suspected COVID-19 case was defined as acute respiratory illness (temperature greater 37.5°C and at least one sign/symptom of respiratory infection such as cough or shortness of breath) whereas a suspected VHF case was defined as fever >37.5°C and unexplained bleeding among pilgrims who visited Namugongo Catholic and Protestant shrines from May 25 to June 5, 2022. Pilgrims were sampled systematically at entrances and demarcated zonal areas to participate in the survey. Additionally, we extracted secondary data on pilgrims who sought emergency medical services from Health Management Information System registers. Descriptive analysis was conducted to identify syndromes suggestive of key priority diseases. Among 1,350 pilgrims interviewed, 767 (57%) were female. The mean age was 37.9 (±17.9) years. Nearly all pilgrims 1,331 (98.6%) were Ugandans. A total of 236 (18%) reported ≥1 case definition symptom and 42 (3%) reported ≥2 symptoms. Thirty-nine (2.9%) were suspected COVID-19 cases and three (0.2%) were suspected VHF cases from different regions of Uganda. Among 5,582 pilgrims who sought medical care from tents, 628 (11.3%) had suspected COVID-19 and one had suspected VHF. Almost one in fifty pilgrims at the 2022 Uganda Martyrs' commemoration had at least one symptom of COVID-19 or VHF. Intensified syndromic surveillance and planned laboratory testing capacity at mass gatherings is important for early detection of public health emergencies that could stem from such events.

Effects of environmental conditions on COVID-19 morbidity as an example of multicausality: a multi-city case study in Italy

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in December 2019 in Wuhan city, in the Hubei province of China. Since then, it has spread practically all over the world, disrupting many human activities. In temperate climates overwhelming evidence indicates that its incidence increases significantly during the cold season. Italy was one of the first nations, in which COVID-19 reached epidemic proportions, already at the beginning of 2020. There is therefore enough data to perform a systematic investigation of the correlation between the spread of the virus and the environmental conditions. The objective of this study is the investigation of the relationship between the virus diffusion and the weather, including temperature, wind, humidity and air quality, before the rollout of any vaccine and including rapid variation of the pollutants (not only their long term effects as reported in the literature). Regarding them methodology, given the complexity of the problem and the sparse data, robust statistical tools based on ranking (Spearman and Kendall correlation coefficients) and innovative dynamical system analysis techniques (recurrence plots) have been deployed to disentangle the different influences. In terms of results, the evidence indicates that, even if temperature plays a fundamental role, the morbidity of COVID-19 depends also on other factors. At the aggregate level of major cities, air pollution and the environmental quantities affecting it, particularly the wind intensity, have no negligible effect. This evidence should motivate a rethinking of the public policies related to the containment of this type of airborne infectious diseases, particularly information gathering and traffic management.

The cost of mass gatherings during a pandemic

In June 2020, the U.S., unlike other regions of the world, faced a surge in cases of COVID-19. Immediately prior to this wave of cases, the largest mass protests in U.S. history took place. We show that when holding other factors constant, COVID-19 cases increased most in places where more demonstrations occurred. We exploit variation in rainfall during the protest period as an exogenous source of variation in attendance. We find that good weather coincides with both more people protesting and more subsequent COVID-19 cases and deaths. Mass gatherings during a pandemic thus lead to more contraction and fatalities of COVID-19, and we quantify these effects.

Chaos of COVID-19 Superspreading Events: An Analysis Via a Data-driven Approach

Superspreading has become a key mechanism of COVID-19 transmission which creates chaos. The classical approach of compartmental models may not sufficiently reflect the epidemiological situation amid superspreading events (SSEs). We perform a data-driven approach and recognise the deterministic chaos of confirmed cases. The first derivative ( ≈difference of total confirmed cases) and the second derivative ( ≈difference of the first derivative) are used upon SSEs to showcase the chaos. Varying solution trajectories, sensitivity and numerical unpredictability are the chaotic characteristics discussed here.

Measurement and rapid assessment of indoor air quality at mass gathering events to assess ventilation performance and reduce aerosol transmission of SARS-CoV-2

To assess risk factors for COVID-19 transmission and address the closure of mass gathering events since March 2020, the UK Government ran the Events Research Programme (ERP), following which it reopened live events in sports, music, and culture in July 2021. We report the rapid post-occupancy evaluation of Indoor Air Quality (IAQ) and associated long-range airborne transmission risk conducted in the Environmental Study of the ERP. Ten large venues around the UK were monitored with CO2 sensors at a high spatial and temporal resolution during 90 events. An IAQ Index based on CO2 concentration was developed, and all monitored spaces were classified in bands from A to G based on their average and maximum CO2 concentrations from all events. High resolution monitoring and the IAQ Index depicted the overall state of ventilation at live events, and allowed identification of issues with ventilation effectiveness and distribution, and of spaces with poor ventilation and the settings in which long-range airborne transmission risk may be increased. In numerous settings, CO2 concentrations were found to follow patterns relating to event management and specific occupancy of spaces around the venues. Good ventilation was observed in 90% of spaces monitored for given occupancies. Practical applications: High-resolution monitoring of indoor CO2 concentrations is necessary to detect the spatial variation of indoor air quality (IAQ) in large mass gathering event venues. The paper summarises COVID-19 ventilation guidance for buildings and defines a methodology for measurement and rapid assessment of IAQ during occupancy at live events that can be implemented by venue managers. Comparisons of the CO2 concentrations measured during the events identified the spaces at high risk of long-range transmission of airborne pathogens. Building operators should be mindful of the ventilation strategies used relative to the total occupancy in different spaces and the occupant's activities.

[Risks, contamination and prevention against COVID-19 in dental work: a review]

INTRODUCTION

In April 2020 The COVID-19 pandemic caused more than one million infections and 54 600 deaths to date around the world. The spread of SARS-CoV-2 is rapid, and its transmission is through droplets of saliva, hence its importance in dentistry.

OBJECTIVE

Identify the main risks, transmission routes and prevention measures against COVID-19.

METHODS

A review of the scientific literature of the last two years on the subject was carried out in the PubMed, ScienceDirect, Google Scholar and Research Gate databases. The descriptors used were: "coronavirus", "COVID-19", "dental", "dentistry", "oral", "stomatology", and "aerosol". 350 articles were found, but 50 were selected for their topicality, relationship, and focus. The transmission of the COVID-19 is carried out mainly through saliva drops, aerosols and fomites. The virus can subsist for a time on the environment and surfaces. Dentists are health workers who are at risk of contagion because several of their procedures release aerosols. The biosecurity in the exercise of this profession must be strict and extreme, also the cleaning and disinfection of the environment and contact surfaces.

CONCLUSIONS

In the dental profession the potential risk of contamination among operators, assistants and patients is high. Knowing the causative agent and the disease allows you to reduce the possibility of contagion. The dentist must consider patients as suspects to COVID-19 and apply biosecurity at all levels.

The impact of mass gatherings on the local transmission of COVID-19 and the implications for social distancing policies: Evidence from Hong Kong

Mass gatherings provide conditions for the transmission of infectious diseases and pose complex challenges to public health. Faced with the COVID-19 pandemic, governments and health experts called for suspension of gatherings in order to reduce social contact via which virus is transmitted. However, few studies have investigated the contribution of mass gatherings to COVID-19 transmission in local communities. In Hong Kong, the coincidence of the relaxation of group gathering restrictions with demonstrations against the National Security Law in mid-2020 raised concerns about the safety of mass gatherings under the pandemic. Therefore, this study examines the impacts of mass gatherings on the local transmission of COVID-19 and evaluates the importance of social distancing policies. With an aggregated dataset of epidemiological, city-level meteorological and socioeconomic data, a Synthetic Control Method (SCM) is used for constructing a 'synthetic Hong Kong' from over 200 Chinese cities. This counterfactual control unit is used to simulate COVID-19 infection patterns (i.e., the number of total cases and daily new cases) in the absence of mass gatherings. Comparing the hypothetical trends and the actual ones, our results indicate that the infection rate observed in Hong Kong is substantially higher than that in the counterfactual control unit (2.63% vs. 0.07%). As estimated, mass gatherings increased the number of new infections by 62 cases (or 87.58% of total new cases) over the 10-day period and by 737 cases (or 97.23%) over the 30-day period. These findings suggest the necessity of tightening social distancing policies, especially the prohibition on group gathering regulation (POGGR), to prevent and control COVID-19 outbreaks.

The role of serum circulating microbial toxins in severity and cytokine storm of COVID positive patients

The emergence of Coronavirus disease 2019 (Covid-19) is a global problem nowadays, causing health difficulty with increasing mortality rates, which doesn't have a verified treatment. SARS-CoV-2 infection has various pathological and epidemiological characteristics, one of them is increased amounts of cytokine production, which in order activate an abnormal unrestricted response called "cytokine storm". This event contributes to severe acute respiratory distress syndrome (ARDS), which results in respiratory failure and pneumonia and is the great cause of death associated with Covid-19. Endotoxemia and the release of bacterial lipopolysaccharides (endotoxins) from the lumen into the bloodstream enhance proinflammatory cytokines. SARS-CoV-2 can straightly interplay with endotoxins via its S protein, leading to the extremely elevating release of cytokines and consequently increase the harshness of Covid-19. In this review, we will discuss the possible role of viral-bacterial interaction that occurs through the transfer of bacterial products such as lipopolysaccharide (LPS) from the intestine into the bloodstream, exacerbating the severity of Covid-19 and cytokine storms.

Respiratory virus detection in returning travelers and pilgrims from the Middle East

BACKGROUND

Pilgrims travelling to Saudi Arabia are commonly infected with respiratory viruses. Since the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012, patients with acute respiratory symptoms returning from an endemic area can be suspected to be infected by this virus.

METHODS

98 patients suspected to have MERS-CoV infection from 2014 to 2019 were included in this retrospective cohort study. Upper and lower respiratory tract samples were tested by real-time RT-PCR for the detection of MERS-CoV and other respiratory viruses. Routine microbiological analyses were also performed. Patient data were retrieved from laboratory and hospital databases retrospectively.

RESULTS

All patients with suspected MERS-CoV infection travelled before their hospitalization. Most frequent symptoms were cough (94.4%) and fever (69.4%). 98 specimens were tested for MERS-CoV RNA and none of them was positive. Most frequently detected viruses were Enterovirus/Rhinovirus (40/83; 48.2%), Influenzavirus A (34/90; 37.8%) and B (11/90; 12.2%), H-CoV (229E and OC43 10/83; 12% and 7/83; 8.4%, respectively).

CONCLUSION

From 2014 to 2019, none of 98 patients returning from endemic areas was MERS-CoV infected. However, infections with other respiratory viruses were frequent, especially with Enterovirus/Rhinoviruses and Influenzaviruses.

The effect of mindfulness-based stress reduction (MBSR) training on serum cortisol levels, depression, stress, and anxiety in type 2 diabetic older adults during the COVID-19 outbreak

Old age is rapidly increasing and is linked to with chronic diseases, especially diabetes. Diabetes is associated with increased anxiety, stress, and depression and, in turn, can increase cortisol secretion. To this end, the present research studied the impact of mindfulness-based stress reduction (MBSR) training on serum cortisol levels, depression, anxiety, and stress in type 2 diabetic (T2DM) older adults during the COVID-19 epidemic. The participants in this interventional work were 56 older adult patients with type 2 diabetes chosen through systematic random sampling and then randomly divided into control and intervention groups containing equal members. In the intervention group, the participants attended eight mindfulness-based stress reduction (MBSR) training sessions. The subjects in the control group received no intervention. Since four patients left the study, only data for 52 patients were collected using the Depression Anxiety Stress Scale (DASS-21) and a demographic and disease information questionnaire. Data were examined with SPSS18 software using the Kolmogorov-Smirnov test, chi-square test, Fisher test, independent samples t-test, and two-way ANOVA; the significance was p<0.05. Statistically significant differences were observed between the mean scores of anxiety, stress, depression, and cortisol levels in the intervention group (p<0.00001) before, directly after, and three months after the intervention. However, no statistically significant difference was observed in the mentioned variables in the control group. The mindfulness-based stress reduction (MBSR) intervention can improve anxiety, depression, stress, and cortisol levels in older adults suffering from T2DM.

Risk Assessment of Arbaeen Mass Gathering in the Covid-19 Pandemic

Introduction

Arbaeen is a religious ceremony held annually with the participation of a large number of pilgrims. During the pandemic of Covid-19, a mass gathering of Arbaeen pilgrims can strengthen the transmission of this disease and put more pressure on the health care system of countries. The aim of the study is to evaluate the risk of Arbaeen ceremony in the Covid-19 pandemic in 2021.

Materials and methods

A mixed method was performed to perform the study using qualitative and quantitative methods. A national risk assessment tool was used that consisted of hazard identification and assessment, scenario development, exposure assessment, vulnerability assessment and risk estimation. The national risk assessment tool was completed through a focused group discussion and the opinions of 20 representatives of the health system and the level of risks were estimated. Data were collected, analyzed, and integrated by the research team.

Results

Based on the results of risk matrix analysis, factors such as the increase in the number of new cases of COVID-19, the probability of exposure to a new variant of COVID-19, the probability of arrival of a new variant of COVID-19 to the country, the probability of increasing referrals to healthcare facilities (score 16), the probability of getting respiratory diseases, and the environmental contamination (score 12) occupied the red area of the matrix and were found to have the highest risk (unbearable risk), that needs immediate action.

Conclusion

Preparing for a mass gathering such as Arbaeen is very important in order to reduce the risk of communicable disease, and the first step in improving preparedness is risk assessment and its continuity in the various stages of the ceremony. Therefore, policy makers and planners of such events should conduct risk assessments with the participation of local and national public health authorities regularly.

Histopathologic Changes of Appendicitis Stage During the COVID-19 Pandemic

Background: We decided to compare the pathology stage of appendicitis in patients referred to Firoozabadi Medical Center before and after the official announcement of the coronavirus outbreak in Iran because we believe that people's fears of COVID-19 are keeping them away from hospitals and it likely causes them to come in later stages of the disease. Therefore, this study aims at investigating the effect of the COVID-19 pandemic on the stage of appendicitis at presentation. Methods: In this retrospective study, histopathology records of all acute appendicitis patients who underwent an emergency appendectomy in the surgical unit in our institute between December 2019 and April 2020 were reviewed retrospectively. The study period was designed to include 2 months before and 2 months after the officially announced onset of the COVID-19 outbreak in Iran on February 20, 2020. All cases of complicated appendicitis (perforated appendicitis, phlegmonous appendix, itis or abscess) were excluded. Descriptive statistics were used to describe our study variables. Furthermore, ordinal logistic regression was used to investigate the effect of the COVID-19 pandemic and demographic variables on the stage of appendicitis at presentation. Data were analyzed using SPSS Statistics Version 22. Results: The study was conducted on 170 clinically diagnosed acute appendicitis patients. The odds ratio for gender was equal to 0.45 (0.23, 0.86), which means that women presented at an earlier pathological stage than men ( p = 0.016). Also, patients who had health insurance were 50% less likely to present in later pathological stages than those who did not ( p = 0.024). The COVID-19 outback did not have a significant role in the pathological stage at presentation ( p = 0.235). Conclusion: The number of appendicitis patients was down by about 50% following the outbreak announcement in Iran. Surprisingly, we did not find any significant changes in the distribution pattern of appendicitis pathological staging after the outbreak. Being uninsured and male sex were found to have the most significant roles in delayed hospital presentation and higher pathological stages in patients with acute appendicitis.

Modelling the dynamic relationship between spread of infection and observed crowd movement patterns at large scale events

Understanding how contact patterns arise from crowd movement is crucial for assessing the spread of infection at mass gathering events. Here we study contact patterns from Wi-Fi mobility data of large sports and entertainment events in the Johan Cruijff ArenA stadium in Amsterdam. We show that crowd movement behaviour at mass gathering events is not homogeneous in time, but naturally consists of alternating periods of movement and rest. As a result, contact duration distributions are heavy-tailed, an observation which is not explained by models assuming that pedestrian contacts are analogous to collisions in the kinetic gas model. We investigate the effect of heavy-tailed contact duration patterns on the spread of infection using various random walk models. We show how different types of intermittent movement behaviour interact with a time-dependent infection probability. Our results point to the existence of a crossover point where increased contact duration presents a higher level of transmission risk than increasing the number of contacts. In addition, we show that different types of intermittent movement behaviour give rise to different mass-action kinetics, but also show that neither one of two mass-action mechanisms uniquely describes events.

The role of precautions: Organising a medical conference during COVID-19 pandemic-Lessons from IADVL MIDDERMACON 2021

Background

The use of virtual platforms for clinical meetings has become the default approach during this pandemic era. Organising an offline conference during a pandemic is a challenge and is possible if the participating crowd is vaccinated and is willing to follow appropriate pandemic protocols.

Objective

To determine the feasibility of conducting a conference among mostly vaccinated delegates using standard precautionary protocols.

Methods

This study was conducted at IADVL MIDDERMACON 2021, held in Mangalore, India, in late October 2021, during the phase of decline of the Delta variant of SARS-CoV-2. The study population included all conference attendees, including support staff. Details were collected about their vaccination status, comorbidities, and mode of travel to the conference venue. An reverse-transcription polymerase chain reaction (RT-PCR) test was done randomly among the attendees for COVID-19 infection. A post-conference assessment and RT-PCR tests were done at the end of 2 weeks to assess the occurrence of infections among study participants.

Results

A total of 1744 people were present at the venue, of which 576 (33.03%) participated in the study. The percentage of fully vaccinated was 88.88% (512/576). The majority had taken the vaccine Covishield (manufactured by AstraZeneca), that is, 85.06% (490/576). Infection post the conference was reported in 0.195% (1/576).

Conclusions

Holding large gatherings like medical conferences pose a challenge during a pandemic. However, to increase the benefits of the conference, it is advisable to hold them offline with vaccinated delegates, follow the advice of the conference organising committee, and practise safe precautionary measures.

A post-occupancy study of ventilation effectiveness from high-resolution CO2 monitoring at live theatre events to mitigate airborne transmission of SARS-CoV-2

Mass-gathering events were closed around the world in 2020 to minimise the spread of the SARS-CoV-2 virus. Emerging research on the transmission of SARS-CoV-2 emphasised the importance of sufficient ventilation. This paper presents the results of an indoor air quality (IAQ) monitoring study over 82 events in seven mechanically ventilated auditoria to support the UK government Events Research Programme. Indoor carbon dioxide concentration was measured at high resolution before, during, and after occupancy to allow for assessment of the ventilation systems. Generally, good indoor air quality was measured in all auditoria, with average IAQ found to be excellent or very good for 70% of spaces. In some auditoria, spatial variation in IAQ was identified, indicating poor mixing of the air. In addition, surface and air samples were taken and analysed for the presence of bacteria by culture and SARS-CoV-2 using RT-qPCR in one venue. SARS-CoV-2 RNA was detected on a small number of surfaces at very low copy numbers, which are unlikely to pose an infection risk. Under the ventilation strategies and occupancy levels investigated, it is likely that most theatres pose a low risk of long-range transmission of COVID-19.

The Statistical Analysis to Find Correlation Between Mass Gathering Event and COVID-19 Pandemic Outbreak: The Prayagraj Magh Mela 2021 Experience

Magh mela, a smaller form of Kumbh mela, organize every year in Prayagraj. With the emergence of novel corona virus, there is worldwide discussion to find out the effective way to organize or cancel the mass gathering events. The present study assesses the challenges in organization of mass gathering events like Magh mela held at Prayagraj, India in 2021. The correlation between increased cases of COVID-19 and Magh mela-2021 has been highlighted through statistical analysis and growth curves using the available data. The study finds that there is a correlation between the Magh mela-2021 mass gathering event and increased rate of COVID-19 infections. After the Magh mela 2021, the average daily increase in the COVID-19 cases started to increase. It was found 4.25%, 6.28% and 2.73% in India, Uttar Pradesh and Prayagraj, respectively.

Rethinking Lockdown Policies in the Pre-Vaccine Era of COVID-19: A Configurational Perspective

The significance of lockdown policies for controlling the COVID-19 pandemic is widely recognized. However, most studies have focused on individual lockdown measures. The effectiveness of lockdown policy combinations has not been examined from a configurational perspective. This research applies fuzzy-set qualitative comparative analysis (fsQCA) to examine different lockdown policy combinations associated with high-epidemic situations in 84 countries. A high-epidemic situation can occur through three different “weak-confined” patterns of lockdown policy combinations. The findings demonstrate that a combination of lockdown policies is more successful than any single lockdown policy, whereas the absence of several key measures in policy combinations can lead to a high-epidemic situation. The importance of international travel controls can become obscured when they are the only measures adopted, and a high-epidemic situation can still arise where restrictions are placed on international travel but not on public transport or when workplaces are closed but schools remain open.

A Perspective towards Multi-Hazard Resilient Systems: Natural Hazards and Pandemics

The concept of resilience has been used extensively across the sciences in engineering and the humanities. It is applied to ecology, medicine, economics, and psychology. The novel coronavirus disease (COVID-19) has posed an extraordinary challenge to the resilience of healthcare systems, communities, and nations and has profoundly altered our previous day-to-day operations. This paper presents a discussion of the definitions and characteristics of resilient systems. Scenarios are utilized to qualitatively explore key relationships, responses, and paths for recovery across different system types. The purpose is to develop an integrated approach that can accommodate simultaneous threats to system resilience, in particular, impacts from a natural hazard in conjunction with COVID-19. This manuscript is the first to advocate for more in-depth and quantitative research utilizing transdisciplinary approaches that can accommodate considerations across our built environment and healthcare system infrastructures in pursuit of designing systems that are resilient to both natural hazards and pandemic impacts.

"A Divine Infection": A Systematic Review on the Roles of Religious Communities During the Early Stage of COVID-19

The objective of this systematic review was to summarize the roles that religious communities played during the early stage of COVID-19 pandemic. Seven databases were searched and a total of 58 articles in English published between February 2020 and July 2020 were included in evidence synthesis. The findings of the literature showed diverse influences of religion as a double-edged sword in the context of COVID-19 pandemic. Religious communities have played detrimental and/or beneficial roles as a response to COVID-19 pandemic. A collaborative approach among religious communities, health science, and government is critical to combat COVID-19 crisis and future pandemics/epidemics.

Harnessing Artificial Intelligence to assess the impact of nonpharmaceutical interventions on the second wave of the Coronavirus Disease 2019 pandemic across the world

In the present paper, we aimed to determine the influence of various non-pharmaceutical interventions (NPIs) enforced during the first wave of COVID-19 across countries on the spreading rate of COVID-19 during the second wave. For this purpose, we took into account national-level climatic, environmental, clinical, health, economic, pollution, social, and demographic factors. We estimated the growth of the first and second wave across countries by fitting a logistic model to daily-reported case numbers, up to the first and second epidemic peaks. We estimated the basic and effective (second wave) reproduction numbers across countries. Next, we used a random forest algorithm to study the association between the growth rate of the second wave and NPIs as well as pre-existing country-specific characteristics. Lastly, we compared the growth rate of the first and second waves of COVID-19. The top three factors associated with the growth of the second wave were body mass index, the number of days that the government sets restrictions on requiring facial coverings outside the home at all times, and restrictions on gatherings of 10 people or less. Artificial intelligence techniques can help scholars as well as decision and policy-makers estimate the effectiveness of public health policies, and implement "smart" interventions, which are as efficacious as stringent ones.

The coronavirus global pandemic and its impacts on society

The aim of the study is to assess the impact of various nationalities, cultures, and religions on the spread of the coronavirus in the human environment. Particular attention was paid to compliance with legal and ethical standards during a pandemic. Different cultures, nationalities, and religions have a significant influence on the development and spread of the coronavirus in the world. During the COVID-19 pandemic, due to the tightening of legal standards, it is necessary to ensure: protection of patient confidentiality; of freedom of the expression; accesses to critical information; the opportunities to belong to social organizations and civil society; the accesses to professionals healthcare; ensure equal rights for women and guarantee the right to water and sanitation; continuity of humanitarian aid and targeted economic aid. Travel locks and bans should comply with legal standards; the right to education should be strictly respected. Artificial intelligence can be used in the fight against the crown.

Non-Pharmacological Infection Prevention and Control Interventions in COVID-19: What Does the Current Evidence Say?

Coronavirus disease-19 (COVID-19), a major global public health emergency has significantly impacted human health and livelihoods. The pandemic continues to spread and treatments and vaccines are at different stages of development. Mass vaccination has been rolled out worldwide. This review article provides a narrative summary of the evidence on various non-pharmacological interventions (NPIs) for COVID-19 containment. The authors reviewed the evidence published by the Norwegian Institute of Public Health map of COVID-19 evidence. Additional literature was identified from PubMed and Google Scholar, preprint sites, and news media. The search terms included "Social distancing measures" and "COVID 19", "Non-pharmacological interventions'' and "COVID 19", "COVID-19", "non-pharmacological interventions", "face mask", etc. The strength of the evidence for most studies on NPIs was 'weak to moderate' for restrictive NPIs. Ascertaining the impact of each NPI as a standalone intervention is difficult since NPIs are implemented simultaneously with other measures. Varying testing and reporting strategies across the countries and classification of deaths directly caused by COVID-19 create challenges in assessing the impact of restrictive NPIs on the case numbers and deaths. Evidence on hygiene measures such as face mask is more robust in design providing credible evidence on prevention of COVID-19 infection. Evidence from modeling studies, natural before-after studies, and anecdotal evidence from the strategies adopted by 'role model' countries suggests that continued use of NPIs is the only containment strategy until 'herd immunity' is achieved to reduce the severe disease and mortality.

Challenges to the implementation and adoption of physical distancing measures against COVID-19 by internally displaced people in Mali: a qualitative study

Background

For almost a decade now, Mali has been facing a security crisis that led to the displacement of thousands of people within the country. Since March 2020, a health crisis linked to the COVID-19 pandemic also surfaced. To overcome this health crisis, the government implemented some physical distancing measures but their adoption proved difficult, particularly among internally displaced people (IDPs). The objective of this study is to identify the challenges relating to the implementation and adoption of physical distancing measures and to determine the main mitigation measures taken by IDPs to adjust to these new policies.

Methods

An exploratory qualitative research was conducted in Bamako and Ségou, two of the ten regions of Mali. The study counted 68 participants including 50 IDPs, seven administrative and health authorities, and 11 humanitarian actors. Sampling was guided by the principle of saturation and diversification, and data was collected through semi-structured individual interviews (n = 36) and focus groups (n = eight). Analysis was based on thematic content analysis through NVivo software.

Results

The main challenges identified concerning the implementation and adoption of physical distancing measures include the proximity in which IDPs live, their beliefs and values, the lack of toilets and safe water on sites, IDPs habits and economic situation, humanitarian actors’ lack of financial resources and authority, and social pressure from religious leaders. Implemented mitigation measures include the building of new shelters or their compartmentalization, the creation of income-generating activities and food banks, psychosocial support, promoting awareness of IDPs, and nightly police patrols and surveillance to discourage IDPs from going out. Finally, a call for action is suggested for the actors involved in IDPs support and management.

Conclusions

The study demonstrates the difficulty for IDPs to follow most of the physical distancing measures and informs about the risk of disease spreading among IDPs with its potential consequences. It also shows the inability of mitigation measures to control the outbreak and suggests actions to be considered.

Structural Modeling on the Determinants of Effectiveness of SOPs Containing COVID-19 in Mass Gatherings

The study is aimed to analyze the determinants of the effectiveness of SOPs in mass gatherings for containing COVID-19. The overall design of the study involves a literature review, data collection by field survey, structural modeling, and analysis. The study is built on the experts' opinion of a focus group (representing people who recently participated in and are responsible for mass gatherings). The study uses the discussion of the literature review to identify the determinants, interpretive structural modeling (ISM) for developing and analyzing a structural model, and Matrice d'Impacts Croises Multiplication Appliquée a un Classement (MICMAC) for corroboration of results of the ISM/classification of determinants. From the literature review, a list of determinants is generated and verified by a panel of experts. The results of the ISM revealed that the determinants “legal environment of the country,” “practicability of SOPs,” “perceived benefit of adapting SOPs,” and “possibilities of avoiding gathering” occupied the top of the model, therefore, they are less critical determinants, whereas “nature of gathering” occupied the bottom of the model, and is thus the most critical determinant. The remaining determinants form the middle of the model, and are therefore moderately severe. The results of MICMAC show that the determinant “perceived benefit of adapting SOPs” is dependent, “nature of gathering” is independent, and all others are linked. The results of MICMAC implicitly substantiate the findings of the ISM. The overall results of the study show that “nature of gathering” is the key determinant. This research does not require a priori theory since it is a theory-building study that uses an inductive approach. It is based on real data and it is useful for local authorities, organizers, participants (attendees/visitors) of mass gatherings, health officials/regulators, researchers, and the community at large. This study has fundamental importance for planning and preparing for such events while ensuring the minimum risk of COVID-19 transmission.

Effect of Resilience on Health-Related Quality of Life during the COVID-19 Pandemic: A Cross-Sectional Study

The unprecedented outbreak of coronavirus disease 2019 (COVID-19) has caused a huge global health and economic crisis. The aim of the study was to examine the extent to which the resilience of a person is associated with the quality of life (QoL) of adults amongst Saudi Arabia. A cross-sectional study was conducted among a sample of adults in Saudi Arabia. A total of 385 adults voluntarily participated in and completed the survey. The quality of life was measured using the “World Health Organization QoL”. The “Connor-Davidson Resilience Scale” instrument was also used to assess resilience during the COVID-19 pandemic. Amongst the 385 participants, 179 (46%) showed a good QoL, and 205 (54%) reported a relatively poor QoL. The resilience was found to be significantly associated with QoL. The study further revealed that gender-based differences were dominant in the QoL; the men respondents reported a significantly higher QoL in all the domains in comparison to the women respondents. The gender, income, and psychological health and interaction effect of resilience and age explained 40% of the variance in the total score of QoL. In reference to the predictors of the physical health domain of QoL, resilience, gender, and psychological health were significantly associated with the physical health domain of the QoL (R² = 0.26, p = 0.001). It was also noted that gender was not associated with the social relationships and environmental domains of QoL (p > 0.05). Findings showed a statistically significant association between the score of QoL and resilience, age, gender, income, and psychological health. These findings highlight the significant contribution of gender-based differences, psychological health, and resilience on the domains of QoL.

Fear of Infection and the Common Good: COVID-19 and the First Italian Lockdown

In the first quarter of 2020, Italy became one of the earliest hotspots of COVID-19 infection, and the government imposed a lockdown. During the lockdown, an online survey of 2053 adults was conducted that asked about health behaviors and about the psychological and overall impact of COVID-19. The present study is a secondary analysis of that data. We hypothesized that self-control, higher socio-economic status, existing health conditions, and fear of infection were all inversely related to actions (or intentions) that violated the lockdown (i.e., infractions). Using partial least squares structural equation modeling (PLS-SEM), we found that only the fear of infection significantly dissuaded people from violating lockdown rules. Since it is not practical or ethical to sow a fear of infection, our study indicates that enacting rules and enforcing them firmly and fairly are important tools for containing the infection. This may become more important as vaccines become more widely available and people lose their fear of infection.

Exploring health impact and safety measures against transmission of COVID-19 pandemic in Saudi Arabia

The pandemic of Covid-19 at the global level cannot be underestimated. Arab world including Saudi Arabia is affected with the pandemic of Covid-19. More importantly, the surge of the numbers of infected individuals in Iran has brought fear and anxiety in the whole region in general and Saudi Arabia in particular. Several studies have investigated the prevalence of the virus in different countries from various perspectives. Nonetheless, little focus is given to academic research on health challenge of the virus resulting to fear and anxiety in the recent time in the context of Saudi Arabia. This study primarily aims at exploring the health effect of Covid-19 in Saudi Arabia despite the fact that, the World Health Organization (WHO) has clamored for preventive measures in addressing global health effect of the virus. The methodology of the study is systematic literature review (SLR) and content analysis of the secondary data on health impact of Covid-19 and preventive measures against its transmission in the country are critically analyzed. The results of secondary data of the study indicated that a number of confirmed cases, active cases and deaths in Saudi Arabia manifested negative impact of Covid-19 on citizens' health especially fear and anxiety despite the fact that records have showed steady recovered cases in the country. More specifically, the findings indicated that, health impact of Covid-19 are as follows namely: fear or anxiety, negative attitude among health workers and women in health workforce. Similarly, Saudi Arabia has put in place various preventive measures such as: preventive measures against transmission of Covid-19 which are as follows: institutional preparedness and strengthening mechanism, curfews and lockdowns and suspension of activities and order of social distancing. In conclusion, this paper has lucidly highlighted the health effect of Covid-19 and safety measures against the transmission of Covid-19 have been elaborated in the context of Saudi Arabia. It is thereby suggested that, the outcome of this study can be helpful to the health workers and policymakers in the country to be acquainted with the magnanimity of the novel coronavirus as well as putting effective safety mechanisms in place in curtailing the spread of Covid-19 in Saudi Arabia.

Social Quarantine and Its Four Modes: Conceptional Exploration and the Theoretical Construction of the Polices Against COVID-19

Building on the studies of health quarantine from a social perspective, this article explores the complex contexts of social quarantine as a mode of public health, a mode of community action and a behavioural and psychological mode of social distancing. To establish a conceptual investigation of the "social quarantine" issue, this study investigates four approaches to quarantine: public health, social administration, behavioural norms, and psychological effects. The study identifies the features of these modes and discusses their relationships. In addition, this study constructs a preventive framework for quarantine that embraces social and health policies to enrich the understanding of policy measures for social distancing and lockdown measures. On this basis, the study evaluates the strategies of policy development in response to the COVID-19 pandemic. The study concludes that these modes can reconstruct social relations and provide some basis for theoretical analysis about the features of social quarantine, which is vital for policymakers when considering national and global prevention strategies for public health.

Measuring the impact of suspending Umrah, a global mass gathering in Saudi Arabia on the COVID-19 pandemic

Since the early days of the coronavirus (COVID-19) outbreak in Wuhan, China, Saudi Arabia started to implement several preventative measures starting with the imposition of travel restrictions to and from China. Due to the rapid spread of COVID-19, and with the first confirmed case in Saudi Arabia in March 2019, more strict measures, such as international travel restriction, and suspension or cancellation of major events, social gatherings, prayers at mosques, and sports competitions, were employed. These non-pharmaceutical interventions aim to reduce the extent of the epidemic due to the implications of international travel and mass gatherings on the increase in the number of new cases locally and globally. Since this ongoing outbreak is the first of its kind in the modern world, the impact of suspending mass gatherings on the outbreak is unknown and difficult to measure. We use a stratified SEIR epidemic model to evaluate the impact of Umrah, a global Muslim pilgrimage to Mecca, on the spread of the COVID-19 pandemic during the month of Ramadan, the peak of the Umrah season. The analyses shown in the paper provide insights into the effects of global mass gatherings such as Hajj and Umrah on the progression of the COVID-19 pandemic locally and globally.

"Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study"

OBJECTIVE

Mass gathering events (MGEs) are associated with the transmission of COVID-19. Between 6 and 10 March 2020, several MGEs related to the Falles festival took place in Borriana, a municipality in the province of Castellon (Spain). The aim of this study was to estimate the incidence of COVID-19 and its association with these MGEs, and to quantify the potential risk factors of its occurrence.

METHODS

During May and June 2020, a population-based retrospective cohort study was carried out by the Public Health Center of Castelló and the Hospital de la Plana in Vila-real. Participants were obtained from a representative sample of 1663 people with potential exposure at six MGEs. A questionnaire survey was carried out to obtain information about attendance at MGEs and COVID-19 disease. In addition, a serologic survey of antibodies against SARS-Cov-2 was implemented. Inverse probability weighted regression was used in the statistical analysis.

RESULTS

A total of 1338 subjects participated in the questionnaire survey (80.5%), 997 of whom undertook the serologic survey. Five hundred and seventy cases were observed with an attack rate (AR) of 42.6%; average age was 36 years, 62.3% were female, 536 cases were confirmed by laboratory tests, and 514 cases were found with SARS-CoV-2 total antibodies. Considering MGE exposure, AR was 39.2% (496/1264). A dose-response relationship was found between MGE attendance and the disease, (adjusted relative risk [aRR] = 4.11 95% confidence interval [CI]3.25-5.19). Two MGEs with a dinner and dance in the same building had higher risks. Associated risk factors with the incidence were older age, obesity, and upper and middle class versus lower class; current smoking was protective.

CONCLUSIONS

The study suggests the significance of MGEs in the COVID-19 transmission that could explain the subsequent outbreak in Borriana.

Fever in the Returned Pediatric Traveler

Global mobility has been steadily increasing in recent years. The assessment of the febrile child returning from international travel is a diagnostic challenge. The COVID-19 pandemic has profoundly affected international travel and made evaluation and management of the sick returned traveler more challenging. Children visiting friends and relatives abroad remain at higher risk of infection compared to tourists. This review presents a guidance on the initial assessment of a traveling febrile child including interpretation of medical history, physical examination, and laboratory findings. Important clues to etiology include exposure to different infectious agents, incubation periods of pathogens, and prophylaxis regimens and vaccines received. Early identification of potentially life-threatening and highly contagious infections is essential. In this article, we discuss the epidemiology, evaluation, and management of specific travel related infections such as malaria, typhoid fever, dengue fever, viral hemorrhagic fever, rickettsiosis, leptospirosis, schistosomiasis, gastrointestinal, and respiratory infections.

Superposed Natural Hazards and Pandemics: Breaking Dams, Floods, and COVID-19

Within the engineering domain, safety issues are often related to engineering design and typically exclude factors such as epidemics, famine, and disease. This article provides a perspective on the reciprocal relationship and interaction between a natural hazard and a simultaneous pandemic outbreak and discusses how a catastrophic dam break, combined with the ongoing COVID-19 pandemic, poses a risk to human life. The paper uses grey- and peer-reviewed literature to support the discussion and reviews fundamentals of dam safety management, potential loss of life due to a dam break, and the recent evolution in dam risk analysis to account for the COVID-19 outbreak. Conventional risk reduction recommendations, such as quick evacuation and sheltering in communal centers, are revisited in the presence of a pandemic when social distancing is recommended. This perspective manuscript aims to provide insight into the multi-hazard risk problem resulting from a concurring natural hazard and global pandemic.

Nanotechnology Integration for SARS-CoV-2 Diagnosis and Treatment: An Approach to Preventing Pandemic

The SARS-CoV-2 outbreak is the COVID-19 disease, which has caused massive health devastation, prompting the World Health Organization to declare a worldwide health emergency. The corona virus infected millions of people worldwide, and many died as a result of a lack of particular medications. The current emergency necessitates extensive therapy in order to stop the spread of the coronavirus. There are various vaccinations available, but no validated COVID-19 treatments. Since its outbreak, many therapeutics have been tested, including the use of repurposed medications, nucleoside inhibitors, protease inhibitors, broad spectrum antivirals, convalescence plasma therapies, immune-modulators, and monoclonal antibodies. However, these approaches have not yielded any outcomes and are mostly used to alleviate symptoms associated with potentially fatal adverse drug reactions. Nanoparticles, on the other hand, may prove to be an effective treatment for COVID-19. They can be designed to boost the efficacy of currently available antiviral medications or to trigger a rapid immune response against COVID-19. In the last decade, there has been significant progress in nanotechnology. This review focuses on the virus's basic structure, pathogenesis, and current treatment options for COVID-19. This study addresses nanotechnology and its applications in diagnosis, prevention, treatment, and targeted vaccine delivery, laying the groundwork for a successful pandemic fight.

Novel Respiratory Viruses in the Context of Mass-Gathering Events: A Systematic Review to Inform Event Planning from a Health Perspective

BACKGROUND

Mass-gathering events (MGEs) occur regularly throughout the world. As people congregate at MGEs, there is an increased risk of transmission of communicable diseases. Novel respiratory viruses, such as Severe Acute Respiratory Syndrome Coronavirus-1 (SARS-CoV-1), Influenza A Virus Subtype H1N1 Strain 2009 (H1N1pdm09), Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), or Coronavirus Disease 2019 (COVID-19), may require specific infection prevention and control strategies to minimize the risk of transmission when planning MGEs. This literature review aimed to identify and analyze papers relating to novel respiratory viruses with pandemic potential and to inform MGE planning.

METHOD

This paper used a systematic literature review method. Various health care databases were searched using keywords relating to MGEs and novel respiratory viruses. Information was extracted from identified papers into various tables for analysis. The analysis identified infection prevention and control strategies used at MGEs to inform planning before, during, and following events.

RESULTS

In total, 27 papers met the criteria for inclusion. No papers were identified regarding SARS-CoV-1, while the remainder reported on H1N1pdm09 (n = 9), MERS-CoV (n = 15), and SARS-CoV-2 (n = 3). Various before, during, and after event mitigation strategies were identified that can be implemented for future events.

CONCLUSIONS

This literature review provided an overview of the novel respiratory virus epidemiology at MGEs alongside related public health mitigation strategies that have been implemented at these events. This paper also discusses the health security of event participants and host communities in the context of cancelling, postponing, and modifying events due to a novel respiratory virus. In particular, ways to recommence events incorporating various mitigation strategies are outlined.

Prediction of Health Risk Preventative Behavior of Amateur Marathon Runners: A Cross-Sectional Study

Introduction

Prevention of the health risk of amateur marathon runners is of great significance for the sustainable development of marathon. To reduce the psychological burden of amateur marathon runners and improve the participation experience, the current study used the health belief model to study the relationship among health beliefs, attitude to preventative behavior, self-efficacy, and health values of amateur marathon runners.

Methods

A total of 342 data were collected, and using the PROCESS (analytical procedures developed for mediating and moderating effects tests based on SPSS and SAS). A series of multiple linear regression models were established to study the relationship between variables, and the bootstrap confidence interval was selected to test the mediating and moderating effect.

Results

The results showed that perceived health threat (b = 0.463, p <0.05), health behavior expectations (b = 0.373, p <0.001), self-efficacy (b = 0.322, p <0.001), and behavioral attitudes (b = 0.230, p <0.001) can be regarded as antecedent variables for predicting preventative behaviors. In addition, the results also show that health behavior expectations, self-efficacy, and behavioral attitudes play chain-mediating role between perceived health threat and preventative behaviors. Health values appear to play a moderating role in the direct/indirect effects of perceived health threat on preventive behavior through a number of mediating variables.

Discussion

This study emphasizes that the amateur marathon runners must improve their health concept and take effective preventive measures before participating in the competition. According to this research, it is the responsibility of the event parties, public health officials and relevant departments of the host city to provide rich health information and risk education to amateur marathon runners. More public service advertisements or educational materials are needed to be placed on runners to enhance their awareness of the necessity and importance of taking preventive measures.

Epidemiological characteristics and initial spatiotemporal visualisation of COVID-19 in a major city in the Middle East

BACKGROUND

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) emerged initially in China in December 2019 causing the COVID-19 disease, which quickly spread worldwide. Iran was one of the first countries outside China to be affected in a major way and is now under the spell of a fourth wave. This study aims to investigate the epidemiological characteristics of COVID-19 cases in north-eastern Iran through mapping the spatiotemporal trend of the disease.

METHODS

The study comprises data of 4000 patients diagnosed by laboratory assays or clinical investigation from the beginning of the disease on Feb 14, 2020, until May 11, 2020. Epidemiological features and spatiotemporal trends of the disease in the study area were explored by classical statistical approaches and Geographic Information Systems.

RESULTS

Most common symptoms were dyspnoea (69.4%), cough (59.4%), fever (54.4%) and weakness (19.5%). Approximately 82% of those who did not survive suffered from dyspnoea. The highest Case Fatality Rate (CFR) was related to those with cardiovascular disease (27.9%) and/or diabetes (18.1%). Old age (≥60 years) was associated with an almost five-fold increased CFR. Odds Ratio (OR) showed malignancy (3.8), nervous diseases (2.2), and respiratory diseases (2.2) to be significantly associated with increased CFR with developments, such as hospitalization at the ICU (2.9) and LOS (1.1) also having high correlations. Furthermore, spatial analyses revealed a geographical pattern in terms of both incidence and mortality rates, with COVID-19 first being observed in suburban areas from where the disease swiftly spread into downtown reaching a peak between 25 February to 06 March (4 incidences per km2). Mortality peaked 3 weeks later after which the infection gradually decreased. Out of patients investigated by the spatiotemporal approach (n = 727), 205 (28.2%) did not survive and 66.8% of them were men.

CONCLUSIONS

Older adults and people with severe co-morbidities were at higher risk for developing serious complications due to COVID-19. Applying spatiotemporal methods to identify the transmission trends and high-risk areas can rapidly be documented, thereby assisting policymakers in designing and implementing tailored interventions to control and prevent not only COVID-19 but also other rapidly spreading epidemics/pandemics.

Why the COVID-19 Is Not Significantly Reduced in Iran?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was transported from China to Iran via passengers. The virus is transmitted through droplets from coughing, sneezing, talking and contact with infected surfaces. Due to high transmissibility in places such as clinics, medical offices, buses and offices where there are large crowds, it spread rapidly in Iran and caused the mortality of a significant number of people, especially the elderly with underlying disease. Preventing travel and gatherings, as well as applying house quarantine in Apr 2020, reduced COVID-19 somewhat but then due to lack of attention to social distancing, reducing the use of masks by the people and inappropriate decisions by the national committee on combating coronavirus (NCCC), including reducing the working hours of public offices and shops, reducing the staff of government offices, monopoly on the distribution of essential materials and supplies, the presence of overcrowding in clinics of medical centers, hospitals, and private clinics caused the decline of the disease in the country to decrease. Measures can be taken to prevent the spread of the virus as much as possible, including: rapid detection of infected people, their isolation, contact tracing, quarantine of people over 65 and under 15, protection of the elderly, prevention of gatherings, forcing the use of protective equipment in possible gatherings, and electronicizing public services.

Unrealistic Optimism and Risk for COVID-19 Disease

Risk perception and consequently engagement in behaviors to avoid illness often do not match actual risk of infection, morbidity, and mortality. Unrealistic optimism occurs when individuals falsely believe that their personal outcomes will be more favorable than others' in the same risk category. Natural selection could favor overconfidence if its benefits, such as psychological resilience, outweigh its costs. However, just because optimism biases may have offered fitness advantages in our evolutionary past does not mean that they are always optimal. The current project examined relationships among personal risk for severe COVID-19, risk perceptions, and preventative behaviors. We predicted that those with higher risk of severe COVID-19 would exhibit unrealistic optimism and behave in ways inconsistent with their elevated risk of morbidity and mortality. Clinical risk scores for severe COVID-19 were calculated and compared with COVID-19 threat appraisal, compliance with shelter-in-place orders (March 13–May 22, 2020) and travel restrictions, compliance with public health recommendations, and potential covariates like self-rated knowledge about COVID-19 in a robust dataset including 492 participants from McLennan County, TX, USA. While those with high clinical risk acknowledged their greater likelihood of experiencing severe illness if infected, they actually reported lower perceived likelihood of becoming infected in the first place. While it is possible that those with higher clinical risk scores truly are less likely to become infected, the pattern and significance of these results held after controlling for possible occupational exposure, household size, and other factors related to infection probability. Higher clinical risk also predicted more recent travel within Texas and lower distress during the pandemic (i.e., feeling less stressed, depressed, and helpless). Additional behavioral data suggested that those with higher clinical risk scores did not generally behave differently than those with lower scores during the shelter-in-place order. While unrealistic optimism may provide some short-term psychological benefits, it could be dangerous due to improper assessment of hazardous situations; inferring that optimism bias has evolutionary origins does not mean that unrealistic optimism is “optimal” in every situation. This may be especially true when individuals face novel sources (or scales) of risk, such as a global pandemic.

Preparedness for containing COVID-19 outbreak in mass religious gathering with non-pharmaceutical interventions (NPIs)

Background

The COVID-19 outbreaks associated with mass religious gatherings which have the potential of invoking epidemics at large scale have been a great concern. This study aimed to evaluate the risk of outbreak in mass religious gathering and further to assess the preparedness of non-pharmaceutical interventions (NPIs) for preventing COVID-19 outbreak in this context.

Methods

The risk of COVID-19 outbreak in mass religious gathering was evaluated by using secondary COVID-19 cases and reproductive numbers. The preparedness of a series of NPIs for preventing COVID-19 outbreak in mass religious gathering was then assessed by using a density-dependent model. This approach was first illustrated by the Mazu Pilgrimage in Taiwan and validated by using the COVID-19 outbreak in the Shincheonji Church of Jesus (SCJ) religious gathering in South Korea.

Results

Through the strict implementation of 80% NPIs in the Mazu Pilgrimage, the number of secondary cases can be substantially reduced from 1508 (95% CI: 900–2176) to 294 (95% CI: 169–420) with the reproductive number (R) significantly below one (0.54, 95% CI: 0.31–0.78), indicating an effective containment of outbreak. The expected number of secondary COVID-19 cases in the SCJ gathering was estimated as 232 (basic reproductive number (R₀) = 6.02) and 579 (R₀ = 2.50) for the first and second outbreak, respectively, with a total expected cases (833) close to the observed data on high infection of COVID-19 cases (887, R₀ = 3.00).

Conclusion

We provided the evidence on the preparedness of NPIs for preventing COVID-19 outbreak in the context of mass religious gathering by using a density-dependent model.

Interrelationship between daily COVID-19 cases and average temperature as well as relative humidity in Germany

COVID-19 pandemic continues to obstruct social lives and the world economy other than questioning the healthcare capacity of many countries. Weather components recently came to notice as the northern hemisphere was hit by escalated incidence in winter. This study investigated the association between COVID-19 cases and two components, average temperature and relative humidity, in the 16 states of Germany. Three main approaches were carried out in this study, namely temporal correlation, spatial auto-correlation, and clustering-integrated panel regression. It is claimed that the daily COVID-19 cases correlate negatively with the average temperature and positively with the average relative humidity. To extract the spatial auto-correlation, both global Moran's [Formula: see text] and global Geary's [Formula: see text] were used whereby no significant difference in the results was observed. It is evident that randomness overwhelms the spatial pattern in all the states for most of the observations, except in recent observations where either local clusters or dispersion occurred. This is further supported by Moran's scatter plot, where states' dynamics to and fro cold and hot spots are identified, rendering a traveling-related early warning system. A random-effects model was used in the sense of case-weather regression including incidence clustering. Our task is to perceive which ranges of the incidence that are well predicted by the existing weather components rather than seeing which ranges of the weather components predicting the incidence. The proposed clustering-integrated model associated with optimal barriers articulates the data well whereby weather components outperform lag incidence cases in the prediction. Practical implications based on marginal effects follow posterior to model diagnostics.

Power-law growth of the COVID-19 fatality incidents in Europe

We report on the dynamic scaling of the diffusion growth phase of the COVID-19 epidemic in Europe. During this initial diffusion stage, the European countries implemented unprecedented mitigation polices to delay and suppress the disease contagion, although not in a uniform way or timing. Despite this diversity, we find that the reported fatality cases grow following a power law in all European countries we studied. The difference among countries is the value of the power-law exponent 3.5 < α < 8.0. This common attribute can prove a practical diagnostic tool, allowing reasonable predictions for the growth rate from very early data at a country level. We propose a model for the disease-causing interactions, based on a mechanism of human decisions and risk taking in interpersonal associations. The model describes the observed statistical distribution and contributes to the discussion on basic assumptions for homogeneous mixing or for a network perspective in epidemiological studies of COVID-19.

Ban of Religious Gatherings during the COVID-19 Pandemic: Impact on Christian Church Leaders' Well-Being in Ghana

This study was conducted during a period of lockdown and ban on social gatherings, including religious gatherings, in Ghana. The restrictions were instituted in response to the COVID-19 pandemic. The purpose of the study was to understand how the well-being of Christian church leaders was impacted during the prohibition in terms of aspects of their vocation and religious practices. Fourteen Christian church leaders located in urban and rural settings in Ghana, with 5 to 32 years of experience, discussed how they and their families were impacted by the ban on religious gatherings in Ghana. Findings revealed negative impacts of the COVID-19 restrictions, including spiritual slacking, loss of fellowship, disruption of normal routine, pandemic anxiety, and financial stress. Positive impacts included increased faith, relief/reduced stress, and increased family time. These findings are discussed from psychological trauma and disaster response perspectives.