Adaptation of the National Plan for the Prevention and Fight Against Pandemic Influenza to the 2020 COVID-19 Epidemic in France

A New Experience in the Turkish Health System in Response to COVID-19

OBJECTIVE

A substantial amount of work addressing strategies on how to respond to the coronavirus disease (COVID-19) crisis already exists. However, there is simply not enough evidence to support a systematic and all-encompassing approach. This study aims to systematically review and present the roadmap of Turkiye's response to COVID-19.

METHODS

This study is based on a thematic content analysis of official policy documents to present the roadmap in Turkiye's fight against COVID-19. The analysis included 46 press releases accessed from the Ministry of Health's website. The coding structure was created by the researchers based on the literature. Documents were analyzed by dividing them into 3 periods: the panic period, the controlled normalization period, and the normalization period. Each document was sub-coded under the main themes of "concerns" and "strategies" and interpreted by comparing them with each other.

RESULTS

The study results show that different categories and coding structures were formed between periods. Some categories that emerged under the theme of concerns were "vaccine concerns" and "social concerns." Similarly, some categories that appeared under the theme of strategies were "vaccine strategies," "monitoring and surveillance strategies," and "intervention strategies."

CONCLUSION

The results provide policy-makers with an appropriate conceptual framework to deal with the pandemic crisis that may be encountered in the future.

Health system, surveillance and the COVID-19 pandemic response in France

France was the first European country to confirm cases of COVID-19, being one of the most affected by the pandemic in the first wave. This case study analyzed the measures adopted by the country in the fight against COVID-19 in 2020 and 2021, correlating it to the characteristics of its health and surveillance system. As a welfare state, it relied on compensatory policies and protection of the economy, as well as increased investments in health. There were weaknesses in the preparation and delay in the implementation of the coping plan. The response was coordinated by the national executive power, adopting strict lockdowns in the first two waves, mitigating restrictive measures in the other waves, after the increase in vaccination coverage and in the face of population resistance. The country faced problems with testing, case and contact surveillance and patient care, especially in the first wave. It was necessary to modify the health insurance rules to expand coverage, access and better articulation of surveillance actions. It indicates lessons learned about the limits of its social security system, but also the potential of a government with a strong response capacity in the financing of public policies and regulation of other sectors to face the crisis.

Obstetrics and Gynecology Emergency Department Activity during Lockdown in a Teaching Hospital, Hub Center, for COVID-19

Background

The lockdown related to the SARS-CoV-2 pandemic has imposed profound changes in the interaction of the population with hospitals and emergency departments. The main aim of this research was to evaluate the impact of lockdown on the activity of obstetrics and gynecology emergency department (OGED) in a teaching hospital, hub center, for COVID-19.

Methods

The study considers all visits to the OGED with their different triage color codes that represent the clinical severity of each case (from the most severe to the least one: red, yellow, green, white). Data were selected through the “PSNet” triage program and collected anonymously. We analyzed frequency distributions of the variables separately for each woman and calculated mean and standard deviations for continuous variables. We then analyzed the association between factors and outcomes for categorical variables (expressed as a number and percentage of the total) using the chi-square test (χ2). The level of significance was established with p < 0.05. Statistical analysis was performed using SPSS Statistics V20.0. Given the fact that the study has a retrospective observational nature and it is based on an anonymous routine database, approval by the Local Ethics Committee was not necessary.

Results

The relative decrease of patients presenting to OGED in 2020 was −50.96%. The percentage of nonpregnant women was significantly lower in 2020 compared to 2019 (p ≤ 0.0001; Δ = −79.46%). Regarding the obstetric group, we saw an important decrease of visits in 2020 compared to 2019 (p < 0.0001; Δ = −40%). The prevalence of yellow codes was significantly higher in 2020 (Δ = +29.72%), while that of white (Δ = −61.58%) and green (Δ = −52.22%) codes was significantly lower (p ≤ 0.0001). Comparing the diagnoses at discharge, we could highlight significant reductions in 2020 for more than one diagnosis: bleeding (p ≤ 0.0001; Δ = −70.42%), pain (p ≤ 0.0001; Δ = −81.22%), urinary diseases (p = 0.004; Δ = −75.64%), and gastrointestinal diseases (p ≤ 0.0001; Δ = −87.50%).

Conclusions

An evident change emerged in relation to the dynamics between the local obstetrical and gynecological population, and OGED resources. The COVID‐19 lockdown greatly reduced the rate of admission to OGED without time-related obstetric and gynecological complications. The reduction of admissions suggests a more appropriate use of the ED by patients that may inspire future policies for the implementation of emergency services.

Panel Associations Between Newly Dead, Healed, Recovered, and Confirmed Cases During COVID-19 Pandemic

Background

Currently, the knowledge of associations among newly recovered cases (NR), newly healed cases (NH), newly confirmed cases (NC), and newly dead cases (ND) can help to monitor, evaluate, predict, control, and curb the spreading of coronavirus disease 2019 (COVID-19). This study aimed to explore the panel associations of ND, NH, and NR with NC.

Methods

Data from China Data Lab in Harvard Dataverse with China (January 15, 2020 to January 14, 2021), the United States of America (the USA, January 21, 2020 to April 5, 2021), and the World (January 22, 2020 to March 20, 2021) had been analyzed. The main variables included in the present analysis were ND, NH, NR, and NC. Pooled regression, stacked within-transformed linear regression, quantile regression for panel data, random-effects negative binomial regression, and random-effects Poisson regression were conducted to reflect the associations of ND, NH, and NR with NC. Event study analyses were performed to explore how the key events influenced NC.

Results

Descriptive analyses showed that mean value of ND/NC ratio regarding China was more than those regarding the USA and the World. The results from tentative analysis reported the significant relationships among ND, NH, NR, and NC regarding China, the USA, and the World. Panel regressions confirmed associations of ND, NH, and NR with NC regarding China, the USA, and the World. Panel event study showed that key events influenced NC regarding USA and the World more greatly than that regarding China.

Conclusion

The findings in this study confirmed the panel associations of ND, NH, and NR with NC in the three datasets. The efficiencies of various control strategies of COVID-19 pandemic across the globe were compared by the regression outcomes. Future direction of research work could explore the influencing mechanisms of the panel associations.

Pediatric Non-COVID-19 Community-Acquired Pneumonia in COVID-19 Pandemic

Introduction

The COVID-19 lockdown strategies were associated with a significant decrease in infectious diseases disseminated through airborne or fecal–oral transmissions. Social distancing and other lockdown strategies effectively slowed down the spread of common respiratory viral diseases and decreased the need for hospitalization among children. Thus, a decline in the incidence of respiratory viral diseases had been reported following the COVID-19 outbreak. However, the trend of non-COVID-19 pneumonia in children remains uncertain. This study aimed to assess the impact of the COVID-19 pandemic on the incidence of non-COVID-19 community-acquired pneumonia in children.

Materials and Methods

We conducted a retrospective analysis of all patients (age ≤18 years) presenting with pulmonary infection from January 2019 to December 2020 in a tertiary-level teaching hospital. We compared the number of pediatric patients admitted to our hospital with community-acquired pneumonia from January to December 2020 to those from the same period in 2019.

Results

A total of 65 patients were diagnosed with community-acquired pneumonia in 2019 and 18 in 2020. The number of patients with community-acquired pneumonia in 2020 was lower than that in 2019 by 47 cases in 2020. The most age distribution of pediatric patients with community-acquired pneumonia was 2–5 years in 2019, indicating the decreasing number of community-acquired pneumonia patients from 36 patients in 2019 to 3 in 2020.

Conclusion

The number of pediatric with community-acquired pneumonia was lower than in the same period in 2019, which markedly decreased (−72.3%) in 2020. These interventions applied to control the COVID-19 pandemic were effective not only in substantial changes in the seasonal influenza activity but also in decreasing cases of pediatric community-acquired pneumonia.

The Early Stage of the COVID-19 Outbreak in Tunisia, France, and Germany: A Systematic Mapping Review of the Different National Strategies

The multitude of national strategies used against the COVID-19 pandemic makes it necessary to review and synthesize them in order to identify potential gaps and shortcomings, and to help prioritize future control efforts. This systematic mapping review is aimed at identifying the coronavirus pandemic management strategies adopted by France, Tunisia, and Germany during the early stage of the COVID-19 outbreak. A set of government websites in addition to the PubMed and Google Scholar databases were searched to identify scientific articles and institutional documents related to the national strategies of the three countries up until July 2020. The references included were mapped and narratively synthesized based on the pillars of the Monitoring and Evaluation Framework of the Strategic Preparedness and Response Plan defined by the World Health Organization. Of the 2765 records screened, 65 documents were included in the study. The analysis of these documents showed that Germany was the first country to implement mass screening of cases and that France was the first country to implement measures to impose general containment at the national level. It also showed that Tunisia was the only country to have imposed the confinement of passengers on repatriation flights in dedicated containment centers and at the expense of the state.

Mitigating SARS-CoV-2 in the Deployed Environment

INTRODUCTION

Unlike other communal living environments (universities, boarding schools, and camps) that have been suspended during the COVID-19 pandemic, the deployed military force must continue its mission. Early challenges in the 2020 deployed environment included limited availability of living and quarantine space and limited testing capacity. This is a brief report of stringent quarantine strategies employed to newly arriving cohorts at a NATO and U.S. military base to prevent release of SARS-CoV-2 into a larger base population.

METHODS

With awareness of the worldwide pandemic, beginning in late February 2020, all personnel arriving to the Hamid Karzai International Airport NATO base were quarantined for 14 days to prevent interaction with the wider base population. Testing capacity was limited. Names, locations, and dates of those within quarantine were tracked to improve contact tracing. Between February and April 2020, the first cases of SARS-CoV-2 were diagnosed on a military base in Afghanistan within quarantine.

RESULTS

Within quarantine, 11 males became PCR positive for SARS-CoV-2 during April 2020. Five of the 11 were PCR tested for symptoms of fever, cough, or loss of taste. A sixth individual, who had been asymptomatic upon leaving the base after completion of quarantine, later developed symptoms and tested positive. Another five asymptomatic individuals were found with antibody testing just before planned release from 14 days of quarantine post-exposure and confirmed with PCR testing. All PCR-positive individuals were diagnosed before being released into the general population of the base because of strict screening, quarantine, and exit criteria.

CONCLUSION

Quarantine creates significant strain on resources in a deployed environment. Group quarantine facilities where social distancing is limited allow for the possibility for intra-quarantine transmission of SARS-CoV-2. Ideally, PCR testing is done upon entry into quarantine and upon exit. With the possibility of false-negative PCR or limited PCR testing, we recommend daily symptom screening, pulse oximetry, temperature checks, and small quarantine groups that must "graduate" together-all meeting exit criteria. Any introduction of new individual, even with negative testing, to a group increases risk of SARS-CoV-2 transmission.Upon exit of quarantine, testing should be performed, regardless of entry testing. If PCR is limited, serology testing should be done, followed by PCR, if positive. Serology testing can be combined with clinical judgment to conserve PCR testing for quarantine release of asymptomatic individuals.

Evaluation of the impact of the COVID-19 lockdown on the quality of life of patients monitored for cancer who practice an adapted physical activity: rugby for health

Purpose

The benefits of regular physical exercise on the tolerability of cancer treatments, quality of life and survival rates post-diagnosis have been demonstrated but all supervised physical activities have been interrupted due to the global health crisis and the need for lockdown to halt the spread of SARS-CoV-2. To reintroduce activities post-lockdown, we wanted to assess the impact of the COVID-19 lockdown on the quality of life and the psychological status of patients who practice an adapted physical activity such as rugby for health.

Methods

The evaluation was conducted in two phases: an initial self-questionnaire comprised of 42 questions sent to all participants to assess the impact of lockdown and a second assessment phase in the presence of the participants. We assessed anthropometric data, functional fitness parameters, quality of life and the psychosocial status of the subjects. The data were compared to pre-lockdown data as part of a standardised follow-up procedure for patients enrolled in the programme.

Results

105/120 (87.5%) individuals responded to the rapid post-lockdown survey analysis. In 20% of the cases, the patients reported anxiety, pain, a decline in fitness and a significant impact on the tolerability of cancer treatments. Twenty-seven patients agreed to participate in the individual analysis. Following lockdown, there was a significant decrease in the intensity of physical activity (p = 8.223e–05). No post-lockdown changes were noted in the assessments that focus on the quality of life and the level of psychological distress. Conversely, there was a significant correlation between the total of high energy expended during lockdown and the quality of life (p = 0.03; rho = 0.2248) and the level of psychological distress post-lockdown (p = 0.05; rho = − 0.3772).

Conclusion

Lockdown and reduced physical activity, particularly leisure activities, did not impact the overall health of the patients. However, there was a significant correlation with the level of physical activity since the higher the level of physical activity, the better the quality of life and the lower the level of psychological distress.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00432-021-03621-7.

Coronavirus Disease 2019 Pandemic: Impact Caused by School Closure and National Lockdown on Pediatric Visits and Admissions for Viral and Nonviral Infections-a Time Series Analysis

A time series analysis of 871 543 pediatric emergency visits revealed that the coronavirus disease 2019 (COVID-19) lockdown and school closures were associated with a significant decrease in infectious diseases disseminated through airborne or fecal-oral transmission: common cold, gastroenteritis, bronchiolitis, and acute otitis. No change was found for urinary tract infections.

[Hygiene as a weapon in the fight against SARS-Cov-2. All experts in taking care!]

To combat SARS-Cov-2, hygiene is essential for the safety of caregivers and saves lives. In hospital as well as in everyday social and professional environments, everyone is concerned by hygiene and distancing rules. It is an opportunity for us to reinvent ourselves, protect ourselves and protect the most vulnerable. In hospital, at the heart of the crisis, the action of the infection control team, which includes the infection control nurse, is one of the cornerstones of the fight against COVID-19.

Adaptation to SARS-CoV-2 under stress: Role of distorted information

BACKGROUND

Since the time of global SARS-CoV-2 spread across the earth in February 2020, most of countries faced the problem of massive stress of their healthcare systems. In many cases, the structural stress was a result of incorrect allocation of medical care resources. In turn, this misallocation resulted from fear and apprehensions that superseded thorough calculations. A key role in exacerbating the healthcare sector overburdening was played by misleading information on the virus and disease caused by it. In the current paper, we study the situation in Russian healthcare system and advance recommendations how to avoid further crises.

MATERIALS AND METHODS

(a) Surveying the medical personnel (231 doctors, 317 nurses and 355 ambulance medical workers of lower levels) in five hospitals and six ambulance centres in Moscow. (b) Content analysis of 3164 accounts in Russian segment of social networks (VKontakte, Facebook, Instagram, Twitter, Odnoklassniki); official and unofficial media (TV, informational webpages).

RESULTS

We revealed positive-feedback loop that threatened the sustainability of Russian care sector. The main knot was occupied by incorrect/exaggerated media coverage of COVID-19. General public scared by misinformation in media and social networks, started to panic. This negative social background undermined the productivity of a significant part of medical workers who were afraid of COVID-19 patients.

CONCLUSIONS

The most serious problems of Russian healthcare sector related to COVID-19 pandemic, were informational problems. The exaggerated information on COVID-19 had big negative influence upon Russian society and healthcare system, despite SARS-CoV-2 relatively low epidemiological hazard.

Comprehensive Overview on Multiple Strategies Fighting COVID-19

Lately, myriad of novel viruses have emerged causing epidemics such as SARS, MERS, and SARS-CoV-2, leading to high mortality rates worldwide. Thus, these viruses represented a challenging threat to mankind, especially considering the miniscule data available at our disposal regarding these novel viruses. The entire world established coordinative relations in research projects regarding drug and vaccine development on the external range, whereas on the internal range, all countries declared it an emergency case through imposing different restrictions related to their border control, large gatherings, school attendance, and most social activities. Pandemic combating plans prioritized all sectors including normal people, medical staff politicians, and scientists collectively shouldered the burden. Through planning and learning the previous lessons from SARS and MERS, healthcare systems could succeed in combating the viral spread and implications of these new pandemics. Different management strategies including social distance, social awareness and isolation represented successful ways to slow down the spread of the pandemic. Furthermore, pre-preparedness of some countries for emergencies is crucial to minimize the consequences of the crisis.