Why does the spread of COVID-19 vary greatly in different countries? Revealing the efficacy of face masks in epidemic prevention

Increased incidence of the type 1 diabetes and diabetic ketoacidosis severity in children during COVID-19 pandemic

AIM

The effect of COVID-19 on the occurrence of type 1 diabetes and ketoacidosis in children and adolescent.

METHODS

In this descriptive-analytical cross-sectional study, the records of all children and adolescents hospitalized due to type1 diabetes for two years ago and during the COVID-19 pandemic and its peaks were investigated (January 2018-2022). Also, the desired variables including the frequency of hospitalized patients (known and new cases), the frequency of DKA, the severity of DKA, the duration of discharge from DKA, age, body mass index, duration of hospitalization, clinical symptoms including cerebral edema, laboratory data and the total daily dose insulin required at the time of discharge were compared and statistically analyzed.

RESULTS

Out of the 334 hospitalized T1DM patients, the rate of new T1DM patients was significantly higher (P = 0.006) during the pandemic. Clearly, there were more cases of DKA during the pandemic (P = 0.007). The higher severity of DKA (0.026) and the need for higher doses of insulin (P = 0.005) were also observed. The hospitalization rate was higher during the corona peaks, particularly peaks 1 and 4, compared to the non-peak days of COVID-19.

CONCLUSION

The increase in the incidence of diabetes (new cases) in the pandemic can suggest the role of the COVID-19 virus as an igniter. Also, as a trigger for the higher incidence of DKA with higher severities, which is probably caused by more damage to the pancreatic beta cells and requires higher doses of insulin.

Seroprevalence of Epstein-Barr virus infection in children during the COVID-19 pandemic in Zhejiang, China

AIM

We aimed to investigate the seroprevalence of Epstein-Barr virus (EBV) infection in children before and during the COVID-19 pandemic.

METHODS

All children admitted to the Children's Hospital Affiliated to Zhejiang University from January 2019 to December 2021 with suspected EBV-associated disease and EBV antibodies were detected by a two-step indirect method of chemiluminescence technology. A total of 44,943 children were enrolled in this study. The seroprevalence of EBV infections was compared from January 2019 to December 2021.

RESULTS

The total seropositive rate of EBV infections was 61.02% between January 2019 and December 2021, and the seropositive trend decreased year by year. The total number of seropositive EBV infections in 2020 was reduced by 30% compared to that in 2019. In particular, nearly 30% and 50% reductions in the number of acute EBV infections and EBV reactivations or late primary infections from 2019 to 2020 were found, respectively. The number of acute EBV infections in children aged 1-3 years and EBV reactivation or late primary infection in children aged 6-9 years in 2020 sharply dropped by approximately 40% and 64% compared to that in 2019.

CONCLUSIONS

Our study further demonstrated that the prevention and control measures for COVID-19 in China had a certain effect on containing acute EBV infections and EBV reactivations or late primary infections.

Implementation barriers and facilitators to a COVID-19 intervention in Bangladesh: The benefits of engaging the community for the delivery of the programme

BACKGROUND

BRAC (Bangladesh Rural Advancement Committee), the largest NGO globally, implemented a community-based comprehensive social behavior communication intervention to increase community resilience through prevention, protection, and care for COVID-19. We conducted implementation research to assess fidelity and explore the barriers and facilitators of this intervention implementation.

METHODS

We adopted a concurrent mixed-method triangulation design. We interviewed 666 members of 60 Community Corona Protection Committees (CCPCs) and 80 members of 60 Community Support Teams (CSTs) through multi-stage cluster sampling using a structured questionnaire. The qualitative components relied on 54 key informant interviews with BRAC implementers and government providers.

RESULTS

The knowledge about wearing mask, keeping social distance, washing hands and COVID-19 symptoms were high (on average more than 70%) among CCPC and CST members. While 422 (63.4%) CCPC members reported they 'always' wear a mask while going out, 69 (86.3%) CST members reported the same practice. Only 247 (37.1%) CCPC members distributed masks, and 229 (34.4%) donated soap to the underprivileged population during the last two weeks preceding the survey. The key facilitators included influential community members in the CCPC, greater acceptability of the front-line health workers, free-of-cost materials, and telemedicine services. The important barriers identified were insufficient training, irregular participation of the CCPC members, favouritism of CCPC members in distributing essential COVID-19 preventive materials, disruption in supply and shortage of the COVID-19 preventative materials, improper use of handwashing station, the non-compliant attitude of the community people, challenges to ensure home quarantine, challenges regarding telemedicine with network interruptions, lack of coordination among stakeholders, the short duration of the project.

CONCLUSIONS

Engaging the community in combination with health services through a Government-NGO partnership is a sustainable strategy for implementing the COVID-19 prevention program. Engaging the community should be promoted as an integral component of any public health intervention for sustainability. Engagement structures should incorporate a systems perspective to facilitate the relationships, ensure the quality of the delivery program, and be mindful of the heterogeneity of different community members concerning capacity building. Finally, reaching out to the underprivileged through community engagement is also an effective mechanism to progress through universal health coverage.

Mask disinfection using atmospheric pressure cold plasma

OBJECTIVES

Mask usage has increased over the last few years due to the COVID-19 pandemic, resulting in a mask shortage. Furthermore, their prolonged use causes skin problems related to bacterial overgrowth. To overcome these problems, atmospheric pressure cold plasma was studied as an alternative technology for mask disinfection.

METHODS

Different microorganisms (Pseudomonas aeruginosa, Escherichia coli, Staphylococcus spp.), different gases (nitrogen, argon, and air), plasma power (90-300 W), and treatment times (45 seconds to 5 minutes) were tested.

RESULTS

The best atmospheric pressure cold plasma treatment was the one generated by nitrogen gas at 300 W and 1.5 minutes. Testing of breathing and filtering performance and microscopic and visual analysis after one and five plasma treatment cycles, highlighted that these treatments did not affect the morphology or functional capacity of the masks.

CONCLUSION

Considering the above, we strongly believe that atmospheric pressure cold plasma could be an inexpensive, eco-friendly, and sustainable mask disinfection technology enabling their reusability and solving mask shortage.

Face mask use during the COVID-19 pandemic: how risk perception, experience with COVID-19, and attitude towards government interact with country-wide policy stringency

BACKGROUND

During the 2020 COVID-19 pandemic, governments imposed numerous regulations to protect public health, particularly the (mandatory) use of face masks. However, the appropriateness and effectiveness of face mask regulations have been widely discussed, as is apparent from the divergent measures taken across and within countries over time, including mandating, recommending, and discouraging their use. In this study, we analyse how country-level policy stringency and individual-level predictors associate with face mask use during the early stages of the global COVID-19 pandemic.

METHOD

First, we study how (self and other-related) risk perception, (direct and indirect) experience with COVID-19, attitude towards government and policy stringency shape face mask use. Second, we study whether there is an interaction between policy stringency and the individual-level variables. We conduct multilevel analyses exploiting variation in face mask regulations across countries and using data from approximately 7000 students collected in the beginning of the pandemic (weeks 17 through 19, 2020).

RESULTS

We show that policy stringency is strongly positively associated with face mask use. We find a positive association between self-related risk perception and mask use, but no relationship of mask use with experience with COVID-19 and attitudes towards government. However, in the interaction analyses, we find that government trust and perceived clarity of communication moderate the link between stringency and mask use, with positive government perceptions relating to higher use in countries with regulations and to lower use in countries without regulations.

CONCLUSIONS

We highlight that those countries that aim for widespread use of face masks should set strict measures, stress self-related risks of COVID-19, and use clear communication.

Human Mobility and Droplet-Transmissible Pediatric Infectious Diseases during the COVID-19 Pandemic

The study tested the hypothesis that human mobility may be a potential factor affecting reductions in droplet-transmissible pediatric infectious diseases (PIDs) during the coronavirus disease-2019 (COVID-19) pandemic mitigation period in 2020. An ecological study was conducted using two publicly available datasets: surveillance on infectious diseases collected by the Japanese government and COVID-19 community mobility reports presented by Google. The COVID-19 community mobility reports demonstrated percentage reductions in the movement of people over time in groceries and pharmacies, parks, and transit stations. We compared the weekly trends in the number of patients with droplet-transmissible PIDs identified in 2020 with those identified in the previous years (2015–2019) and assessed the correlations between the numbers of patients and percentage decreases in human mobility during 2020. Despite experiencing their peak seasons, dramatic reductions were found in the numbers of patients with pharyngoconjunctival fever (PCF) and group A streptococcal (GAS) pharyngitis after the tenth week of 2020. Beyond the 20th week, no seasonal peaks were observed in the number of patients with all PIDs identified in 2020. Significant correlations were found between the percentage decreases in human mobility in transit stations and the number of patients with hand-foot-and-mouth disease (Pearson correlation coefficient [95% confidence interval]: 0.65 [0.44–0.79]), PCF (0.47 [0.21–0.67]), respiratory syncytial virus infection (0.45 [0.19–0.66]), and GAS pharyngitis (0.34 [0.06–0.58]). The highest correlations were found in places underlying potential human-to-human contacts among adults. These findings suggest that reductions in human mobility for adults might contribute to decreases in the number of children with droplet-transmissible PIDs by the potential prevention of adult-to-child transmission.

COVID-19 in patients with systemic lupus erythematosus: A systematic review

The objectives of the study were to review the articles to identify (a) the epidemiology of systemic lupus erythematosus (SLE) and coronavirus disease 2019 (COVID-19); (b) the clinical characteristics of SLE patients with COVID-19; (c) the treatment of COVID-19 in SLE patients; and (d) the impact of COVID-19 pandemic on SLE patients. PubMed was systematically reviewed for literature published from December 2019 to June 2021. Our search was limited to human studies, with language restriction of English. Studies were included if they reported COVID-19 in SLE patients. Our systematic review included 52 studies. The prevalence of COVID-19 infection ranged from 0.0% to 18.1% in SLE patients, and the hospitalisation rates ranged from 0.24% to 10.6%. COVID-19 infection is likely to mimic SLE flare. Hydroxychloroquine (HCQ) was ineffective in prevention of COVID-19, and SLE patients with COVID-19 faced difficulty in healthcare access, had financial constraints and suffered from psychological distress during the pandemic. The pandemic had a significant effect on mental and physical health. Adequate healthcare access, along with containment policies, social distancing measures and psychological nursing was required.

Reuse of medical face masks in domestic and community settings without sacrificing safety: Ecological and economical lessons from the Covid-19 pandemic

The need for personal protective equipment increased exponentially in response to the Covid-19 pandemic. To cope with the mask shortage during springtime 2020, a French consortium was created to find ways to reuse medical and respiratory masks in healthcare departments. The consortium addressed the complex context of the balance between cleaning medical masks in a way that maintains their safety and functionality for reuse, with the environmental advantage to manage medical disposable waste despite the current mask designation as single-use by the regulatory frameworks. We report a Workflow that provides a quantitative basis to determine the safety and efficacy of a medical mask that is decontaminated for reuse. The type IIR polypropylene medical masks can be washed up to 10 times, washed 5 times and autoclaved 5 times, or washed then sterilized with radiations or ethylene oxide, without any degradation of their filtration or breathability properties. There is loss of the anti-projection properties. The Workflow rendered the medical masks to comply to the AFNOR S76-001 standard as "type 1 non-sanitory usage masks". This qualification gives a legal status to the Workflow-treated masks and allows recommendation for the reuse of washed medical masks by the general population, with the significant public health advantage of providing better protection than cloth-tissue masks. Additionally, such a legal status provides a basis to perform a clinical trial to test the masks in real conditions, with full compliance with EN 14683 norm, for collective reuse. The rational reuse of medical mask and their end-of-life management is critical, particularly in pandemic periods when decisive turns can be taken. The reuse of masks in the general population, in industries, or in hospitals (but not for surgery) has significant advantages for the management of waste without degrading the safety of individuals wearing reused masks.

Can culture beat Covid-19? Evidence that exposure to facemasks with cultural symbols increases solidarity

Facemasks have become integral to everyday life. We propose that exposure to facemasks with a solidarity-related cultural symbol can activate cultural values such as mutual trust and increase corresponding interpersonal perceptions, thereby enhancing collective resilience in the Covid-19 pandemic. In three (two of which preregistered) studies, we examined whether exposure to facemasks with a solidarity-related cultural symbol predicts positive interpersonal perceptions, and whether this depends on death awareness. Across studies, exposure to facemasks with a cultural symbol (either pride flag or National Health Service) increased positive interpersonal perceptions, an index of solidarity, in people for whom this symbol represents a meaningful social identity. This was found whether participants were reminded of death, a neutral experience, or a negative experience. Importantly, in Study 3, exposure to facemasks with a solidarity-related cultural symbol (vs. surgical) led to greater increases in positive interpersonal perceptions when death awareness was high. Together, our findings suggest that wearing facemasks with a cultural symbol that relates to solidarity can be a vehicle for shaping people's personality impressions of others. Applied directions for the activation of people's social identities via facemask selection to promote collective resilience in the Covid-19 pandemic are discussed.

Protective measures are associated with the reduction of transmission of COVID-19 in Bangladesh: A nationwide cross-sectional study

Coronavirus disease 2019 (COVID-19) pandemic has become a major public health issue globally. Preventive health measures against COVID-19 can reduce the health burden significantly by containing the transmission. A few research have been undertaken on the effectiveness of preventive strategies such as mask use, hand washing, and keeping social distance in preventing COVID-19 transmission. The main aim of this study was to determine the association of the preventive measures with the reduction of transmission of COVID-19 among people. Data was collected during January 06, 2021 to May 10, 2021 from 1690 participants in Bangladesh. A validated questionnaire was used to collect both the online and offline data. Chi-square test and logistic regression analyses were performed to determine the association among the variables. The prevalence of COVID-19 was 11.5% (195 of 1690) among the population. Age, gender, occupation and monthly income of the participants were significantly associated with the likelihood of following the preventive measures. The risk of infection and death reduced significantly among the participants following preventive measures (p = .001). The odds of incidence was lower among the participants using masks properly (OR: 0.02, 95% CI: 0.01-0.43), maintaining social distances (OR: 0.04, 95% CI: 0.01-0.33), avoiding crowded places (OR: 0.07, 95% CI: 0.02-0.19) and hand shaking (OR: 0.17, 95% CI: 0.09-0.41). This study suggests that preventive health measures are significantly associated with the reduction of the risk of infection of COVID-19. Findings from this study will help the policymakers to take appropriate steps to curb the health burden of COVID-19.

Fluid dynamics of respiratory droplets in the context of COVID-19: Airborne and surfaceborne transmissions

The World Health Organization has declared COVID-19 a global pandemic. Several countries have experienced repeated periods of major spreading over the last two years. Many people have lost their lives, employment, and the socioeconomic situation has been severely impacted. Thus, it is considered to be one of the major health and economic disasters in modern history. Over the last two years, several researchers have contributed significantly to the study of droplet formation, transmission, and lifetime in the context of understanding the spread of such respiratory infections from a fluid dynamics perspective. The current review emphasizes the numerous ways in which fluid dynamics aids in the comprehension of these aspects. The biology of the virus, as well as other statistical studies to forecast the pandemic, is significant, but they are not included in this review.

Systematic review of the effects of environmental factors on virus inactivation: implications for coronavirus disease 2019

Environmental factors such as temperature and relative humidity can affect the inactivation and transmission of coronaviruses. By reviewing medical experiments on virus survival and virus transmission between infected and susceptible species in different temperature and humidity conditions, this study explores the influence of temperature and relative humidity on the survival and transmission of viruses, and provides suggestions, with experimental evidence, for the environmental control measures of Coronavirus Disease 2019. The results indicated that (1) virus viability and infectivity is increased at a low temperature of 5 ℃ and reduced at higher temperatures. (2) Virus survival and transmission is highly efficient in a dry environment with low relative humidity, and also in a wet environment with high relative humidity, and it is minimal at intermediate relative humidity. Therefore, in indoor environments, the lack of heating in winter or overventilation, leading to low indoor temperature, can help virus survival and help susceptible people being infected. On the contrary, modulating the indoor relative humidity at an intermediate level is conducive to curb epidemic outbreaks.

Evolving public behavior and attitudes towards COVID-19 and face masks in Taiwan: A social media study

Facing the COVID-19 pandemic, Taiwan demonstrated resilience at the initial stage of epidemic prevention, and effectively slowed down its spread. This study aims to document public epidemic awareness of COVID-19 in Taiwan through collecting social media- and Internet-based data, and provide valuable experience of Taiwan’s response to COVID-19, involving citizens, news media, and the government, to aid the public in overcoming COVID-19, or infectious diseases that may emerge in the future. The volume of Google searches related to COVID-19 and face masks was regarded as an indicator of public epidemic awareness in the study. A time-series analysis was used to explore the relationships among public epidemic awareness and other COVID-19 relevant variables, which were collected based on big data analysis. Additionally, the content analysis was adopted to analyze the transmission of different types of fear information related to COVID-19 and their effects on the public. Our results indicate that public epidemic awareness was significantly correlated with the number of confirmed cases in Taiwan and the number of news reports on COVID-19 (correlation coefficient: .33–.56). Additionally, the findings from the content analysis suggested that the fear of the loss of control best explains why panic behavior occurs among the public. When confronting the highly infectious COVID-19, public epidemic awareness is vital. While fear is an inevitable result when an emerging infectious disease occurs, the government can convert resistance into assistance by understanding why fear arises and which fear factors cause excessive public panic. Moreover, in the digitalization era, online and social media activities could reflect public epidemic awareness that can e harnessed for epidemic control.

SARS-CoV-2 biology and variants: anticipation of viral evolution and what needs to be done

The global propagation of SARS-CoV-2 and the detection of a large number of variants, some of which have replaced the original clade to become dominant, underscores the fact that the virus is actively exploring its evolutionary space. The longer high levels of viral multiplication occur - permitted by high levels of transmission -, the more the virus can adapt to the human host and find ways to success. The third wave of the COVID-19 pandemic is starting in different parts of the world, emphasizing that transmission containment measures that are being imposed are not adequate. Part of the consideration in determining containment measures is the rationale that vaccination will soon stop transmission and allow a return to normality. However, vaccines themselves represent a selection pressure for evolution of vaccine-resistant variants, so the coupling of a policy of permitting high levels of transmission/virus multiplication during vaccine roll-out with the expectation that vaccines will deal with the pandemic, is unrealistic. In the absence of effective antivirals, it is not improbable that SARS-CoV-2 infection prophylaxis will involve an annual vaccination campaign against 'dominant' viral variants, similar to influenza prophylaxis. Living with COVID-19 will be an issue of SARS-CoV-2 variants and evolution. It is therefore crucial to understand how SARS-CoV-2 evolves and what constrains its evolution, in order to anticipate the variants that will emerge. Thus far, the focus has been on the receptor-binding spike protein, but the virus is complex, encoding 26 proteins which interact with a large number of host factors, so the possibilities for evolution are manifold and not predictable a priori. However, if we are to mount the best defence against COVID-19, we must mount it against the variants, and to do this, we must have knowledge about the evolutionary possibilities of the virus. In addition to the generic cellular interactions of the virus, there are extensive polymorphisms in humans (e.g. Lewis, HLA, etc.), some distributed within most or all populations, some restricted to specific ethnic populations and these variations pose additional opportunities for/constraints on viral evolution. We now have the wherewithal - viral genome sequencing, protein structure determination/modelling, protein interaction analysis - to functionally characterize viral variants, but access to comprehensive genome data is extremely uneven. Yet, to develop an understanding of the impacts of such evolution on transmission and disease, we must link it to transmission (viral epidemiology) and disease data (patient clinical data), and the population granularities of these. In this editorial, we explore key facets of viral biology and the influence of relevant aspects of human polymorphisms, human behaviour, geography and climate and, based on this, derive a series of recommendations to monitor viral evolution and predict the types of variants that are likely to arise.