A new twenty-first century science for effective epidemic response

A system dynamics modelling and analytical framework for imported dengue outbreak surveillance and risk mapping

System Dynamics (SD) models have been used to understand complex, multi-faceted dengue transmission dynamics, but a gap persists between research and actionable public health tools for decision-making. Spain is an at-risk country of imported dengue outbreaks, but only qualitative assessments are available to guide public health action and control. We propose a modular SD model combining temperature-dependent vector population, transmission parameters, and epidemiological interactions to simulate outbreaks from imported cases accounting for heterogeneous local climate-related transmission patterns. Under our assumptions, 15 provinces sustain vector populations capable of generating outbreaks from imported cases, with heterogeneous risk profiles regarding seasonality, magnitude and risk window shifting from late Spring to early Autum. Results being relative to given vector-to-human populations allow flexibility when translating outcomes between geographic scales. The model and the framework are meant to serve public health by incorporating transmission dynamics and quantitative-qualitative input to the evidence-based decision-making chain. It is a flexible tool that can easily adapt to changing contexts, parametrizations and epidemiological settings thanks to the modular approach.

Human movement and environmental barriers shape the emergence of dengue

Understanding how emerging infectious diseases spread within and between countries is essential to contain future pandemics. Spread to new areas requires connectivity between one or more sources and a suitable local environment, but how these two factors interact at different stages of disease emergence remains largely unknown. Further, no analytical framework exists to examine their roles. Here we develop a dynamic modelling approach for infectious diseases that explicitly models both connectivity via human movement and environmental suitability interactions. We apply it to better understand recently observed (1995-2019) patterns as well as predict past unobserved (1983-2000) and future (2020-2039) spread of dengue in Mexico and Brazil. We find that these models can accurately reconstruct long-term spread pathways, determine historical origins, and identify specific routes of invasion. We find early dengue invasion is more heavily influenced by environmental factors, resulting in patchy non-contiguous spread, while short and long-distance connectivity becomes more important in later stages. Our results have immediate practical applications for forecasting and containing the spread of dengue and emergence of new serotypes. Given current and future trends in human mobility, climate, and zoonotic spillover, understanding the interplay between connectivity and environmental suitability will be increasingly necessary to contain emerging and re-emerging pathogens.

Evolutionary game analysis of multiple subjects in the management of major public health emergencies

The frequent occurrence of major public health emergencies (MPHEs) significantly challenges national security, economic stability, social operation and the safety of people's lives and property worldwide. Consequently, enhancing the emergency management of MPHEs is critically urgent. This paper constructs a game model involving local government, social organisations, and the public for MPHE management, exploring strategy combinations and influencing factors across various scenarios. Several results were obtained. (1) Local government, social organisations, and the public each have positive and negative strategy choices based on cost-benefit analysis, leading to eight different strategy combinations. Furthermore, all three take positive strategies as the optimal way to achieve the game equilibrium. (2) The transformation of strategy combinations is primarily influenced by the cost-benefit gap and the strategic decisions of local government. (3) Altering a subject's initial strategy value doesn't change its final choice but impacts the time to achieve a stable strategy equilibrium. The severity of local government punishments on social organisations influences their strategic choices and the time to optimal strategy, whereas rewards to the public or social organisations only affect the time to achieve this strategy. The findings of this study can not only help improve the collaborative governance system of MPHEs but also provide scientific guidance on how governments can manage MPHEs.

Six dilemmas for stakeholders inherently affecting data sharing during a zoonotic (re-)emerging infectious disease outbreak response

BACKGROUND

Timely access to outbreak related data, particularly in the early events of a spillover, is important to support evidence based control measures in response to outbreaks of zoonotic Emerging Infectious Diseases (EID). Yet, this is impeded by several barriers that need to be understood to promote timely sharing of data. Using the MERS epidemic as a model for a zoonotic EID outbreak, this study sought to provide an in-depth understanding of data sharing practices.

METHODS

Semi-structured interviews with 25 experts were conducted, along with Focus Group Discussions with 15 additional experts. A root-cause analysis was performed to examine the causal relationships between barriers. Enablers were mapped to the root-cause analysis to understand their influence on the barriers. Finally, root causes were placed in context of core dilemmas identified from the qualitative analysis.

FINDINGS

Eight barriers to data sharing were identified, related to collaboration, technical preparedness, regulations, and (conflict of) interests, and placed in the context of six dilemmas inherent to the multi-stakeholder collaboration required for a zoonotic outbreak response. Fourteen identified enablers showed the willingness of stakeholders to overcome or circumvent these barriers, but also indicated the inherent trial and error nature of implementing such enablers.

INTERPRETATION

Addressing the barriers requires solutions that must consider the complexity and interconnectedness of the root causes underlying them, and should consider the distinct scopes and interests of the different stakeholders. Insights provided by this study can be used to encourage data sharing practices for future outbreaks FUNDING: Wellcome Trust and UK Aid; EU-H2020 Societal Challenges (grant agreement no. 643476), Nederlandse Organisatie voor Wetenschappelijk Onderzoek (VI.Veni.201S.044).

Emerging and re-emerging pediatric viral diseases: a continuing global challenge

The twenty-first century has been marked by a surge in viral epidemics and pandemics, highlighting the global health challenge posed by emerging and re-emerging pediatric viral diseases. This review article explores the complex dynamics contributing to this challenge, including climate change, globalization, socio-economic interconnectedness, geopolitical tensions, vaccine hesitancy, misinformation, and disparities in access to healthcare resources. Understanding the interactions between the environment, socioeconomics, and health is crucial for effectively addressing current and future outbreaks. This scoping review focuses on emerging and re-emerging viral infectious diseases, with an emphasis on pediatric vulnerability. It highlights the urgent need for prevention, preparedness, and response efforts, particularly in resource-limited communities disproportionately affected by climate change and spillover events. Adopting a One Health/Planetary Health approach, which integrates human, animal, and ecosystem health, can enhance equity and resilience in global communities. IMPACT: We provide a scoping review of emerging and re-emerging viral threats to global pediatric populations This review provides an update on current pediatric viral threats in the context of the COVID-19 pandemic This review aims to sensitize clinicians, epidemiologists, public health practitioners, and policy stakeholders/decision-makers to the role these viral diseases have in persistent pediatric morbidity and mortality.

Engaging the public in decisions about emergency vaccine deployment strategies: Lessons from scenario-based discussions in Sierra Leone

ABSTRACTThe COVID-19 pandemic has amplified discussions on emergency vaccine deployment strategies, with current perspectives often neglecting extensive community involvement in ethical, logistical and political aspects. Existing social science literature predominantly delves into factors influencing trust, overlooking the untapped potential for community engagement.Our study examines community preparedness in Sierra Leone's Kambia District, exploring diverse viewpoints on vaccine deployment strategies, emphasising Ebola and COVID-19 vaccinations. Utilising extensive ethnographic research from the Ebola vaccine trials (EBOVAC Salone) conducted in Kambia District from 2015 to 2021, including participant observation and tailored focus group discussions, we investigated various deployment scenarios with community leaders and citizens.Our findings underscore the multifaceted contributions of social science research with communities in shaping emergency vaccination strategies. These contributions span logistical insights, aligning campaigns with local livelihoods and social structures, and grounded ethical concerns assessing social justice outcomes across epidemic scenarios. This study emphasises the imperative of integrating discussions on vaccine confidence and deployment. It highlights communities' proficiency in epidemiological reasoning and their ability to bring this in conversation with salient socio-cultural, economic and religious dimensions. We therefore promote the cultivation of public dialogue, collaborative creation of impactful vaccination initiatives alongside relevant communities in recognition of their invaluable perspectives .

Resilience of research capacity strengthening initiatives in Africa during crises: the case of CARTA during COVID

Background: Several research capacity strengthening (RCS) initiatives have been established in Africa over the past decade. One such initiative is the Consortium for Advanced Research Training in Africa (CARTA) that has gained traction over the years and has been proven as an effective multidisciplinary approach to strengthen research capacity to address public and population health in Africa. Objectives: In this article, we document the experiences and management-related interventions that cushioned the CARTA programme and enabled it to remain resilient during the COVID pandemic. We further make recommendations on the enablers of resilience and optimal performance of such RCS initiatives during crises and beyond. Methods: We used routine information gathered by the CARTA secretariat from consortium correspondence, meeting minutes, reports and other related documents produced in the year 2020 in order to consolidate the experiences and interventions taken by the programme at programmatic, institutional and fellowship levels. Results: We identified a series of management-related cyclic phases that CARTA went through during the pandemic period, which included immobilisation, reflection, brainstorming, decision-making, intervening and recovery. We further identified strategic management-related interventions that contributed to the resilience of the programme during the pandemic including assessment and monitoring, communication management, policy and resource management, making investments and execution. Moreover, we observed that the strength of the leadership and management of CARTA, coupled with the consortium´s culture of collaboration, mutual trust, respect, openness, transparency, equitability, ownership, commitment and accountability, all contributed to its success during the pandemic period. Conclusion: We conclude that RCS initiatives undergo a series of phases during crises and that they need to promptly adopt and adapt appropriate management-related strategic interventions in order to remain resilient during such periods. This can be significantly realised if RCS initiatives build a culture of trust, commitment and joint ownership, and if they invest in strong management capacity.

Developing One Health surveillance systems

The health of humans, domestic and wild animals, plants, and the environment are inter-dependent. Global anthropogenic change is a key driver of disease emergence and spread and leads to biodiversity loss and ecosystem function degradation, which are themselves drivers of disease emergence. Pathogen spill-over events and subsequent disease outbreaks, including pandemics, in humans, animals and plants may arise when factors driving disease emergence and spread converge. One Health is an integrated approach that aims to sustainably balance and optimize human, animal and ecosystem health. Conventional disease surveillance has been siloed by sectors, with separate systems addressing the health of humans, domestic animals, cultivated plants, wildlife and the environment. One Health surveillance should include integrated surveillance for known and unknown pathogens, but combined with this more traditional disease-based surveillance, it also must include surveillance of drivers of disease emergence to improve prevention and mitigation of spill-over events. Here, we outline such an approach, including the characteristics and components required to overcome barriers and to optimize an integrated One Health surveillance system.

Role and effectiveness of telephone hotlines in outbreak response in Africa: A systematic review and meta-analysis

BACKGROUND

In Africa, little is known about the role of telephone hotlines in outbreak response. We systematically reviewed the role and effectiveness of hotlines on outbreak response in Africa.

METHOD

We used the Cochrane handbook and searched five databases. The protocol was registered on PROSPERO (CRD42021247141). Medline, Embase, PsycINFO, Global Health and Web of Science were searched from 30 June 2020 to August 2020 for studies on the use of telephone hotlines in outbreak response in Africa published between January 1995 and August 2020. The search was also repeated on 16 September 2022. Data on effectiveness (alerts generated, cases confirmed) were extracted from peer-reviewed studies. Meta-analysis of alerts generated, and proportion of cases confirmed was done using the random effects model. The quality of studies was assessed using the Joanna Briggs Institute (JBI) tools. The heterogeneity and publication bias were assessed using the Galbraith and funnel plots, respectively.

RESULTS

Our search yielded 1251 non-duplicate citations that were assessed. 41 full texts were identified, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. The hotlines were local (seven studies) or national (three studies). A combination of a local and national hotline was used in one study. The hotlines were set up for unusual respiratory events (one study), polio (one study), Ebola (10 studies), COVID-19 (two studies), malaria (one study), influenza-like illnesses (ILI) (one study) and rift valley fever in livestock (one study). Hotlines were mainly used for outbreak surveillance at the local level. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24-52%). The sensitivity was 41% (95% CI: 24-59%) for local hotlines and 26%(95%CI:5-47%) for national hotlines. Hotlines were also used for surveillance of rift valley fever in livestock (one study) vaccination promotion (one study), death reporting (five studies), rumour tracking and fighting misinformation (two studies) and community engagement (five studies). The studies were of low to moderate quality with high publication bias and heterogeneity(I2 = 99%). The heterogeneity was not explained by the sample size.

CONCLUSION

These data suggest that telephone hotlines can be effective in outbreak disease surveillance in Africa. Further implementation research is needed to scale up telephone hotlines in rural areas.

A holistic approach in epidemics

This paper explores the concept of a holistic approach in preventing and responding to epidemics. Epidemics are defined as the occurrence of an illness or health-related event exceeding normal expectations within a specific community or region. Holism emphasizes viewing systems as a whole rather than a collection of parts. In the context of epidemics, a holistic approach considers not only medical interventions but also social, economic, psychological and environmental factors that influence disease transmission and management. The impact of climate change on epidemic response, the understanding of the significance of animal health and agriculture, the consideration of art, culture and societal factors, the exploration of the use of technology and innovation, the addressing of limitations in resources and the provision of enhanced support for the mental and emotional well-being of individuals and affected communities, are parts of this holistic approach. By integrating them, innovative practices as well as cross-sectoral and interdisciplinary techniques can be employed. Such an approach has the potential to enhance epidemic prevention and response strategies, ultimately contributing to positive public health outcomes.

Novel 1,2,4-Triazole- and Tetrazole-Containing 4H-Thiopyrano[2,3-b]quinolines: Synthesis Based on the Thio-Michael/aza-Morita-Baylis-Hillman Tandem Reaction and Investigation of Antiviral Activity

A novel method for synthesizing 1,2,4-triazole- and tetrazole-containing 4H-thiopyrano[2,3-b]quinolines using a new combination of the thio-Michael and aza-Morita-Baylis-Hillman reactions was developed. Target compounds were evaluated for their cytotoxicities and antiviral activities against influenza A/Puerto Rico/8/34 virus in MDCK cells. The compounds showed low toxicity and some exhibited moderate antiviral activity. Molecular docking identified the M2 channel and polymerase basic protein 2 as potential targets. We observed that the antiviral activity of thiopyrano[2,3-b]quinolines is notably affected by both the nature and position of the substituent within the tetrazole ring, as well as the substituent within the benzene moiety of quinoline. These findings contribute to the further search for new antiviral agents against influenza A viruses among derivatives of thiopyrano[2,3-b]quinoline.

A global research agenda on public health and social measures during emergencies

The importance of strong coordination for research on public health and social measures was highlighted at the Seventy-fourth World Health Assembly in 2021. This article describes efforts undertaken by the World Health Organization (WHO) to develop a global research agenda on the use of public health and social measures during health emergencies. This work includes a multistep process that started with a global technical consultation convened by WHO in September 2021. The consultation included experts from around the world and from a wide range of disciplines, such as public health, education, tourism, finance and social sciences, and aimed to identify research and implementation approaches based on lessons learnt during the coronavirus disease 2019 pandemic. To prepare for future epidemics and pandemics, it is essential to adopt a more robust, comparable and systematic research approach to public health and social measures. Such comprehensive approach will better inform agile, balanced and context-specific implementation decisions during future emergencies. This article describes the methods used to develop global research priorities for public health and social measures and the next steps needed.

One Health System Strengthening in India: Co-creating One Health Workforce to Combat Future Pandemics

One Health has been coming of age through the G7 and G20 leadership and explicitly referred to in increasing ministerial declarations. Those leaderships, however, have been slow in knitting the One Health approach into the larger systems approach. by understanding the complexity of resilience and health system resilience is one of the key features of pandemic preparedness. Among others, health system strengthening is another key factor that urgently requires much attention in the theme of pandemic preparedness. Here, how the health system strengthening requires more imperative attention in the One Health gambit is discussed in the Indian context.

An elephant in the glasshouse? Trade-offs between acceleration and transformation in COVID-19 vaccine innovation policies

Against the backdrop of a failing vaccine innovation system, innovation policy aimed at creating a COVID-19 vaccine was surprisingly fast and effective. This paper analyzes the influence of the COVID-19 landscape shock and corresponding innovation policy responses on the existing vaccine innovation system. We use document analysis and expert interviews, performed during vaccine development. We find that the sharing of responsibility between public and private actors on various geographical levels, and the focus on accelerating changes in the innovation system were instrumental in achieving fast results. Simultaneously, the acceleration exacerbated existing societal innovation barriers, such as vaccine hesitancy, health inequity, and contested privatization of earnings. Going forward, these innovation barriers may limit the legitimacy of the vaccine innovation system and reduce pandemic preparedness. Next to a focus on acceleration, transformative innovation policies for achieving sustainable pandemic preparedness are still urgently needed. Implications for mission-oriented innovation policy are discussed.

The Intersection of the COVID-19 Pandemic and the 2021 Heat Dome in Canadian Digital News Media: A Content Analysis

During the 2021 Heat Dome, 619 people in British Columbia died due to the heat. This public health disaster was made worse by the ongoing COVID-19 pandemic. Few studies have explored the intersection of heat with COVID-19, and none in Canada. Considering that climate change is expected to increase the frequency of extreme heat events, it is important to improve our understanding of intersecting public health crises. Thus, this study aimed to explore media-based public health communication in Canada during the COVID-19 pandemic and the 2021 Heat Dome. A qualitative content analysis was conducted on a subset of media articles (n = 520) related to the COVID-19 pandemic which were identified through a previous media analysis on the 2021 Heat Dome (n = 2909). Many of the articles provided conflicting health messages that may have confused the public about which health protective actions to take. The articles also showed how the COVID-19 pandemic may have exacerbated the health impacts of the 2021 Heat Dome, as pandemic-related public health measures may have deterred people away from protecting themselves from heat. This study, which provides novel insight into the prioritization of public health messaging when an extreme heat event occurs concurrently with a pandemic, supports the need for consistent heat health guidance.

Spatiotemporal effects of meteorological conditions on global influenza peaks

BACKGROUND

Numerous studies have suggested that meteorological conditions such as temperature and absolute humidity are highly indicative of influenza outbreaks. However, the explanatory power of meteorological factors on the seasonal influenza peaks varied widely between countries at different latitudes.

OBJECTIVES

We aimed to explore the modification effects of meteorological factors on the seasonal influenza peaks in multi-countries.

METHODS

Data on influenza positive rate (IPR) were collected across 57 countries and data on meteorological factors were collected from ECMWF Reanalysis v5 (ERA5). We used linear regression and generalized additive models to investigate the spatiotemporal associations between meteorological conditions and influenza peaks in cold and warm seasons.

RESULTS

Influenza peaks were significantly correlated with months with both lower and higher temperatures. In temperate countries, the average intensity of cold season peaks was stronger than that of warm season peaks. However, the average intensity of warm season peaks was stronfger than of cold season peaks in tropical countries. Temperature and specific humidity had synergistic effects on influenza peaks at different latitudes, stronger in temperate countries (cold season: R2=0.90; warm season: R2=0.84) and weaker in tropical countries (cold season: R2=0.64; warm season: R2=0.03). Furthermore, the effects could be divided into cold-dry and warm-humid modes. The temperature transition threshold between the two modes was 16.5-19.5 °C. During the transition from cold-dry mode to warm-humid mode, the average 2 m specific humidity increased by 2.15 times, illustrating that transporting a large amount of water vapor may compensate for the negative effect of rising temperatures on the spread of the influenza virus.

CONCLUSION

Differences in the global influenza peaks were related to the synergistic influence of temperature and specific humidity. The global influenza peaks could be divided into cold-dry and warm-humid modes, and specific thresholds of meteorological conditions were needed for the transition of the two modes.

Voices of society: the emergence of civil-society practices aiming to engage in the management of the COVID-19 pandemic in the Netherlands

During the COVID-19 pandemic, public groups mobilised themselves in civil-society engagement practices (CSEPs) aiming to improve or suggest alternative epidemic management. This study explores the motivation to establish CSEPs and their perceived contributions to epidemic management, to gain insight whether integrating views of CSEPs could add value. A systematic online search was executed to identify CSEPs focused on COVID-19 management between January 2020 and January 2022 in the Netherlands. In order to create a comprehensible overview of the identified CSEPs, relevant characteristics were gathered and mapped, for example, local or national scope, subject of action and goals. A selection of CSEPs was interviewed between April and June 2022 to study their motivators to start the CSEPs and perceived contributions to management. The search resulted in the identification of 22 CSEPs, of which members of 14 CSEPs were interviewed. These members indicated several issues that motivated the start of their CSEP, namely; shortage of equipment, sense of solidarity, and a perceived lack of governmental action, lack of democratic values and lack in diversity of perspectives in epidemic management. All respondents believed to have contributed to policy or society, by influencing opinions, and occasionally by altering policy. However, respondents encountered obstacles in their attempts to contribute such as inability to establish contact with authorities, feeling unheard or undermined, and complications due to the interplay of political interests. In conclusion, CSEPs have fulfilled various roles such as providing alternative management policies, producing equipment, representing the needs of vulnerable populations, and supporting citizens and providing citizens with other viewpoints and information. The identified motivators to establish CSEPs in this study uncover room for improvements in policy. These insights, together with the identified perceived barriers of CSEPs, can be used to improve the connection between (future) epidemic management and public priorities and interests.

Strengthened public awareness of one health to prevent zoonosis spillover to humans

The COVID-19 outbreak has forced the world to rethink the interconnected health of humans and nature, i.e. One Health (OH). However, the current sector-technology-based solutions have a high cost. We propose a human-oriented One Health (HOH) concept to restrain the unsustainable behaviors of natural resource exploitation and consumption, which may trigger original zoonosis spillover from an imbalanced natural ecosystem. HOH can complement a nature-based solution (NBS), where the former refers to the unknown part of nature, while the latter is based on already known natural knowledge. Additionally, a systemic analysis of popular Chinese social media during the pandemic outbreak (January 1-March 31, 2020) revealed that the wide public was influenced by OH thought. In the post-pandemic era, it is time to deepen public awareness of HOH to guide the world onto a more sustainable track and prevent more serious zoonosis spillover in the future.

Self-stigma in schizophrenia: a systematic review and meta-analysis of 37 studies from 25 high- and low-to-middle income countries

In schizophrenia, it is currently thought that stigma experience is increased by psychotic and depressive symptomatology, exposure to stigma at the workplace, and that self-stigma levels vary across countries without knowing the factors explaining these variations. The aim of the present meta-analysis was to synthetize the data of observational studies comprehensively exploring multiple self-stigma dimensions and associated factors. A systematic literature search without language or time restrictions was conducted in Medline, Google Scholar, and Web of Science for studies, last 09/2021. Eligible studies that included ≥80% of patients diagnosed with schizophrenia-spectrum disorders and used a validated scale measuring self-stigma dimensions were meta-analysed using random-effects models, followed by subgroup and meta-regression analyses. Study registration: PROSPERO CRD42020185030. Overall, 37 studies (n = 7717) from 25 countries (5 continents) published between 2007 and 2020 were included, with 20 studies conducted in high-income countries. These studies used two scales with total scores ranging 1-4. The mean estimate of perceived stigma was 2.76 [95% confidence interval (CI) = 2.60-2.94], experienced stigma 2.29 [95% CI = 2.18, 2.41], alienation 2.40 [95% CI = 2.29, 2.52], stereotype endorsement 2.14 [95% CI = 2.03, 2.27], social withdrawal 2.28 [95% CI = 2.17, 2.39] and stigma resistance 2.53 [95% CI = 2.43, 2.63]). Self-stigma levels did not reduce over time. Living outside urban areas, low-income, singleness, unemployment, high antipsychotic dose and low functioning were associated with different stigma dimensions. Some stigma dimensions were lower in studies carried out in Europe compared to other regions. Most studies published since 2007 report that self-stigma is a particular concern for a specific subgroup of patients. This subgroup is characterized by unemployment, high antipsychotic dose and low functioning. We identified important other missing factors that should be explored to improve the effectiveness of public policies and personalized interventions to reduce self-stigma. Importantly, classical illness severity indices (psychotic severity, age at illness onset, illness duration) and sociodemographic variables (age, sex and education) were not associated with self-stigma, moderating previous findings.

Enabling technologies driving drug research and development

One of the strategic goals of the European Medicines Agency (EMA) and the European Medicines Regulatory Network is to support the research and uptake of innovative methods and technologies in the development of medicines. To promote this goal, EMA drew up a list of enabling technologies (ETs), which are novel and fast-growing technologies that have the potential to enable innovation and therefore exert considerable impact on drug development. In this work, enabling technologies identified by the EMA are analysed to measure their impact on drug development by following their journey from publications through early regulatory interactions to clinical trials between 2019 and 2022. This work also reviews the current list of EMA-identified ETs by scrutinising previously unseen innovative technologies identified in EMA submissions data. The analysis shows large variations in the appearance of the various innovative technologies in the different studied data sources, which provided valuable insights into the “Journey of Innovation” that innovative technologies undergo. Several emerging technologies were identified and endorsed for inclusion in the enabling technologies list, whereas some others already on the list were proposed to be excluded due to their low appearance in regulatory interactions as well as clinical trials and publications. Overall, this analysis highlights the relevance and value of continuously scanning and monitoring enabling technologies, supporting Europe’s goal to remain a leader in research and development of innovative technologies, methods, and methodologies relevant to drug development.

The increasing relevance of immunobiology within a connected animal science curriculum

Modern technological agriculture emerged in the 20th century and has expanded into a global enterprise occupying approximately 38% of the Earth's land area and accounting for over 40% of the world's workforce. The United Nations Food and Agriculture Organization estimates that to feed a world population of 9-billion people in 2050 will require an almost doubling of overall food production, including meat, dairy, and egg production over 2010 levels. However, our collective ability to meet this demand cannot be taken for granted. Despite many successes, global agricultural systems now face multiple unprecedented challenges including a dearth of new treatments for livestock diseases. The discovery of antibiotics led to a complacency now reflected in a dependency on exogenous antimicrobials and a growing threat of antimicrobial resistance. Developments within the field of immunobiology had led to significant breakthroughs in understanding of human health and disease. However, despite over 60% of infectious diseases being zoonotic in nature and nonhuman animals acting as an important disease reservoir, research in livestock immunobiology has not been as resourced. As a direct result, recalcitrant animal diseases continue to threaten sustainability of animal production systems, security of the food chain and human health. It is within the context of collective One Health action that ambitious innovation in the connectivity of animal science undergraduate curricula is urgently required, specifically to include threshold concepts in immunobiology. Fostering transformative learning is critical to equip future generations of animal scientists with the knowledge and interdisciplinary skills to counter these existential challenges of our time.

Digital health: trends, opportunities and challenges in medical devices, pharma and bio-technology

Digital health interventions refer to the use of digital technology and connected devices to improve health outcomes and healthcare delivery. This includes telemedicine, electronic health records, wearable devices, mobile health applications, and other forms of digital health technology. To this end, several research and developmental activities in various fields are gaining momentum. For instance, in the medical devices sector, several smart biomedical materials and medical devices that are digitally enabled are rapidly being developed and introduced into clinical settings. In the pharma and allied sectors, digital health-focused technologies are widely being used through various stages of drug development, viz. computer-aided drug design, computational modeling for predictive toxicology, and big data analytics for clinical trial management. In the biotechnology and bioengineering fields, investigations are rapidly growing focus on digital health, such as omics biology, synthetic biology, systems biology, big data and personalized medicine. Though digital health-focused innovations are expanding the horizons of health in diverse ways, here the development in the fields of medical devices, pharmaceutical technologies and biotech sectors, with emphasis on trends, opportunities and challenges are reviewed. A perspective on the use of digital health in the Indian context is also included.

COVID-19 pandemic and tourism: The impact of health risk perception and intolerance of uncertainty on travel intentions

Understanding tourist behavior during and after major tourism crises is essential to help destinations recover. The COVID-19 pandemic - a period of uncertainty and risk - makes it relevant to assess factors that influence travel intentions. There has been little research on tourist behavior during health crises and, in particular, on perceived health risk and uncertainty effects on travel intentions. This study was carried out at the beginning of the pandemic in Brazil and aims to investigate the role of health risk perception and intolerance of uncertainty on travel intentions for 2020 and 2021. We applied an online survey to 1150 Brazilian participants from April to May 2020. Our findings indicate that perceived COVID-19 severity, perceived probability of infection, and expected duration of the pandemic are significant predictors of travel intentions for both years. This paper contributes to a deeper understanding of crisis-resistant tourists' characteristics and provides insights for destinations' recovery.

Predictive Model for National Minimal CFR during Spontaneous Initial Outbreak of Emerging Infectious Disease: Lessons from COVID-19 Pandemic in 214 Nations and Regions

The minimal case fatality rate (CFR) is one of the essential fundaments for the establishment of a diverse national response strategy against the COVID-19 epidemic, but cannot be quantitatively predicted. The aim of the present study was to explore the applicable quantitative parameters labeling integrating responding capacity from national daily CFR curves, and whether the minimal CFR during initial emerging epidemic outbreaks can be predicted. We analyzed data from 214 nations and regions during the initial 2020 COVID-19 epidemic and found similar falling zones marked with two turning points within a fitting three-day-moving CFR curve which occurred for many nations and regions. The turning points can be quantified with parameters for the day duration (T1, T2, and ΔT) and for the three-day moving arithmetic average CFRs (CFR1, CFR2, and ΔCFR) under wave theory for 71 nations and regions after screening. Two prediction models of minimal CFR were established with multiple linear regressions (M1) and multi-order curve regressions (M2) after internal and external evaluation. Three kinds of falling zones could be classified in the other 71 nations and regions. Only the minimal CFR showed significant correlations with nine independent national indicators in 65 nations and regions with CFRs less than 7%. Model M1 showed that logarithmic population, births per 1000 people, and household size made significant positive contributions, and logarithmic GDP, percentage of population aged 65+ years, domestic general government health expenditure, physicians per 1000 people, nurses per 1000 people, and body mass index made negative contributions to the minimal CFR against COVID-19 epidemics for most nations and regions. The spontaneous minimal CFR was predicted well with model M1 for 57 nations and regions based on the nine national indicators (R² = 0.5074), or with model M2 for 59 nations and regions based on the nine national indicators (R² = 0.8008) at internal evaluation. The study confirmed that national spontaneous minimal CFR could be predicted with models successfully for most nations and regions against COVID-19 epidemics, which provides a critical method to predict the essential early evidence to evaluate the integrating responding capacity and establish national responding strategies reasonably for other emerging infectious diseases in the future.

Optimal reduced-mixing for an SIS infectious-disease model

Which reduced-mixing strategy maximizes economic output during a disease outbreak? To answer this question, we formulate an optimal-control problem that maximizes the difference between revenue, due to healthy individuals, and medical costs, associated with infective individuals, for SIS disease dynamics. The control variable is the level of mixing in the population, which influences both revenue and the spread of the disease. Using Pontryagin's maximum principle, we find a closed-form solution for our problem. We explore an example of our problem with parameters for the transmission of Staphylococcus aureus in dairy cows, and we perform sensitivity analyses to determine how model parameters affect optimal strategies. We find that less mixing is preferable when the transmission rate is high, the per-capita recovery rate is low, or when the revenue parameter is much smaller than the cost parameter.

Strain-stream model of epidemic spread in application to COVID-19

ABSTRACT

The recently developed model of the epidemic spread of two virus strains in a closed population is generalized to the situation typical for the couple of strains delta and omicron, when there is a high probability of omicron infection soon enough after recovering from delta infection. This model can be considered as a kind of combination of SIR and SIS models for the case of competition of two strains of the same virus with different contagiousness in a population. The obtained equations and results can be directly implemented for practical calculations of the replacement of strains of the SARS-CoV-2 virus. A comparison between the estimated replacement time and the corresponding statistics shows reasonable agreement.

Public engagement in decision-making regarding the management of the COVID-19 epidemic: Views and expectations of the 'publics'

Background

In the management of epidemics, like COVID‐19, trade‐offs have to be made between reducing mortality and morbidity and minimizing socioeconomic and political consequences. Traditionally, epidemic management (EM) has been guided and executed attentively by experts and policymakers. It can, however, still be controversial in the public sphere. In the last decades, public engagement (PE) has been successfully applied in various aspects of healthcare. This leads to the question if PE could be implemented in EM decision‐making.

Methods

From June to October 2020, seven deliberative discussion focus groups were executed with 35 Dutch citizens between 19 and 84 years old. Their views on PE in COVID‐19 management were explored. The deliberative approach allows for the education of participants on the topic before the discussion. The benefits, barriers, timing and possible forms of PE in EM were discussed.

Results

Almost all participants supported PE in EM, as they thought that integrating their experiences and ideas would benefit the quality of EM, and increase awareness and acceptance of measures. A fitting mode for PE was consultation, as it was deemed important to provide the public with possibilities to share ideas and feedback; however, final authority remained with experts. The publics could particularly provide input about communication campaigns and control measures. PE could be executed after the first acute phase of the epidemic and during evaluations.

Conclusions

This paper describes the construction of an empirically informed framework about the values and conditions for PE in EM from the perspective of the public. Participants expressed support to engage certain population groups and considered it valuable for the quality and effectiveness of EM; however, they expressed doubts about the feasibility of PE and the capabilities of citizens. In future studies, these results should be confirmed by a broader audience.

Patient or Public Contribution

No patients or members of the public were involved in the construction and execution of this study. This study was very exploratory, to gain a first insight into the views of the public in the Netherlands, and will be used to develop engagement practices accordingly. At this stage, the involvement of the public was not yet appropriate.

Human Respiratory Infections in Nigeria: Influenza and the Emergence of SARS-CoV-2 Pandemic

The increasing outbreak of zoonotic diseases presents challenging times for nations and calls for a renewed effort to disrupt the chain of events that precede it. Nigeria's response to the 2006 bird flu provided a platform for outbreak response, yet it was not its first experience with Influenza. This study describes the impact of SARS-CoV-2 on Influenza surveillance and, conversely, while the 1918 Influenza pandemic remains the most devastating (500,000 deaths in 18 million population) in Nigeria, the emergence of SARS CoV-2 presented renewed opportunities for the development of vaccines with novel technology, co-infection studies outcome, and challenges globally. Although the public health Intervention and strategies left some positive outcomes for other viruses, Nigeria and Africa's preparation against the next pandemic may involve prioritizing a combination of technology, socioeconomic growth, and active surveillance in the spirit of One Health.

Development and Validation of a Performance Assessment Checklist Scale for Vaccine Administration

Objective Vaccination technique is a crucial skill for medical trainees to learn, especially in the current coronavirus disease 2019 pandemic. To this end, validated assessment tools are essential in teaching appropriate techniques. However, valid instruments for assessing vaccine administration skills have not yet been developed. We therefore explored the development and validation of an assessment tool for vaccination techniques based on expert consensus. Methods We implemented a modified Delphi process to develop a vaccination technique assessment tool. We then conducted a validation study to establish the reliability and validity of the tool. Results Two rounds of the modified Delphi process were performed to generate a 19-item, vaccination performance assessment checklist. In the validation study, the linear weighted kappa value for inter-rater reliability of the overall checklist score was 0.725. Spearman's correlation coefficient between the mean checklist score and the global rating was 0.98 (p<0.01). Conclusions This is a pioneering study examining the development and validation of an assessment tool for vaccine administration techniques. The tool will be widely used in vaccination-related education.

United by Contagion: How Can China Improve Its Capabilities of Port Infectious Disease Prevention and Control?

The rapid development of the social economy and science and technology has led to more frequent transnational movements of people, goods and vehicles. At the same time, various cross-border risks have significantly increased. The rapid global spread and continuous mutation of Coronavirus Disease 2019 (COVID-19) have again exposed the international community’s extreme vulnerability to major transnational public health emergencies. China started a “war against the epidemic” with tight quarantine regulations and border restrictions on people, vehicles and international goods. However, it also revealed the weaknesses in and incapacity for disease prevention and control at ports in terms of obstructed performance of the whole chain of public agencies, incompatible laws and regulations, lack of key technologies, and difficulties in international cooperation. Combined with persuasive data, this paper systematically illustrates how transnational infectious diseases lead humans to be “united by contagion”. On this basis, this paper makes a targeted analysis of the deficiencies of port epidemic prevention and control in China’s fight against COVID-19 and suggests corresponding countermeasures and reflections.

From a recombinant key antigen to an accurate, affordable serological test: lessons learnt from COVID-19 for future pandemics

Serological tests detect antibodies generated by infection or vaccination, and are indispensable tools along different phases of a pandemic, from early monitoring of pathogen spread up to seroepidemiological studies supporting immunization policies. This work discusses the development of an accurate and affordable COVID-19 antibody test, from production of a recombinant protein antigen up to test validation and economic analysis. We first developed a cost-effective, scalable technology to produce SARS-COV-2 spike protein and then used this antigen to develop an enzyme-linked immunosorbent assay (ELISA). A receiver operator characteristic (ROC) analysis allowed optimizing the cut-off and confirmed the high accuracy of the test: 98.6% specificity and 95% sensitivity for 11+ days after symptoms onset. We further showed that dried blood spots collected by finger pricking on simple test strips could replace conventional plasma/serum samples. A cost estimate was performed and revealed a final retail price in the range of one US dollar, reflecting the low cost of the ELISA test platform and the elimination of the need for venous blood sampling and refrigerated sample handling in clinical laboratories. The presented workflow can be completed in 4 months from first antigen expression to final test validation. It can be applied to other pathogens and in future pandemics, facilitating reliable and affordable seroepidemiological surveillance also in remote areas and in low-income countries.

Smartphone apps in the COVID-19 pandemic

At the beginning of the COVID-19 pandemic, analog tools such as nasopharyngeal swabs for PCR tests were center stage and the major prevention tactics of masking and physical distancing were a throwback to the 1918 influenza pandemic. Overall, there has been scant regard for digital tools, particularly those based on smartphone apps, which is surprising given the ubiquity of smartphones across the globe. Smartphone apps, given accessibility in the time of physical distancing, were widely used for tracking, tracing and educating the public about COVID-19. Despite limitations, such as concerns around data privacy, data security, digital health illiteracy and structural inequities, there is ample evidence that apps are beneficial for understanding outbreak epidemiology, individual screening and contact tracing. While there were successes and failures in each category, outbreak epidemiology and individual screening were substantially enhanced by the reach of smartphone apps and accessory wearables. Continued use of apps within the digital infrastructure promises to provide an important tool for rigorous investigation of outcomes both in the ongoing outbreak and in future epidemics.

Dynamic topic modeling of twitter data during the COVID-19 pandemic

In an effort to gauge the global pandemic’s impact on social thoughts and behavior, it is important to answer the following questions: (1) What kinds of topics are individuals and groups vocalizing in relation to the pandemic? (2) Are there any noticeable topic trends and if so how do these topics change over time and in response to major events? In this paper, through the advanced Sequential Latent Dirichlet Allocation model, we identified twelve of the most popular topics present in a Twitter dataset collected over the period spanning April 3^rd to April 13^th, 2020 in the United States and discussed their growth and changes over time. These topics were both robust, in that they covered specific domains, not simply events, and dynamic, in that they were able to change over time in response to rising trends in our dataset. They spanned politics, healthcare, community, and the economy, and experienced macro-level growth over time, while also exhibiting micro-level changes in topic composition. Our approach differentiated itself in both scale and scope to study the emerging topics concerning COVID-19 at a scale that few works have been able to achieve. We contributed to the cross-sectional field of urban studies and big data. Whereas we are optimistic towards the future, we also understand that this is an unprecedented time that will have lasting impacts on individuals and society at large, impacting not only the economy or geo-politics, but human behavior and psychology. Therefore, in more ways than one, this research is just beginning to scratch the surface of what will be a concerted research effort into studying the history and repercussions of COVID-19.

A parametrized nonlinear predictive control strategy for relaxing COVID-19 social distancing measures in Brazil

The SARS-CoV-2 virus was first registered in Brazil by the end of February 2020. Since then, the country counts over 150000 deaths due to COVID-19 and faces a profound social and economic crisis; there is also an ongoing health catastrophe, with the majority of hospital beds in many Brazilian cities currently occupied with COVID-19 patients. Thus, a Nonlinear Model Predictive Control (NMPC) scheme used to plan appropriate social distancing measures (and relaxations) in order to mitigate the effects of this pandemic is formulated in this paper. The strategy is designed upon an adapted data-driven Susceptible-Infected-Recovered-Deceased (SIRD) model, which includes time-varying auto-regressive immunological parameters. A novel identification procedure is proposed, composed of analytical regressions, Least-Squares optimization and auto-regressive model fits. The adapted SIRD model is validated with real data and able to adequately represent the contagion curves over large forecast horizons. The NMPC strategy is designed to generate piecewise constant quarantine guidelines, which can be reassessed (relaxed/strengthened) each week. Simulation results show that the proposed NMPC technique is able to mitigate the number of infections and progressively loosen social distancing measures. With respect to a "no-control" condition, the number of deaths could be reduced in up to 30% if the proposed NMPC coordinated health policy measures are enacted.

Systems-Based Approach for Optimization of Assembly-Free Bacterial MLST Mapping

Epidemiological surveillance of bacterial pathogens requires real-time data analysis with a fast turnaround, while aiming at generating two main outcomes: (1) species-level identification and (2) variant mapping at different levels of genotypic resolution for population-based tracking and surveillance, in addition to predicting traits such as antimicrobial resistance (AMR). Multi-locus sequence typing (MLST) aids this process by identifying sequence types (ST) based on seven ubiquitous genome-scattered loci. In this paper, we selected one assembly-dependent and one assembly-free method for ST mapping and applied them with the default settings and ST schemes they are distributed with, and systematically assessed their accuracy and scalability across a wide array of phylogenetically divergent Public Health-relevant bacterial pathogens with available MLST databases. Our data show that the optimal k-mer length for stringMLST is species-specific and that genome-intrinsic and -extrinsic features can affect the performance and accuracy of the program. Although suitable parameters could be identified for most organisms, there were instances where this program may not be directly deployable in its current format. Next, we integrated stringMLST into our freely available and scalable hierarchical-based population genomics platform, ProkEvo, and further demonstrated how the implementation facilitates automated, reproducible bacterial population analysis.

Bridging global health actors and agendas: the role of national public health institutes

Global health crises require coordination and collaboration among actors and global health agendas including health security, health promotion, and universal health coverage. This study investigated whether national public health institutes (NPHIs) unify agendas and actors, how this can be achieved, and what factors contribute to success. We conducted semi-structured interviews with 24 public health leaders from 18 countries in six WHO regions between 2019 and 2020. Respondents described how NPHIs bridge agendas reporting five strategies that institutes employ: serving as a trusted scientific advisor; convening actors across and within sectors; prioritizing transdisciplinary approaches; integrating public health infrastructures, and training that builds public health capacity. Findings also revealed five enabling factors critical to success: a strong legal foundation; scientific independence; public trust and legitimacy; networks and partnerships at global, national, and local levels; and stable funding. The Covid-19 pandemic underscores the urgency of securing scientific independence and promoting national institutes’ responsiveness to public health challenges.

Knowledge Mapping Analysis of Public Health Emergency Management Research Based on Web of Science

At present, major public health emergencies frequently occur worldwide, and it is of great significance to analyze the research status and latest developments in this field to improve the ability of public health emergency management in various countries. This paper took 5,143 related studies from 2007 to 2020 from the Web of Science as research object and used CiteSpace, VOSviewer, and other software to perform co-word analysis, social network analysis, and cluster analysis. The results and conclusions were as follows: (1) the related research identified three periods: the exploration, growth, and outbreak period; (2) chronologically: the relevant research evolved from medical and health care for major diseases to emergency management and risk assessment of public health emergencies and then researched the novel coronavirus (COVID-19) pneumonia epidemic; (3) clustering analysis of high-frequency keywords, identifying three research hotspots: “disaster prevention and emergency medical services,” “outbreak and management of infectious diseases in Africa,” and “emergency management under the COVID-19 pneumonia epidemic.” Finally, this study combined the data and literature analysis to point out possible future research directions: from the research of the COVID-19 pneumonia epidemic to the research of general major public health emergencies, thinking and remodeling of the national public health emergency management system, and exploring the establishment of an efficient international emergency management cooperation mechanism.

Unlocking capacities of genomics for the COVID-19 response and future pandemics

During the COVID-19 pandemic, genomics and bioinformatics have emerged as essential public health tools. The genomic data acquired using these methods have supported the global health response, facilitated development of testing methods, and allowed timely tracking of novel SARS-CoV-2 variants. Yet the virtually unlimited potential for rapid generation and analysis of genomic data is also coupled with unique technical, scientific, and organizational challenges. Here, we discuss the application of genomic and computational methods for the efficient data driven COVID-19 response, advantages of democratization of viral sequencing around the world, and challenges associated with viral genome data collection and processing.

Prevalence of domestic violence in a time of catastrophic disease outbreaks including COVID-19 pandemic: a systematic review protocol

BACKGROUND

Domestic violence is a public health issue that has a long-term and irreversible effect on the victims. There are vulnerable groups like children, women, and elders. The problem becomes worse for these populations in the time of catastrophic events including disease pandemics. However, few attempts have been made to systematically review the prevalence and pattern of domestic violence during these times all over the world.

METHODS

An initial search of PubMed will be followed by CINAHL, Scopus, Google Scholar, Embase, and ProQuest Health. The titles and abstracts of studies will be reviewed, and full-text articles will be selected if the inclusion criteria are met. Studies that meet the eligibility criteria will then be assessed by two independent reviewers. Full-text articles will be selected if the inclusion criteria are met. A standardized critical appraisal checklist for studies reporting prevalence data will be used to assess the methodological quality, and a standardized data extraction tool will be used. The results from the included studies will be analysed using the JBI SUMARI software.

DISCUSSION

This systematic review will provide solid evidence on the magnitude of domestic violence of any forms during catastrophic disease outbreaks including the current pandemic, COVID-19.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020192255 .

How has academia responded to the urgent needs created by COVID-19? A multi-level global, regional and national analysis

In the context of the COVID-19 pandemic, gaining insights into how academia has responded to this urgent challenge is of great significance. This article presents academic response patterns at a global, regional and national level from an analysis of publication volume versus reported cases of COVID-19, scientific collaboration and research focus. We also compare academic activity associated with this newly emerging infection to that related to long-standing infections. Our results show that the research community has responded quickly to COVID-19. The highly developed countries, which have the highest number of confirmed cases, are also the major academic contributors. National-level analysis reveals diverse response patterns from different countries. Specifically, academic research in the United Kingdom remained at a relatively constant level throughout the whole year (2020), while the global share of China’s research output was prone to shift as its domestic pandemic status changed. Strong alliances have formed among countries with academic capabilities in response to the COVID-19 pandemic. The distribution of disciplines is relatively decentralised, indicating that a diverse and broad knowledge base contributes to the COVID-19 literature. Most of the analysed countries show dynamic patterns of research focus that vary over time as the pandemic evolves, except India. As one of the world’s biggest suppliers of vaccines, India makes consistent efforts on vaccine research, especially those related to pharmaceutical preparations. Our findings may serve as resources for fostering strategies to respond to future threats of pandemics.

Baseline assessment findings of the Africa Society for Blood Transfusion Step-Wise Accreditation Programme in 10 sub-Saharan African countries, 2016-2018

BACKGROUND AND OBJECTIVES

The accreditation of blood services promotes continuous quality improvement in blood and transfusion services. The Africa Society for Blood Transfusion (AfSBT) conducted 20 baseline assessments of National Blood Transfusion Services (NBTS) or blood banks as part of the Step-Wise Accreditation Programme (SWAP) in 10 sub-Saharan African (SSA) countries from 2016 to 2018. This paper aims to elucidate the process and findings of the baseline assessments.

MATERIALS AND METHODS

This is a descriptive study of 20 baseline assessments of NBTS. Eleven sections of the AfSBT assessment were reviewed, and 48 out of 68 standards and 356 out of 466 criteria were assessed. Each standard was assigned a value of 1 if it was fully achieved, 0.5 if partially achieved and 0 if not achieved. We defined average section scores >75% as having 'met AfSBT Standards', ≤25% as not meeting standards, 26%-50% as needs major improvement, and 51%-75% as needs some improvement and >75% as meets standards.

RESULTS

The AfSBT SWAP standards were met in 4 out of the 11 sections: donor management, blood collection, component production and compatibility testing. Three sections were determined to need some improvement (quality system; handling, transport and storage and testing of donated blood), and three sections were determined to need major improvement (haemovigilance, blood administration and national blood service accreditation). One section (receipt, ordering, and issuing of blood) did not meet standards.

CONCLUSION

Despite improvements in the quality of blood services in SSA over the past two decades, governments may consider the importance of prioritizing investments in NBTS, ensuring these institutions meet international accreditation standards that are aligned with safe blood transfusion services.

The "One Health" approach in the face of Covid-19: how radical should it be?

BACKGROUND

The 2020-2021 coronavirus (Covid-19) pandemic is just the latest epidemic event that requires us to rethink and change our understanding of health. Health should no longer be conceived only in relation to human beings, but in unitary terms, as a dimension that connects humans, animals, plants, and the environment (holistic view, One Health). In general, alterations occurring in this articulated chain of life trigger a domino effect.

METHODOLOGY

In this paper, we review the One Health paradigm in the light of the Covid-19 pandemic and distinguish two approaches within it that might be dubbed the Prudent one and the Radical one. Each approach is structured in three levels - epistemological, medical, and ethical.

RESULTS

In this way, we show how we humans can better address the pandemic today and how, in the future, we can treat the whole living system better, by renouncing our anthropocentric perspective on health.

CONCLUSION

We hold that the Prudent approach can be very helpful, and we discuss the medical and ethical issues related to it. We also consider the Radical view and the epistemological turn it requires compared to the Prudent one.

Efficacy and practice of facemask use in general population: a systematic review and meta-analysis

In recent decades, respiratory infections, including SARS, HINI and the currently spreading COVID-19, caused by various viruses such as influenza and coronavirus have seriously threatened human health. It has generated inconsistent recommendations on the mandatory use of facemasks across countries on a population level due to insufficient evidence on the efficacy of facemask use among the general population. This meta-analysis aimed to explore (1) the efficacy of facemask use on preventing respiratory infections, and (2) the perceptions, intentions, and practice about facemask use among the general population worldwide. We searched PubMed, MEDLINE, Web of Science, Cochrane, bioRxiv, and medRxiv databases since inception to August 17, 2020. From 21,341 records identified, eight RCTs on facemask in preventing infections and 78 studies on perception, intention, and practice of facemask use among the general population were included in the analysis. The meta-analysis of RCTs found a significant protective effect of facemask intervention (OR = 0.84; 95% CI = 0.71-0.99; I2 = 0%). This protective effect was even more pronounced when the intervention duration was more than two weeks (OR = 0.76; 95% CI = 0.66-0.88; I2 = 0%). The meta-analysis of observational studies on perception, intention, and practice on facemask use showed that 71% of respondents perceived facemasks to be effective for infection prevention, 68% of respondents would wear facemasks, and 54% of respondents wore facemasks for preventing respiratory infections. Differences in perception, intention, and practice behavior of facemask use in different regions may be related to the impact of respiratory infections, regional culture, and policies. The governments and relevant organizations should make effort to reduce the barriers in the use of facemasks.

COVID-19: inflammatory responses, structure-based drug design and potential therapeutics

The COVID-19 pandemic caused by SARS-CoV-2 is responsible for the global health emergency. Here, we explore the diverse mechanisms of SARS-CoV-induced inflammation. We presume that SARS-CoV-2 likely contributes analogous inflammatory responses. Possible therapeutic mechanisms for reducing SARS-CoV-2-mediated inflammatory responses comprise FcR inactivation. Currently, there is no specific remedy available against the SARS-CoV-2. Consequently, recognizing efficacious antiviral leads to combat the virus is crucially desired. The coronavirus (CoV) main protease (Mpro also called 3CLpro), which plays an indispensable role in viral replication and transcription, is an interesting target for drug design. This review compiles the latest advances in biological and structural research, along with development of inhibitors targeting CoV Mpros. It is anticipated that inhibitors targeting CoV Mpros could be advanced into wide-spectrum antiviral drugs in case of COVID-19 and other CoV-related diseases. The crystal structural and docking results have shown that Ebselen, N3, TDZD-8 and α-ketoamide (13b) inhibitors can bind to the substrate-binding pocket of COVID-19 Mpro. α-ketoamide-based inhibitor 13b inhibits the replication of SARS-CoV-2 in human Calu3 lung cells. Quantitative real-time RT-PCR (qRT-PCR) showed that the treatment with Ebselen, TDZD-8 and N3 reduced the amounts of SARS-CoV-2, respectively, 20.3-, 10.19- and 8.4-fold compared to the treatment in the absence of inhibitor. Moreover, repurposing of already present drugs to treat COVID-19 serves as one of the competent and economic therapeutic strategies. Several anti-malarial, anti-HIV and anti-inflammatory drugs as mentioned in Table 2 were found effective for the COVID-19 treatment. Further, hydroxychloroquine (HCQ) was found more potent than chloroquine (CQ) in inhibiting SARS-CoV-2 in vitro. Furthermore, convalescent plasma from patients who have recuperated from viral infections can be employed as a therapy without the appearance of severe adverse events. Hence, it might be valuable to examine the safety and efficacy of convalescent plasma transfusion in SARS-CoV-2-infected patients.

Analyzing changes to U.S. municipal heat response plans during the COVID-19 pandemic

Extreme heat events are the deadliest weather-related event in the United States. Cities throughout the United States have worked to develop heat adaptation strategies to limit the impact of extreme heat on vulnerable populations. However, the COVID-19 pandemic presented unprecedented challenges to local governments. This paper provides a preliminary review of strategies and interventions used to manage compound COVID-19-extreme heat events in the 25 most populous cities of the United States. Heat adaptation strategies employed prior to the COVID-19 pandemic were not adequate to meet during the co-occurring compound hazard of COVID-19-EHE. Long-term climate-adaptation strategies will require leveraging physical, financial, and community resources across multiple city departments to meet the needs of compound hazards, such as COVID-19 and extreme heat.