Disaster management of the psychological impact of the COVID-19 pandemic

Development and validation of the Environmental Confinement Stressors Scale (ECSS-20)

The COVID-19 pandemic has generated a global crisis with severe consequences for public health. There have been negative impacts on people's quality of life and mental health due to various stressors arising in this context, such as physical, social, economic, and psychological challenges. Noteworthy among these are the indirect effects of health measures, especially social distancing and confinement, which have significantly altered people's daily lives and social activities, producing high levels of anxiety, depression, and stress. This study proposes developing and validating a cross-sectional scale called the "Environmental Stressors Scale (ECSS-20)" to address the need to measure the impact of environmental stressors during confinement. The scale, which has been validated following ethical and methodological guidelines, consists of four dimensions: economic stressors (EE), social activities (SA), habitability (H), and exposure to virtual media (EMV). A pilot study (n = 113) and a main study (n = 314) were applied. The results showed that the instrument has a reliable and valid structure, with satisfactory internal consistency and factorial validity. Likewise, gender invariance tests supported its suitability for its applicability to women and men. Overall, the ECSS-20 is a valuable instrument for assessing the impact of confinement and improving the understanding of people's subjective experiences in this situation. Future research could further develop its applicability in different contexts and populations to better understand its usefulness and psychometric properties.

The Use of Contact Tracing Technologies for Infection Prevention and Control Purposes in Nosocomial Settings: A Systematic Literature Review

BACKGROUND

Pandemic management and preparedness are more needed than ever before and there is widespread governmental interest in learning from the COVID-19 pandemic in order to ensure the availability of evidence-based Infection Prevention and Control measures. Contact tracing is integral to Infection Prevention and Control, facilitating breaks in the chain of transmission in a targeted way, identifying individuals who have come into contact with an infected person, and providing them with instruction/advice relating to testing, medical advice and/or self-isolation.

AIM

This study aims to improve our understanding of the use of contact tracing technologies in healthcare settings. This research seeks to contribute to the field of Infection Prevention and Control by investigating how these technologies can mitigate the spread of nosocomial infections. Ultimately, this study aims to improve the quality and safety of healthcare delivery.

METHODS

A systematic literature review was conducted, and journal articles investigating the use of contact tracing technologies in healthcare settings were retrieved from databases held on the OvidSP platform between March and September 2022, with no date for a lower limit.

RESULTS

In total, 277 studies were retrieved and screened, and 14 studies were finally included in the systematic literature review. Most studies investigated proximity sensing technologies, reporting promising results. However, studies were limited by small sample sizes and confounding factors, revealing contact tracing technologies remain at a nascent stage. Investment in research and development of new testing technologies is necessary to strengthen national and international contact tracing capabilities.

CONCLUSION

This review aims to contribute to those who intend to create robust surveillance systems and implement infectious disease reporting protocols.

The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project

BACKGROUND

Colorectal (CRC) cancer is becoming a disease of the elderly. Ageing is the most significant risk factor for presenting CRC. Early diagnosis of CRC and management is the best way in achieving good outcomes and longer survival but patients aged ≥75 years are usually not screened for CRC. This group of patients is often required to be managed when they are symptomatic in the emergency setting with high morbidity and mortality rates. Our main aim is to provide clinical data about the management of elderly patients presenting complicated colorectal cancer who required emergency surgical management to improve their care.

METHODS

The management of complicated COlorectal cancer in OLDER patients (CO-OLDER; ClinicalTrials.gov ID: NCT05788224; evaluated by the local ethical committee CPP EST III-France with the national number 2023-A01094-41) in the emergency setting project provides carrying out an observational multicenter international cohort study aimed to collect data about patients aged ≥75 years to assess modifiable risk factors for negative outcomes and mortality correlated to the emergency surgical management of this group of patients at risk admitted with a complicated (obstructed and perforated) CRC. The CO-OLDER protocol was approved by Institutional Review Board and released. Each CO-OLDER collaborator is asked to enroll ≥25 patients over a study period from 1st January 2018 to 30th October 2023. Data will be analyzed comparing two periods of study: before and after the COVID-19 pandemic. A sample size of 240 prospectively enrolled patients with obstructed colorectal cancer in a 5-month period was calculated. The secured database for entering anonymized data will be available for the period necessary to achieve the highest possible participation.

RESULTS

One hundred eighty hospitals asked to be a CO-OLDER collaborator, with 36 potentially involved countries over the world.

CONCLUSIONS

The CO-OLDER project aims to improve the management of elderly people presenting with a complicated colorectal cancer in the emergency setting. Our observational global study can provide valuable data on the effectiveness of different management strategies in improving primary assessment, management and outcomes for elderly patients with obstructed or perforated colorectal cancer in the emergency setting, guiding clinical decision-making. This information can help healthcare providers make informed decisions about the best course of action for these patients.

Disparities in COVID-19-Related Psychological Distress Among Recipients of a State's Public Mental Health Services

OBJECTIVE

The authors examined changes in perceived anxiety, stress, and mental health symptoms (i.e., psychological distress) reported by recipients of New York State public mental health services during the early months of the COVID-19 pandemic, as well as whether these changes varied by demographic characteristics or pandemic-related socioeconomic challenges.

METHODS

A statewide survey of service recipients (N=3,483) was conducted (May 8-June 22, 2020). Descriptive analyses were summarized, and logistic regression was used to evaluate associations between increases in reported psychological distress and age, gender, region of residence, race and ethnicity, socioeconomic challenges, and alcohol or drug use.

RESULTS

Fifty-five percent of respondents (N=1,933) reported a slight or moderate increase in COVID-19-related psychological distress, and 15% (N=520) reported a substantial increase. In adjusted models, substantial elevations in psychological distress were associated with identifying as female (AOR=1.83, 95% CI=1.50-2.25), experiencing three or more pandemic-related socioeconomic challenges (AOR=2.41, 95% CI=1.91-3.03), and reporting increased use of alcohol or drugs (AOR=1.81, 95% CI=1.34-2.44). Compared with non-Hispanic/Latinx White service recipients, non-Hispanic/Latinx Black individuals had lower odds of reporting substantially increased psychological distress (AOR=0.59, 95% CI=0.45-0.76), as did non-Hispanic/Latinx Asian-descent individuals (AOR=0.28, 95% CI=0.12-0.64).

CONCLUSIONS

In this large sample of recipients of New York State public mental health services, the COVID-19 pandemic's impact on psychological well-being was widespread and varied by gender, race and ethnicity, and socioeconomic vulnerability. These relationships must be considered in ongoing efforts to provide optimal care for this population.

Pediatric Traumatic Brain Injury Outcomes and Disparities During the COVID-19 Pandemic

BACKGROUND

To study the impact of the COVID-19 pandemic on traumatic brain injury (TBI) patient demographic, clinical and trauma related characteristics, and outcomes.

METHODS

Retrospective chart review was conducted on pediatric TBI patients admitted to a Level I Pediatric Trauma Center between January 2015 and June 2022. The pre-COVID era was defined as January 1, 2015, through March 12, 2020. The COVID-19 era was defined as March 13, 2020, through June 30, 2022. Bivariate analysis and logistic regression were performed.

RESULTS

Four hundred-thirty patients were treated for pediatric TBI in the pre-COVID-19 period, and 166 patients during COVID-19. In bivariate analyses, the racial/ethnic makeup, age, and sex varied significantly across the two time periods (p < 0.05). Unwitnessed TBI events increased during the COVID-19 era. Logistic regression analyses also demonstrated significantly increased odds of death, severe disability, or vegetative state during COVID-19 (AOR 7.23; 95 % CI 1.43, 36.41).

CONCLUSION

During the COVID-19 pandemic, patients admitted with pediatric TBI had significantly different demographics with regards to age, sex, and race/ethnicity when compared to patients prior to the pandemic. There was an increase in unwitnessed events. In the COVID period, patients had a higher odds ratio of severe morbidity and mortality despite adjustment for confounding factors.

LEVEL OF EVIDENCE AND STUDY TYPE

Level II, Prognosis.

Occupational well-being in medical workers in Inner Mongolia after the Normalized Epidemic Prevention and Control Strategy: A cross-sectional study

Little is known about the status of occupational well-being among the Chinese medical workers after the implementation of Normalized Epidemic Prevention and Control strategy as most studies are performed during the COVID-19 pandemic. This study was designed to investigate the occupational well-being among the medical workers in our city in the COVID-19 after the release of Normalized Epidemic Prevention and Control Strategy since May 7, 2020 in mainland China. We included the medical workers involved in the front-line of COVID-19 that were randomly selected from 7 hospitals in Inner Mongolia Autonomous Region, China. The occupational well-being among medical workers was evaluated using the modified occupational well-being scales and the symptom Checklist-90 (SCL-90) scale. Then Logistic regression analysis was given to identify the risk factors that may affect the occupational well-being among the medical workers. Our data showed that hospital type (p < 0.01), hospital grade (p < 0.01), marital status (p < 0.01) and monthly income (p < 0.01) were independent risk factors for the occupational well-being among the medical workers. Obsessive-compulsive disorder, somatization, phobic anxiety, depression and interpersonal sensitivity were risk factors for poor occupational well-being. Therefore, attention should be given to the occupational well-being of the medical workers. Meanwhile, appropriate measurements are necessary to improve their working quality.

Public Perception Toward the Malaysian National COVID-19 Immunisation Programme (PICK) in the State of Sabah, Malaysia: A Cross-Sectional Survey

The Malaysian Government has initiated the National COVID-19 Immunisation Programme, known as PICK, to be a national strategy for addressing the spread of the coronavirus disease (COVID-19) pandemic across the country. Although the government intensified public awareness to increase program registration, the total number that registered in the state of Sabah, located in East Malaysia, was relatively low during August 2021, accounting for only 42.9% as compared to that of Peninsular Malaysia. Therefore, this paper examines the public perception toward the PICK program in Sabah based on 4 main components: safety, communication, psychology, and milieu. This study is based on the empirical findings drawn from 1024 respondents across Sabah using online Google Form surveys. This study adopts 5 methodologies for data analysis by using K-means clustering, mean score, Mann-Whitney U test, spatial analysis, and frequency analysis. It has been revealed that the percentage of respondents (categorized as Cluster 1) who have a negative perception toward the vaccination program is higher (55.9%) than those who have a positive perception (44.1%). This study further discovered that Cluster 1 has shown high skepticism regarding the vaccination program, which can be explained through the communication component (M = 3.33, SD = 0.588), especially Co2, Co3, Co1, and Co4. Following the communication factor, a chain of negative perceptions also affects other components such as safety, psychology, and milieu among Cluster 1, all of which contribute to poor participation in the PICK program. The study outcomes are extremely useful for informing local authorities to establish policies related to public interests, primarily in the areas of public health. Understanding the community's perspectives and their obstacles in participating in such programs may assist local authorities in developing or implementing public policies and campaigns that ensure such related public programs can be conducted more effectively in the future.

Emergency Department Use by Young Adults With Chronic Illness Before and During the COVID-19 Pandemic

INTRODUCTION

There was a significant decrease in emergency department encounters during the COVID-19 pandemic. Our large urban emergency department observed decreased encounters and admissions by youths with chronic health conditions. This study aimed to compare the frequency of emergency department encounters for certain young adults before the pandemic and during the COVID-19 pandemic.

METHODS

A retrospective cohort study using medical records of patients ages 20 to 26 years from October 2018 to September 2019 and February 2020 to February 2021. Files set for inclusion were those with a primary diagnosis of human immunodeficiency virus, diabetes mellitus, epilepsy, cerebral palsy, sickle cell disease, asthma, and certain psychiatric disorders for potentially preventable health events.

RESULTS

We included 1203 total encounters (853 before the pandemic and 350 during the pandemic), with the total number of subjects included in the study 568 (293 before the pandemic to 239 during the pandemic). During the pandemic, young adults with mental health conditions (53.1%) accounted for most encounters. Encounters requiring hospital admissions increased from 27.4% to 52.5% during the pandemic, primarily among patients with diabetes (41.8% vs 61.1%) and mental health conditions (50% vs 73.3%).

DISCUSSION

The number of young adults with certain chronic health conditions decreased during COVID-19, with encounters for subjects with mental health conditions increasing significantly. The proportion of admissions increased during the pandemic with increases for subjects with mental health disorders and diabetes. The number of frequent users decreased during COVID-19. Future research is needed to understand better the causes for these disparities in young adults with chronic conditions who use the emergency department as a source of care.

Elements that associate with participants' psychological discomfort during simplified fire drills

Fire drills may reinforce the survival skills of participants on the one hand, and on the other hand, they might bring a certain amount of psychological discomfort. To identify elements associated with the psychological discomfort, a designed questionnaire was distributed to postgraduate students who had experienced fire drills in Islington (London) and 1640 valid responses were obtained. With the help of regression analysis, this research found that participants' awareness of precaution, individual initiative of participation, the personal judgement of simplified fire drills (SFDs), participation of SFDs, evaluation of SFDs' function in practical applications, and satisfaction with SFDs' performance are positively associated with participants' psychological discomfort, while the procedural arrangement of SFDs, time interval of joining in the last SFD, and the frequency of simplified fire drills experienced are negatively associated with participants' psychological discomfort. Moreover, personal awareness of precaution, individual initiative of participation, individual satisfaction with SFDs' performance, the time interval of joining in the last SFD, procedural arrangement of SFDs, and the frequency of simplified fire drills experienced could explain 30.02% of the variance in participants' psychological discomfort.

Factors, enablers and challenges for COVID-19 vaccine development

The COVID-19 pandemic triggered a sense of vulnerability and urgency that led to concerted actions by governments, funders, regulators and industry to overcome traditional challenges for the development of vaccine candidates and to reach authorisation. Unprecedented financial investments, massive demand, accelerated clinical development and regulatory reviews were among the key factors that contributed to accelerating the development and approval of COVID-19 vaccines. The rapid development of COVID-19 vaccines benefited of previous scientific innovations such as mRNA and recombinant vectors and proteins. This has created a new era of vaccinology, with powerful platform technologies and a new model for vaccine development. These lessons learnt highlight the need of strong leadership, to bring together governments, global health organisations, manufacturers, scientists, private sector, civil society and philanthropy, to generate innovative, fair and equitable access mechanisms to COVID-19 vaccines for populations worldwide and to build a more efficient and effective vaccine ecosystem to prepare for other pandemics that may emerge. With a longer-term view, new vaccines must be developed with incentives to build expertise for manufacturing that can be leveraged for low/middle-income countries and other markets to ensure equity in innovation, access and delivery. The creation of vaccine manufacturing hubs with appropriate and sustained training, in particular in Africa, is certainly the way of the future to a new public health era to safeguard the health and economic security of the continent and guarantee vaccine security and access, with however the need for such capacity to be sustained in the interpandemic period.

An improved method of global dynamics: Analyzing the COVID-19 model with time delays and exposed infection

Considering the transmission characteristics of the coronavirus disease 2019 (COVID-19), there are certain time delays in the transition from susceptible individuals to exposed individuals after contact with exposed, symptomatically infected, and asymptomatically infected individuals. A COVID-19 model with time delays and exposed infection is developed and then the global dynamics of this model is investigated by an improved method; moreover, the numerical simulations are carried out. It is shown that the COVID-19-free equilibrium T0 is globally asymptotically stable (GAS) if and only if the control reproduction number Rc≤1, while T0 is unstable and the COVID-19 equilibrium T∗ is GAS if and only if Rc>1. The numerical results reveal that strengthening quarantine measures is helpful to control the COVID-19 epidemic in India. Furthermore, when Rc<1, the numbers of symptomatically infected, asymptomatically infected, and quarantined individuals eventually tend to the zero equilibrium state, and with the increase in the time delay, the three kinds of variables change faster and their peaks become larger; when Rc>1, the three kinds of variables eventually tend to the positive equilibrium state, which are oscillatory and the amplitudes of the oscillation enlarge as the value of time delay increases. The numerical results show that when Rc<1, the smaller the value of time delay, the smaller the final epidemic size. In short, the longer it takes time for susceptible individuals to transform exposed individuals, the harder COVID-19 will be controlled.

From fearful to hopeful: A thematic content analysis of COVID-19 survivors' YouTube videos

COVID-19 survivors experienced a spectrum of emotions as a result of surviving the said disease. Employing thematic content analysis, the researchers characterized the various emotional manifestations among recovered COVID-19 patients, which are crucial indicators of their mental well-being postinfection. From March 2020 to June 2021, data was collated from 31 Filipino COVID-19 Survivors' YouTube videos. 51.61% of the videos were posted in 2020 and 48.39% were posted in 2021 where 70.97% of the survivors were female while 29.03% were male. 579 primary codes emerged and were narrowed down into sixteen themes where Hope (18.83%) arose as the most predominant emotion followed by Gratitude (14.68%), Joy and Relief (14.16%), Faith (11.57%), Plight Response (10.88%), Sadness (10.88%), Fear (6.39%), and nine others (12.61%).

The effect of self-esteem on the spread of a pandemic. A cross-country analysis of the role played by self-esteem in the spread of the COVID-19 pandemic

Extant research on COVID-19 suggests that many socio-economic determinants, by affecting personal behavior, have influenced the evolution of the pandemic. In this paper we study the role played in this regard by average levels of self-esteem in the public. There are reasons to believe that both low and very levels of self-esteem may have an effect on the spread of COVID-19, for opposite reasons. On the one hand, people with low self-esteem may not worry enough to behave in the way recommended (and prescribed, through non-pharmaceutical interventions) by the authorities; people with very high self-esteem, on the other hand, may be over-confident and fail to follow the prescriptions, believing that they do not need them. In this study we test this hypothesis by means of a quantitative cross-country analysis, using a hybrid model and the Rosenberg self-esteem scale. Our results suggest the existence of a U-shaped relationship between the trend of COVID-19 and average levels of self-esteem in a country.

Monkeypox: A current emergency global health threat

Monkeypox (MPXV) is an emerging zoonotic disease carrying a global health threat. Using a multi-disciplinary approach, we review the current MPXV virus infection outbreak including virology, prevention, clinical presentation, and disaster management. MPXV is caused by a double-stranded deoxyribonucleic acid virus. Despite its clinical similarities with smallpox, it is less severe with low mortality. Human-to-human transmission occurs through prolonged direct or close contact, or through blood, body fluids, or mucosal lesions. Risk groups include frontline health workers who care for MPXV patients, household members of an infected patient, and men who have sex with men. Skin lesions are usually, but not always, at the same stage. They may affect the face followed by the distal extremities with fewer lesions on the trunk (centrifugal distribution). Lesions may involve the mouth, genitalia, conjunctiva, and rectum. The majority of cases are mild. Nevertheless, the disease may have long-term effects on the skin, the neurological system, and the eye. Vaccination against MPXV is available but meanwhile should be limited to those who are at high risk. Those vaccinated against smallpox (usually older than 40 years) might be immune against MPXV. Infectious diseases are without borders. If proper action is not taken, there is considerable risk that MPXV will be entrenched worldwide. Our world has a delicate balance between animals, environment, and humans reflecting the need for a "one globe, one health approach" to address this risk. Following the principles of disaster management and using the lessons we have learned from the COVID-19 pandemic will reduce the impact of the MPXV outbreak.

1.5 years pandemic - Psychological burden over the course of the COVID-19 pandemic in Germany: A nine-wave longitudinal community study

BACKGROUND

The dynamic COVID-19 pandemic has been associated with mental strain. However, most studies focused primarily on the beginning of the pandemic and rarely took into account the long-term course. The aim of this prospective-longitudinal study was to investigate levels and changes of pandemic-related fears, unspecific anxiety, depressive symptoms, and psychosocial-behavioral factors over the first 1.5 years of the pandemic.

METHODS

We conducted a nine-wave longitudinal online-survey from March 2020 to October 2021 with a total of 8148 participants of the adult general population in Germany. Descriptive examination and multilevel analysis were carried out to assess psychological burden, risk-bearing and protective psychosocial-behavioral factors, and associations with sociodemographics and the pandemic's duration and severity over the course of the pandemic.

RESULTS

Symptoms of mental strain fluctuated across the pandemic and displayed a relative maximum at the pandemic's early beginning and during the second and third COVID-19 waves. Most participants (approximately 67.4 %-82.1 %) reported mild and transient symptoms, but a substantial portion (approximately 17.9 %-32.6 %) experienced pronounced mental health problems during the pandemic. Symptom severity was negatively associated with the duration of the pandemic and positively associated with the rate of new infections.

LIMITATIONS

The observational study design, non-probability-sampling methods, and online self-report assessments limit the generalizability of our results.

CONCLUSIONS

The fluctuating course of psychological burden during the pandemic emphasizes the relevance of continuous monitoring during this challenging time. Particularly individuals with pronounced subclinical symptoms or manifesting mental disorders should be targeted with adequate prevention and early intervention programs.

Interplay between Discrete Emotions and Preventive Behavior in Health Crises: Big Data Analysis of COVID-19

Understanding the interplay between discrete emotions and COVID-19 prevention behaviors will help healthcare professionals and providers to implement effective risk communication and effective risk decision making. This study analyzes data related to COVID-19 posted by the American public on Twitter and identifies three discrete negative emotions (anger, anxiety, and sadness) of the public from massive text data. Next, econometric analyses (i.e., the Granger causality test and impulse response functions) are performed to evaluate the interplay between discrete emotions and preventive behavior based on emotional time series and Google Shopping Trends time series, representing public preventive behavior. Based on the textual analysis of tweets from the United States, the following conclusions are drawn: Anger is a Granger cause of preventive behavior and has a slightly negative effect on the public's preventive behavior. Anxiety is a Granger cause of preventive behavior and has a positive effect on preventive behavior. Furthermore, preventive behavior is a Granger cause of anxiety and has a negative and lagging effect on anxiety. Exploring how discrete emotions, such as anger and anxiety, affect preventive behaviors will effectively demonstrate how discrete emotions play qualitatively different roles in promoting preventive behaviors. Moreover, understanding the impact of preventive behaviors on discrete emotions is useful for better risk communication.

Changes in Sexual Behavior Over the COVID-19 Pandemic Among a Community-Based Cohort of Men Who Have Sex With Men in Columbus, Ohio

BACKGROUND

The purpose was to assess COVID-19 beliefs and attitudes and examine COVID-19-related changes in sexual behavior of men who have sex with men during 3 time periods: April-July 2020 (T1), August-December 2020 (T2), January-May 2021 (T3).

METHODS

Data were analyzed from 157 men who have sex with men in Ohio recruited to participate in a longitudinal multisite network study of syphilis epidemiology in 3 US cities: Columbus, Ohio; Baltimore, Maryland; and Chicago, Illinois. In April 2020, a COVID-19 module was appended to existing baseline and follow-up surveys to assess beliefs, attitudes, and changes in sexual behavior. Sample characteristics were summarized. Correlations between demographic variables (age, racial identity) and COVID-19 outcomes were examined.

RESULTS

In response to COVID-19 social distancing restrictions and self-reported anxiety, some men limited sexual activity at T1, but the majority (n = 105 [67%]) continued to engage in sex. The number of men engaging in sex increased over time (T2: n = 124 [79%]; T3: n = 121 [77%]). At T1, men not in a relationship more frequently reported having less sex compared with prepandemic (n = 39 [57%]). By T3, men in a relationship more frequently reported less sex (n = 32 [54%]). Increased anxiety about sex and condom use was positively correlated with identifying as a man of color (P < 0.001). Most of the sample reported either starting or increasing online sexual activity during each time period.

CONCLUSIONS

Future efforts to target sexual health during a pandemic or other health emergencies should prioritize men of color and address the unique perspective of both single and partnered men.

Sex-related disparities in students' disaster responses in the post-COVID-19 era

This study aimed to understand whether sex-related variations existed in responses to the pandemic as well as campus climate change of anti-epidemic measures. An online survey was distributed to full-time undergraduates in 13 postsecondary institutions located in an eastern province in China. First, we matched "similar" students in terms of a set of observational variables. Second, we compared female students with these "similar" male peers in terms of their responses to COVID-19 and responses to the campus climate change of anti-epidemic measures. Finally, the robustness of matching estimators was checked for the potential biases that might be caused by unobserved variables. The primary results showed that female students had higher awareness, preparedness, and fear, but lesser knowledge of the pandemic, and considered getting vaccinated of lesser necessity compared with male students. Also, we observed a pronounced pattern of sex-related difference in responding to campus climate changes; male students were more likely to be indifferent in keeping social distance, adopting other measures, and participating in campus activities. The findings inform postsecondary administrators and other related stakeholders to avoid making the existing sex-related disparities larger and help every student well prepare for and appropriately respond to COVID-19.

Social Connectedness, Physical Distancing, and Anxiety in Complying with Shelter-In-Place Orders and Advisories during the Once-In-A-Century COVID-19 Pandemic in the US: A Study of Social Media and Internet Users

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was first identified in Wuhan, China, in December 2019. As of 20 October 2020, the virus had infected 8,202,552 people, with 220,061 deaths in US, and in countries around the world, over 38 million people have become infected and over one million have died. The virus usually spreads via respiratory droplets from an infected person. At the time of compiling this paper, while countries around the world are still striving to find a "pharmaceutical intervention (PI)", including treatments and vaccines, they are left with only "non-pharmaceutical interventions (NPIs)", such as physical distancing, wearing masks, and maintaining personal hygiene. In the US, all 50 states, the District of Columbia, and five US territories issued mandatory stay-at-home orders between March 1 and 31 May 2020 to lower the risk of virus transmission. This study empirically examined how social connectedness and anxiety interact with shelter-in-place compliance and advisories during the pandemic. The study collected information from 494 adults using an online survey during April and July 2020.

Implications of COVID-19 on oxbow lake (Baors) Fisher's community, Bangladesh: resilience to food security against probable natural calamities

The purpose of studying the consequence of COVID-19 on oxbow lake (Baor) fisher's community is to counteract the negative impacts on livelihoods with food security and figure out diversified resilience options for sustaining basic needs of life. Individual questionnaire interviews, oral history, focus group discussion, and telephonic interviews were among the methodological techniques used to gather primary data. The Baor fisher's community was impaired with income, food and feeding habit, health and marketing. The Baor fishers had to stop harvesting or reducing the amount of fish harvest because of gradual decreasing of consumer demand and prices of fish during the course of COVID-19 pandemic period. The transportation costs were raised up to 50%–80%, while the prices of fish decreased by 15%–30% prior to the onset of COVID-19 pandemic. The frequency of fish consumption was significantly come down to 37.5%. Many households substituted fish to farm reared hens, eggs, domestic hens and ducks, lentils, and vegetables during the period of lockdown across the country. Supply chains of fish and fish culture inputswere disrupted due to inadequacy of transportation facilities. Many school- and college-going students were dropped outduring the ongoing pandemic situation due to their financial problems (10%) and early marriage (7.5%). The secondary sources of income (labor of netting in other aquaculture farms) of Baor fisher's community were also impaired. The resilience options of this study will be helpful to minimize the sudden economic crises, ensure dynamic fish value chains and food security, protect individuals from ongoing health hazards, and promote sustainable food production systems followed by social cohesion and stabilityagainst the prevailing challenges owing to the pandemic and other natural calamities.

International R&D diffusion in disaster management: a systematic review

There are several challenges to the international diffusion of research and development (R&D) in disaster management. The present study aimed to examine a paradigm shift in international R&D diffusion in the field. Qualitative content analysis was used as the methodology in comparing commercialization-based versus humanity-based international R&D diffusion in terms of international organizations, developed nations, and developing nations. A key finding is that the field needs to shift from commercialization-based to humanity-based international R&D diffusion, while enhancing international cooperation, equality and human rights, and networking, among other factors. Compared with previous studies, this research reviewed a paradigm shift in international R&D diffusion in disaster management in a more comprehensive and timely manner.

Experiences and challenges faced by patients with COVID-19 who were hospitalised and participated in a randomised controlled trial: a qualitative study

OBJECTIVES

As part of a randomised controlled trial, this qualitative study aimed to identify experiences and challenges of hospitalised patients with COVID-19 during illness and treatment (objective 1: COVID-19-related perspectives; objective 2: trial participation-related perspectives).

DESIGN

Semistructured interviews following a prespecified interview guide, transcribed verbatim and analysed in accordance with the grounded theory process. Investigator triangulation served to ensure rigour of the analysis.

SETTING

Interviews were embedded in a multicentre, randomised, active-controlled, open-label platform trial testing efficacy and safety of experimental therapeutics for patients with COVID-19 (Austrian Corona Virus Adaptive Clinical Trial).

PARTICIPANTS

20 patients (60±15 years) providing 21 interviews from 8 June 2020 to 25 April 2021.

RESULTS

Qualitative data analysis revealed four central themes with subthemes. Theme 1, 'A Severe Disease', related to objective 1, was characterised by subthemes 'symptom burden', 'unpredictability of the disease course', 'fear of death' and 'long-term aftermaths with lifestyle consequences'. Theme 2, 'Saved and Burdened by Hospitalization', related to objective 1, comprised patients describing their in-hospital experience as 'safe haven' versus 'place of fear', highlighting the influence of 'isolation'. Theme 3, 'Managing One's Own Health', related to objective 1, showed how patients relied on 'self-management' and 'coping' strategies. Theme 4, 'Belief in Medical Research', related to objective 2, captured patients' 'motivation for study participation', many expressing 'information gaps' and 'situational helplessness' in response to study inclusion, while fewer mentioned 'therapy side-effects' and provided 'study reflection'. Investigator triangulation with an expert focus group of three doctors who worked at the study centre confirmed the plausibility of these results.

CONCLUSIONS

Several of the identified themes (2, 3, 4) are modifiable and open for interventions to improve care of patients with COVID-19. Patient-specific communication and information is of utmost importance during clinical trial participation, and was criticised by participants of the present study. Disease self-management should be actively encouraged.

TRIAL REGISTRATION NUMBER

NCT04351724.

Exploring the over-time, multifaceted impacts of three COVID-19 lockdowns on aspects of capability, wellbeing and mental health across vulnerabilities in Austria

The Austrian government imposed multiple major lockdowns during the COVID-19 pandemic, but the relevant measures and their perceptions varied over time. The aim of this study was to compare the over-time impacts of the three COVID-19 lockdowns between March 2020 and December 2021 for (capability) wellbeing and mental health in Austria. Adult Austrian residents (n = 87) completed an online survey about their experiences during three COVID-19 lockdowns, including capabilities (OxCAP-MH), depression and anxiety (HADS), and general wellbeing (WHO-5). Differences across the baseline and follow-up scores of these instruments were summarised by demographic/socioeconomic characteristics. Longitudinal comparisons of the impacts of the lockdowns were conducted using random effect models on panel data for overall instrument scores and individual capability items. The levels of (capability) wellbeing and mental health decreased for most respondents across the three lockdowns: average 2.4% reduction in OxCAP-MH scores, 18.8% and 9% increases in HADS depression and anxiety subscale scores respectively, and 19.7% reduction in WHO-5 score between the first and third lockdowns. Mental health treatment prior to the pandemic, social support and satisfaction with government measures were the most influential characteristics that determine the association with impacts of the chain of lockdowns. Our study is the first to assess the differential capability limiting aspects of lockdowns over time alongside their impacts on mental health and general wellbeing and calls for special attention for mental health patients, isolation and satisfaction with government measures.

Measuring Occupational Fatigue among Higher and Middle Management at a Specialized Cancer Center during the COVID-19 Pandemic

PURPOSE

This study aims to measure the occupational fatigue level and describe the sources and consequences of occupational fatigue among middle and higher management at an international specialized cancer center during the COVID-19 pandemic.

METHODS

A mixed-method design was used in this study. A convenience sampling technique was utilized to select the participants from King Hussein Cancer Center, Amman, Jordan. The data was collected through a self-administered questionnaire. This questionnaire included both quantitative and qualitative sections. We utilized Fatigue Risk Assessment and Management in High-Risk Environments (FRAME)-26 items scale for the quantitative section. Two main questions were included in the survey to identify the sources and consequences of occupational fatigue.

RESULTS

The results show that the average mean of occupational fatigue was 2.95/5 (SD=0.70). The level of changes in fatigue levels after the COVID-19 pandemic increased by 0.87/3 (SD=1.45). The sources of occupational fatigue could be categorized into five themes: workload, work environment, staffing, psychological, and physical sources. There are four themes categorizing occupational fatigue: social, economic, health, and daily activity and lifestyle.

CONCLUSION

This study affords valuable insight into the level, source, and consequences of occupational fatigue among middle and higher management at an international specialized cancer hospital in developing countries. The results indicate that the occupational fatigue level was moderate, and the fatigue level was negatively impacted by the COVID-19 pandemic.

The Involvement of the European Master in Disaster Medicine (EMDM) Alumni in the COVID-19 Pandemic Response: An Example of the Perceived Relevance of Disaster Medicine Education during Disasters

Introduction:

The coronavirus disease 2019 (COVID-19) pandemic has revealed a gap in disaster preparedness of health workers globally. Disaster medicine education is a key element to fill this gap.

Objectives:

This study evaluated the involvement of the European Master in Disaster Medicine (EMDM) Alumni in the current COVID-19 pandemic response and their self-perceived value of the EMDM educational program in accomplishing their tasks during the disaster.

Methods:

An online survey targeting the EMDM Alumni was conducted from January through March 2021. Quantitative data were described using percentages or means, as appropriate, while qualitative data were categorized using deductive thematic analysis.

Results:

In total, 259 Alumni completed the survey. Most of the Alumni (88.03%; standard error of the proportion [SEp] = 0.02) participated directly in the COVID-19 pandemic response – nationally or internationally – with different roles and responsibilities at different levels and sectors. Around 25% of the Alumni reported an increase in their tasks and responsibilities due to COVID-19 response, but few worked beyond their main specialization (5.26%) or expertise (2.19%). Moreover, Alumni shifted their role from clinical practice to managerial, public health, education and training, and policymaking roles during COVID-19 (P <.001). Participants believed that the EMDM study program and the competencies acquired during the course were relevant and useful to perform their tasks during the COVID-19 pandemic response (mean = 5.26; 5.17 standard error of the mean [SEM] = 0.108, 0.107), respectively. Around 36% (SEp = 0.03) of the participants deemed that some contents were not sufficient for COVID-19 response.

Conclusion:

Most of the EMDM Alumni were involved in the COVID-19 pandemic response, playing diverse roles with an increased level of responsibility compared to those played before the pandemic. Moreover, the Alumni perceived the EMDM curriculum as relevant for accomplishing their tasks. However, they also reported gaps within the curriculum, especially topics related to outbreak and pandemic response. The findings of the study stress the value of investing in disaster medicine education world-wide and of pushing to update and standardize post-graduate disaster medicine curricula.

COVID-19 vaccine hesitancy in Malaysia: Exploring factors and identifying highly vulnerable groups

Vaccine hesitancy is a global health challenge in controlling the virulence of pandemics. The prevalence of vaccine hesitancy will put highly vulnerable groups, such as the elderly or groups with pre-existing health conditions, at a higher risk, as seen with the outbreak of the pandemic Covid-19. Based on the trends of vaccine hesitancy in the state of Sabah, located in East Malaysia, this study seeks to identify several variables that contribute to vaccine hesitancy. In addition to this, this study also determines which groups are affected by vaccine hesitancy based on their demographics. This study is based on a sampling of 1,024 Sabahan population aged 18 and above through an online and face-to-face questionnaire. The raw data was analysed using the K-Means Clustering Analysis, Principal Component Analysis (PCA), Mann-Whitney U Test, Kruskal-Wallis Test, and frequency. The K-Means Clustering found that more than half of the total number of respondents (Cluster 2 = 51.9%) tend to demonstrate vaccine hesitancy. Based on the PCA analysis, six main factors were found to cause vaccine hesitancy in Sabah: confidence (var(X) = 21.6%), the influence of local authority (var(X) = 12.1%), ineffectiveness of mainstream media (var(X) = 8.4%), complacency (var(X) = 7.4%), social media (var(X) = 6.4%), and convenience issues (var(X) = 5.8%). Findings from both Mann-Whitney U and Kruskal-Wallis tests demonstrate that several factors of group demographics, such as employment status, level of education, religion, gender, and marital status, may explain the indicator of vaccine hesitancy. In particular, specific groups tend to become vaccine hesitancy such as, unemployed, self-employed, students, male, single, level of education, and Muslim. Findings from this empirical study are crucial to inform the relevant local authorities on the level of vulnerability among certain groups in facing the hazards of COVID-19. The main contribution of this study is that it seeks to analyse the factors behind vaccine hesitancy and identifies which groups more likely hesitant toward vaccines based on their demographics.

Evaluating the Effectiveness of the COVID-19 Emergency Outbreak Prevention and Control Based on CIA-ISM

The COVID-19 pandemic, characterized by high uncertainty and difficulty in prevention and control, has caused significant disasters in human society. In this situation, emergency management of pandemic prevention and control is essential to reduce the pandemic’s devastation and rapidly restore economic and social stability. Few studies have focused on a scenario analysis of the entire emergency response process. To fill this research gap, this paper applies a cross impact analysis (CIA) and interpretive structural modeling (ISM) approach to analyze emergency scenarios and evaluate the effectiveness of emergency management during the COVID-19 crisis for outbreak prevention and control. First, the model extracts the critical events for COVID-19 epidemic prevention and control, including source, process, and resultant events. Subsequently, we generated different emergency management scenarios according to different impact levels and conducted scenario deduction and analysis. A CIA-ISM based scenario modeling approach is applied to COVID-19 emergency management in Nanjing city, China, and the results of the scenario projection are compared with actual situations to prove the validity of the approach. The results show that CIA-ISM based scenario modeling can realize critical event identification, scenario generation, and evolutionary scenario deduction in epidemic prevention and control. This method effectively handles the complexity and uncertainty of epidemic prevention and control and provides insights that can be utilized by emergency managers to achieve effective epidemic prevention and control.

The psychological impact of the coronavirus disease 2019 pandemic on women who become pregnant after receiving treatment for infertility: a longitudinal study

OBJECTIVE

To compare the impact of the coronavirus disease 2019 (COVID-19) pandemic on the psychological health of patients with infertility who have become pregnant with that of women who have not.

DESIGN

Prospective cohort study conducted from April 2020 to June 2020. The participants completed three questionnaires over this period.

SETTING

A single large, university-affiliated infertility practice.

PATIENTS

A total of 443 pregnant women and 1,476 women still experiencing infertility who completed all three questionnaires.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Patient-reported primary stressor over three months of the first major COVID-19 surge; further data on self-reported sadness, anxiety, loneliness, and the use of personal coping strategies.

RESULTS

Pregnant participants were significantly less likely to report taking an antidepressant or anxiolytic medication, were less likely to have a prior diagnosis of depression, were more likely to cite COVID-19 as a top stressor, and overall were less likely to practice stress-relieving activities during the first surge.

CONCLUSIONS

Women who became pregnant after receiving treatment for infertility cited the pandemic as their top stressor and were more distressed about the pandemic than their nonpregnant counterparts but were less likely to be engaging in stress-relieving activities. Given the ongoing impact of the pandemic, patients with infertility who become pregnant after receiving treatment should be counseled and encouraged to practice specific stress-reduction strategies.

The COVID-19 pandemic reduced the trauma incidence and modified its pattern in Al-Ain City, United Arab Emirates

AIM

We aimed to study the impact of the COVID-19 pandemic on the pattern of injury and outcome of hospitalized trauma patients in Al-Ain City, United Arab Emirates, to use this information in the preparedness for future pandemics.

METHODS

We retrospectively compared the trauma registry data of all hospitalised trauma patients, who were treated at the two main trauma centres in Al-Ain City (Al-Ain Hospital and Tawam Hospital); those who were treated over 1 year before the pandemic (n = 2002) and those who were treated at the first year of the COVID-19 pandemic (n = 1468).

RESULTS

There was a 26.7% reduction in the overall incidence of trauma admissions in the COVID-19 pandemic period. The mechanism of injury significantly differed between the two periods (p < 0.0001, Fisher's exact test). There was an absolute increase in the number of injuries, due to machinery and falling objects during the pandemic (39.7% and 54.1% respectively, p < 0.001). In contrast, road traffic collisions and falls were reduced by 33.5% and 31.3%, respectively. Location significantly differed between the two periods (p < 0.0001, Fisher's exact test). There was an absolute increase of 18.4% in workplace injuries and a reduction of 39.3% in home injuries over the study period. In addition, we observed relatively more workplace injuries and fewer home injuries during the pandemic (11.3% and 42.8% compared with 7.1% and 52.4%, respectively). Mortality was similar between the two periods (1.8% compared with 1.2%, p = 0.16, Fisher's exact test).

CONCLUSIONS

The COVID-19 pandemic has modified the trauma risk exposure in our population. It reduced trauma hospital admissions by around 27%. Work-related injuries, including falling objects and machinery injuries, were relatively higher during the pandemic. Prevention of work-related injuries should be an important component of preparedness for future pandemics.

The Prevalence of Depression Symptoms among Pregnant Women during the Second Wave of COVID-19

BACKGROUND: Pregnant women are vulnerable to depression. We hypothesized that the COVID-19 pandemic would increase depression in pregnancy leading to complications to both mother and fetus. AIM: This study is aimed to identify antenatal depression symptoms during the second wave COVID-19 pandemic. METHODS: This was a community-based, cross-sectional study conducted from 10 to 21 June 2021. A number of 130 pregnant women were recruited through both convenience and snowball sampling. An online survey with self-administered Whooley questions was used to assess antenatal depression symptoms. RESULTS: We found elevated antenatal depression symptoms similar to other countries during the COVID-19 pandemic. The prevalence of pregnant women with depression symptoms was 42.3%. The majority of pregnant women who had antenatal depression symptoms had the following characteristics: About 44.75% lived outside Jakarta, 60% had low education (Junior high school and below), 42.9% aged 20–35 years, and 44.8% of them were housewives. CONCLUSION: In Indonesia, the second wave of COVID-19 pandemic affected increasing symptoms of depression among pregnant women. Positive protective factors should be taken to prevent negative impacts of both unidentified and untreated antenatal depression among the pregnant women for the sake of maternal and child health.

Perceived Information Overload and Unverified Information Sharing on WeChat Amid the COVID-19 Pandemic: A Moderated Mediation Model of Anxiety and Perceived Herd

Individuals' unverified information sharing on social media, namely, sharing information without verification, is a major cause of the widespread misinformation amid the COVID-19 pandemic. The association between perceived information overload and unverified information sharing has been well documented in the cognitive overload approach. However, little is known about the underlying mechanism of this process. This study aims to explore the mediating role of anxiety and the moderating role of perceived herd between perceived information overload and unverified information sharing on WeChat. Anxiety demonstrates people's emotional response to the pandemic, whereas perceived herd describes a willingness to share certain information if it has been shared by many. The results of an online survey in China (N = 525) showed that perceived information overload was positively associated with unverified information sharing. In addition, this relationship was partially mediated by anxiety. Moreover, perceived herd positively moderated the link between anxiety and unverified information sharing, such that the indirect effect of perceived information overload on unverified information sharing via anxiety was significant in conditions where the level of perceived herd was high, whereas the indirect effect was not significant in conditions where the level of perceived herd was low. The moderated mediation model extends the cognitive overload approach and indicates that unverified information sharing is not only an individual strategy to cope with information overload but also a herding behavior to manage anxiety. Practical implications for curbing people's tendencies toward unverified information sharing on social media are discussed.

Kuala Lumpur train collision during the COVID-19 pandemic

BACKGROUND

Two city trains collided in an underground tunnel on 24 May 2021 at the height of COVID-19 pandemic near the Petronas Towers, Kuala Lumpur, Malaysia, immediately after the evening rush hours. We aim to evaluate the management of this mass casualty incident highlighting the lessons learned to be used in preparedness for similar incidents that may occur in other major cities worldwide.

METHODS

Information regarding incident site and hospital management response were analysed. Data on demography, triaging, injuries and hospital management of patients were collected according to a designed protocol. Challenges, difficulties and their solutions were reported.

RESULTS

The train's emergency response team (ERT) has shut down train movements towards the incident site. Red zone (in the tunnel), yellow zone (the station platform) and green zone (outside the station entrance) were established. The fire and rescue team arrived and assisted the ERT in the red zone. Incident command system was established at the site. Medical base station was established at the yellow zone. Two hundred and fourteen passengers were in the trains. Sixty-four of them were injured. They had a median (range) ISS of 2 (1-43), and all were sent to Hospital Kuala Lumpur (HKL). Six (9.4%) patients were clinically triaged as red (critical), 19 (29.7%) as yellow (semi-critical) and 39 (60.9%) as green (non-critical). HKL's disaster plan was activated. All patients underwent temperature and epidemiology link assessment. Seven (10.9%) patients were admitted to the hospital (3 to the ICU, 3 to the ward and 1 to a private hospital as requested by the patient), while the rest 56 (87.5%) were discharged home. Six (9.4%) needed surgery. The COVID-19 tests were conducted on seven patients (10.9%) and were negative. There were no deaths.

CONCLUSIONS

The mass casualty incident was handled properly because of a clear standard operating procedure, smooth coordination between multi-agencies and the hospitals, presence of a 'binary' system for 'COVID-risk' and 'non-COVID-risk' areas, and the modifications of the existing disaster plan. Preparedness for MCIs is essential during pandemics.

Continuum of care for disasters and catastrophes

Disasters and their more extensive and more serious variant, catastrophes, are different than most human experiences. They are inherently quite complex. Extensive and diverse resources are required to assist disaster survivors as well as disaster response personnel, and hospital medical staffs. Except for warfare, there are few other human predicaments that require such a massive and highly coordinated response. Traditional psycho-therapeutic interventions have little chance of being helpful in the acute stages of a disaster. Research demonstrates that selected crisis intervention processes provided by crisis-trained psychological support personnel have been quite successful in assisting both the survivors and responders in coping with disasters and catastrophes. Assistance to military personnel, emergency operations personnel, and survivors must be carefully crafted to assure that the right type of help is provided at the right time by the most appropriate, well-trained, and experienced personnel. This paper employed a scoping review methodology synthesizing the lessons gleaned from wars and past disasters beginning in the late 1800's up to the present. It sets a course for the appropriate management of the psychological impacts of future disasters and catastrophes. Evidence suggests effective psychiatric and psychological services provided during and in the aftermath of a disaster must be simple, brief, immediate, practical, and innovative. Most importantly, disaster mental health support services must consist of an integrated and comprehensive continuum of mental health services spanning all levels of intensity of support and care.

Global impact of COVID-19 pandemic on road traffic collisions

BACKGROUND

Various strategies to reduce the spread of COVID-19 including lockdown and stay-at-home order are expected to reduce road traffic characteristics and consequently road traffic collisions (RTCs). We aimed to review the effects of the COVID-19 pandemic on the incidence, patterns, and severity of the injury, management, and outcomes of RTCs and give recommendations on improving road safety during this pandemic.

METHODS

We conducted a narrative review on the effects of COVID-19 pandemic on RTCs published in English language using PubMed, Scopus, and Google Scholar with no date restriction. Google search engine and websites were also used to retrieve relevant published literature, including discussion papers, reports, and media news. Papers were critically read and data were summarized and combined.

RESULTS

Traffic volume dropped sharply during the COVID-19 pandemic which was associated with significant drop in RTCs globally and a reduction of road deaths in 32 out of 36 countries in April 2020 compared with April 2019, with a decrease of 50% or more in 12 countries, 25 to 49% in 14 countries, and by less than 25% in six countries. Similarly, there was a decrease in annual road death in 33 out of 42 countries in 2020 compared with 2019, with a reduction of 25% or more in 5 countries, 15-24% in 13 countries, and by less than 15% in 15 countries. In contrast, the opposite occurred in four and nine countries during the periods, respectively. There was also a drop in the number of admitted patients in trauma centers related to RTCs during both periods. This has been attributed to an increase in speeding, emptier traffic lanes, reduced law enforcement, not wearing seat belts, and alcohol and drug abuse.

CONCLUSIONS

The COVID-19 pandemic has generally reduced the overall absolute numbers of RTCs, and their deaths and injuries despite the relative increase of severity of injury and death. The most important factors that affected the RTCs are decreased mobility with empty lines, reduced crowding, and increased speeding. Our findings serve as a baseline for injury prevention in the current and future pandemics.

Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers

The COVID-19 pandemic has had a strong impact on healthcare workers (HCWs), affecting their physical and mental health. In Italy, HCWs have been among the first exposed to unprecedented pressure, dealing with large numbers of infections during the first pandemic wave. However, the severe psychological consequences on HCWs find little evidence in the literature, especially in terms of comparison to the status quo ante pandemic. The aim of this study was to provide an assessment of the mental health burden in a cohort of Italian HCWs during the COVID-19 pandemic, comparing their condition with that before the emergency, to direct the promotion of mental well-being among HCWs worldwide. In this retrospective study, we included physicians, physical therapists, and nurses working in the Respiratory Intensive Care Unit, Neurology Unit, and Rehabilitation Unit from a Southern Italy University Hospital. All study participants underwent a battery of psychological tests, aimed at verifying their state of mental health during the COVID-19 emergency and before it. Depressive, anxiety, and burnout symptoms were assessed using the following questionnaires: Maslach Burnout Inventory, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7. Depressive, anxiety, and burnout clinical relevance symptoms were present in HCWs during the COVID-19 pandemic more than those before the emergency. Fifty percent of the HCWs obtained a score clinically significant during the emergency. Moreover, a depersonalization factor showed a statistically significant increase in average scores (p < 0.0001). The PHQ-9 scale showed that 47.1% of the operators reported depressive state presence. The number of operators scoring above the cut-off for the anxiety scale tripled during the emergency (p < 0.0001). The female gender conferred greater risks for depression. Taken together, the findings of this study showed that our sample of Italian HCWs showed a greater risk for depression, anxiety, and stress during the COVID-19 pandemic. These data might be a starting point to plan mental health monitoring and prevention programs for HCWs, thus ensuring patients receive the best possible care performances even during healthcare crises such as the current pandemic.

Effective Communication at Different Phases of COVID-19 Prevention: Roles, Enablers and Barriers

In an age of globalisation and hyperconnectivity, the COVID-19 pandemic has caused unprecedented and sustained impact worldwide. This article discusses issues related to (science) communication at different phases of the COVID-19 epidemic timeline. We consider the role of communication for prevention from the ecological perspective, taking into consideration that many emerging pathogens, including COVID-19, likely arise in part due to anthropogenic changes to natural environments. Communication forms part of the early response setting the scene for public buy-in of public health interventions at the start of an outbreak, as well as to maintain precautions over time. Finally, communication is a key element in increasing acceptance for new tools that require mass uptake to be effective, as seen with roll-out challenges for the COVID-19 vaccines, which faced heightened concerns of efficacy and safety while mired with rampant misinformation. Ultimately, strategies for prevention of viral epidemics such as COVID-19 must include communication strategies at the forefront to reduce the risk of the emergence of new diseases and enhance efforts to control their spread and burden. Despite key themes emerging, what constitutes effective communication strategies for different people and contexts needs to be investigated further.

COVID-19 knowledge, attitudes, and practices of United Arab Emirates medical and health sciences students: A cross sectional study

The COVID-19 pandemic is the largest viral pandemic of the 21st century. We aimed to study COVID-19 knowledge, attitudes, and practices (KAP) among medical and health sciences students in the United Arab Emirates (UAE). We performed a cross-sectional study between 2 June and 19 August 2020. The survey was distributed online using Survey Monkey. It was conducted in English and comprised two parts: socio-demographic characteristics, and KAP towards COVID-19. 712 responses to the questionnaire were collected. 90% of respondents (n = 695) were undergraduate students, while 10% (n = 81) were postgraduates. The majority (87%, n = 647) stated that they obtained COVID-19 information from multiple reliable sources. They were highly knowledgeable about the COVID-19 pandemic, but 76% (n = 539) did not recognize its routes of transmission. Medical students were significantly more knowledgeable compared with allied health students (P<0.0001, Mann Whitney U test) but there was no difference in knowledge between undergraduate and postgraduate students (P = 0.14, Mann Whitney U test). Medical students thought that more could be done to mitigate the COVID-19 situation compared with the allied health students (66.2% compared with 51.6%, p = 0.002 Fisher's Exact test). 63% (n = 431) were worried about getting COVID-19 infection, while 92% (n = 633)) were worried that a family member could be infected with the virus. 97% (n = 655) took precautions when accepting home deliveries, 94% (n = 637) had been washing their hands more frequently, and 95% (n = 643) had been wearing face masks. In conclusion, medical and health sciences students in the UAE showed high levels of knowledge and good attitudes and practices towards the COVID-19 pandemic. Nevertheless, they were worried about themselves or their family members becoming infected. Medical students had more knowledge about COVID-19 pandemic which was reflected in their opinion that more can be done to mitigate its effects.