Lockdowns and low- and middle-income countries: building a feasible, effective, and ethical COVID-19 response strategy

Reimagining global health scholarship to tackle health inequities

•Significant health inequities persist between and within countries, necessitating a paradigm shift in global health scholarship.•Building on the contributions global health experts, this article proposes four key considerations for reframing global health scholarship.•This requires deeper engagement with macrosocial drivers of health and the application of population health science principles.•An evolving field also necessitates innovation in data sources, multidisciplinary engagement, expanded analytical tools, and diverse global perspectives.

COVID-19 pandemic in Bangladesh: A scoping review of governance issues affecting response in public sector

Background

On January 30, 2020, WHO declared COVID-19 as a Global Public Health Emergency. The first three COVID-19 cases in Bangladesh were confirmed on March 8, 2020. Thus, Bangladesh got substantial time to prepare the people and the health systems to respond to the outbreak However, neither the health ministry nor the government was found to rise to the occasion and provide the necessary stewardship for a coordinated and comprehensive response.

Objective

The importance of governance to mount an evidence-based pandemic response cannot be overemphasised. This study presents critical reflections on the Bangladesh government's COVID-19 response through a review of selected papers, with expert deliberations on the review findings to consolidate emerging lessons for future pandemic preparedness.

Study design

A scoping review approach was taken for this study.

Methods

Documents focusing on COVID-19 governance were selected from a repository of peer-reviewed articles published by researchers using data from Bangladesh (n = 11).

Results

Findings reveal Bangladesh's COVID-19 response to be delayed, slow, and ambiguous, reflecting poorly on its governance. Lack of governance capability in screening for COVID-19, instituting quarantine and lockdown measures in the early weeks, safety and security of frontline healthcare providers, timely and equitable COVID-19 testing, and logistics and procurement were phenomenal. The pandemic unmasked the weaknesses of the health system in this regard and "created new opportunities for corruption." The failure to harmonise coordination among the government's different agencies for the COVID-19 response, along with poor risk communication, which was not culture-sensitive and context-specific. Over time, the government initiated necessary actions to mitigate the pandemic's impact on the lives and livelihoods of the people. Diagnostic and case management services gained strength after some initial faltering; however, the stewardship functions were not seamless.

Conclusions

Shortage of healthcare workers, incapability of health facilities to cater to COVID-19 suspects and cases, absence of health system resilience, and corruption in procurement and purchases were limited the government's COVID-19 response. These need urgent attention from policymakers to better prepare for the next epidemic/pandemic.

Ethical frameworks should be applied to computational modelling of infectious disease interventions

This perspective is part of an international effort to improve epidemiological models with the goal of reducing the unintended consequences of infectious disease interventions. The scenarios in which models are applied often involve difficult trade-offs that are well recognised in public health ethics. Unless these trade-offs are explicitly accounted for, models risk overlooking contested ethical choices and values, leading to an increased risk of unintended consequences. We argue that such risks could be reduced if modellers were more aware of ethical frameworks and had the capacity to explicitly account for the relevant values in their models. We propose that public health ethics can provide a conceptual foundation for developing this capacity. After reviewing relevant concepts in public health and clinical ethics, we discuss examples from the COVID-19 pandemic to illustrate the current separation between public health ethics and infectious disease modelling. We conclude by describing practical steps to build the capacity for ethically aware modelling. Developing this capacity constitutes a critical step towards ethical practice in computational modelling of public health interventions, which will require collaboration with experts on public health ethics, decision support, behavioural interventions, and social determinants of health, as well as direct consultation with communities and policy makers.

Setting research priorities for global pandemic preparedness: An international consensus and comparison with ChatGPT's output

Background

In this priority-setting exercise, we sought to identify leading research priorities needed for strengthening future pandemic preparedness and response across countries.

Methods

The International Society of Global Health (ISoGH) used the Child Health and Nutrition Research Initiative (CHNRI) method to identify research priorities for future pandemic preparedness. Eighty experts in global health, translational and clinical research identified 163 research ideas, of which 42 experts then scored based on five pre-defined criteria. We calculated intermediate criterion-specific scores and overall research priority scores from the mean of individual scores for each research idea. We used a bootstrap (n = 1000) to compute the 95% confidence intervals.

Results

Key priorities included strengthening health systems, rapid vaccine and treatment production, improving international cooperation, and enhancing surveillance efficiency. Other priorities included learning from the coronavirus disease 2019 (COVID-19) pandemic, managing supply chains, identifying planning gaps, and promoting equitable interventions. We compared this CHNRI-based outcome with the 14 research priorities generated and ranked by ChatGPT, encountering both striking similarities and clear differences.

Conclusions

Priority setting processes based on human crowdsourcing - such as the CHNRI method - and the output provided by ChatGPT are both valuable, as they complement and strengthen each other. The priorities identified by ChatGPT were more grounded in theory, while those identified by CHNRI were guided by recent practical experiences. Addressing these priorities, along with improvements in health planning, equitable community-based interventions, and the capacity of primary health care, is vital for better pandemic preparedness and response in many settings.

The paradox of pandemic mitigation? Moderating role of pandemic severity on the impact of social distancing policies: a cultural value perspective

BACKGROUND

Social distancing policies were of utmost importance during the early stages of the COVID-19 pandemic. These policies aimed to mitigate the severity of local outbreaks by altering public behavior. However, if the severity of the pandemic reduces, the impact of these policies on actual behavior may decrease. This study aims to examine, from a global perspective, whether the impact of social distancing policies on actual mobility is moderated by local pandemic severity and whether this moderating effect varies across cultural value contexts.

METHODS

We combined multiple publicly available global datasets for structural equation model analysis. 17,513 rows of data from 57 countries included in all databases were analyzed. Multilevel moderated moderation models were constructed to test the hypotheses.

RESULTS

More stringent policies in a region mean less regional mobility (β = -0.572, p < 0.001). However, the severity of local outbreaks negatively moderated this effect (β = -0.114, p < 0.001). When the pandemic was not severe, the influence of policy intensity on mobility weakened. Furthermore, based on Schwartz's cultural values theory, cultural values of autonomy (β = -0.109, p = 0.011), and egalitarianism (β = -0.108, p = 0.019) reinforced the moderating effect of pandemic severity. On the other hand, cultural values of embeddedness (β = 0.119, p = 0.006) and hierarchy (β = 0.096, p = 0.029) attenuated the moderating effect.

CONCLUSIONS

Social distancing policies aim to reduce the severity of local pandemics; however, the findings reveal that mitigating local pandemics may reduce their impact. Future policymakers should be alert to this phenomenon and introduce appropriate incentives to respond. The results also show that the moderating role of pandemic severity varies across cultures. When policies are promoted to deal with global crises, policymakers must seriously consider the resistance and potential incentives of cultural values.

Fruit and Vegetable Intake of Females Before, During, and After Introduction of 3 Bundled Food System Interventions in Urban Vietnam and Nigeria

Background

Low fruit and vegetable (FV) intake in low- and middle-income countries, which is associated with noncommunicable diseases and micronutrient deficiencies, requires food system interventions addressing FV accessibility, affordability, and acceptability. Periodic FV intake monitoring during interventions informs progress toward achieving increased intakes and contributes to understanding the effectiveness of these interventions.

Objectives

This study evaluates the trend in FV intake before, during, and after implementation of a set of nutrition-sensitive food system interventions addressing accessibility, affordability, and acceptability to increase FV consumption over a 1-y period in Vietnamese and Nigerian low-income urban and periurban females.

Methods

We used the Diet Quality Questionnaire to assess FV food group consumption among 600 Vietnamese (Hanoi) and 610 Nigerian (Ibadan) females before, during, and after the interventions (Vietnam: July 2020-September 2021; Nigeria: November 2020-December 2021). A FV score was compared between exposure groups with (mixed) count modeling. The trend in consumption of individual FV groups was analyzed with mixed logistic regression.

Results

The FV score was stable over time, and a small increase was observed after the intervention period especially in Nigeria and in urban Vietnam. A decrease in the total score was observed in periurban Vietnam. Fluctuations were detected in the probability of consumption of individual FV groups over time especially within the fruit groups, probably due to seasonal availability. The degree of exposure could not explain differences in FV intake.

Conclusions

We found a marginal increase in the proportion of females consuming FV during the interventions in both countries. The FV score appeared to be a simple, quick, and easy-to-use indicator for monitoring diversity, variety, and consumption.

Rapid Induction of Long-Lasting Systemic and Mucosal Immunity via Thermostable Microneedle-Mediated Chitosan Oligosaccharide-Encapsulated DNA Nanoparticles

Most existing vaccines, delivered by intramuscular injection (IM), are typically associated with stringent storage requirements under cold-chain distribution and professional administration by medical personnel and often result in the induction of weak mucosal immunity. In this context, we reported a microneedle (MN) patch to deliver chitosan oligosaccharide (COS)-encapsulated DNA vaccines (DNA@COS) encoding spike and nucleocapsid proteins of SARS-CoV-2 as a vaccination technology. Compared with IM immunization, intradermal administration via the MN-mediated DNA vaccine effectively induces a comparable level of neutralizing antibody against SARS-CoV-2 variants. Surprisingly, we found that MN-mediated intradermal immunization elicited superior systemic and mucosal T cell immunity with enhanced magnitude, polyfunctionality, and persistence. Importantly, the DNA@COS nanoparticle vaccine loaded in an MN patch can be stored at room temperature for at least 1 month without a significant decrease of its immunogenicity. Mechanically, our strategy enhanced dendritic cell maturation and antiviral immunity by activating the cGAS-STING-mediated IFN signaling pathway. In conclusion, this work provides valuable insights for the rapid development of an easy-to-administer and thermostable technology for mucosal vaccines.

An Ethics of Justice in Elderly Care: Ageism and the Covid-19 Pandemic

BACKGROUND

The study looks into the condition of elderly Covid-19 patients regarding the kind of attention they received during the pandemic given the scarcity of medical resouces in the countries mentioned in this investigation. In this case, we apply the bioethical principle of justice on the age-based criteria in determining which patient must receive treatment The argument is that the same is a form of discimination against the elderly.

PURPOSE

The purpose of this study is to emphasize that the age-based criteria in deciding whether to treat elderly Covid-19 patients or not is violative of the bioethical principle of justice since it discriminates against them.

METHOD

This study uses the interpretive method. The authors analyzed the literature and the arguments pertaining to the issue of ageism at the height of the Covid-19 Pandemic. We mentioned the countries where the issue of prioritization was a big concern. The qualitative analysis in this paper is meant to respond to such medical dilemma.

ANALYSIS

In our analysis, we determined that when age is used as a criterion, it violates the bioethical principle of justice. The principle is meant to ensure that physicians are fair in dealing with patients. Using age in deciding whether a life is worth saving or not is a prejudice against old people who require care and attention.

DISCUSSION

Medical doctors must treat patients equally and without bias. The challenge, however, is that due to the unprecedented nature of the pandemic, a triage is put in place to be able to manage the overwhelming influx of Covid-19 patients. Some age-based medical treatment criteria that recommend age-based cutoffs for specific treatments are morally untenable. This is because the same is bereft of any acceptable justification that warrants the judgment that the elderly must have less priority when medical resources are scarce.

CONCLUSION

In conclusion, doctors must not discriminate patients on the basis of age. All lives are equal in moral worth. We argue that governments must promulgate non-discriminatory policies when it comes to medical treatment during a global public health emergency.

Self-Harm in Children and Adolescents Who Presented at Emergency Units During the COVID-19 Pandemic: An International Retrospective Cohort Study

OBJECTIVE

To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations.

METHOD

This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed.

RESULTS

Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58).

CONCLUSION

Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

COVID-19 pandemic-related depression and anxiety under lockdown: The chain mediating effect of self-efficacy and perceived stress

Objective

In early March 2022, the highly contagious Omicron variant rapidly emerged in Shanghai. This study aimed to explore the prevalence and associated factors of depression and anxiety in isolated or quarantined populations under lockdown.

Methods

A cross-sectional study was conducted between May 12 and 25, 2022. The depressive and anxiety symptoms, perceived stress, self-efficacy and perceived social support in the 167 participants under isolated or quarantined were examined using the Patient Health Questionnaires-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Perceived Stress Scale-10 (PSS-10), the General Self-Efficacy Scale (GSES) and the Perceived Social Support Scale (PSSS). Data on demographic information were also collected.

Findings

The prevalence of depression and anxiety in isolated or quarantined populations was estimated to be 12 and 10.8%, respectively. Higher education level, being healthcare workers, being infected, longer duration of segregation and higher perceived stress level were identified as risk factors for depression and anxiety. Furthermore, the relationship between perceived social support and depression (anxiety) was mediated not only by perceived stress but also the chain of self-efficacy and perceived stress.

Conclusion

Being infected, higher education level, longer duration of segregation and higher perceived stress were associated with higher levels of depression and anxiety among isolated or quarantined populations under lockdown. The formulation of psychological strategies that promote one's perceived social support and self-efficacy as well as reduce perceived stress is supposed to be drawn.

Unveiling the paths of COVID-19 in a large city based on public transportation data

Human mobility plays a key role in the dissemination of infectious diseases around the world. However, the complexity introduced by commuting patterns in the daily life of cities makes such a role unclear, especially at the intracity scale. Here, we propose a multiplex network fed with 9 months of mobility data with more than 107 million public bus validations in order to understand the relation between urban mobility and the spreading of COVID-19 within a large city, namely, Fortaleza in the northeast of Brazil. Our results suggest that the shortest bus rides in Fortaleza, measured in the number of daily rides among all neighborhoods, decreased [Formula: see text]% more than the longest ones after an epidemic wave. Such a result is the opposite of what has been observed at the intercity scale. We also find that mobility changes among the neighborhoods are synchronous and geographically homogeneous. Furthermore, we find that the most central neighborhoods in mobility are the first targets for infectious disease outbreaks, which is quantified here in terms of the positive linear relation between the disease arrival time and the average of the closeness centrality ranking. These central neighborhoods are also the top neighborhoods in the number of reported cases at the end of an epidemic wave as indicated by the exponential decay behavior of the disease arrival time in relation to the number of accumulated reported cases with decay constant [Formula: see text] days. We believe that these results can help in the development of new strategies to impose restriction measures in the cities guiding decision-makers with smart actions in public health policies, as well as supporting future research on urban mobility and epidemiology.

The Impact of COVID-19 Regulations on Adherence to Recombinant Human Growth Hormone Therapy: Evidence from Real-World Data

Worldwide regulations during COVID-19 positively and negatively impacted self-management in paediatric patients with chronic medical conditions. We investigated the impact of regulations on adherence to recombinant human growth hormone (r-hGH) therapy in paediatric patients with growth disorders, using real-world adherence data extracted March 2019–February 2020 (before COVID-19) and March 2020–February 2021 (during COVID-19) from the easypod™ connect ecosystem. Data from three measures of regulations were analysed: stringency index (SI), school closure and stay-at-home. The mean SI, and the proportion of days with required school closure or stay-at-home during COVID-19 were categorised as high versus medium/low based on the 75th percentile. Adherence was categorised as optimal (≥85%) versus suboptimal (<85%). Adherence data were available for 8915 patients before and 7606 patients during COVID-19. A high SI (mean ≥68) and a high proportion of required school closure (≥88%) resulted in an increase in the proportion of optimal adherence during COVID-19 versus pre-COVID-19 (p < 0.001). Stay-at-home requirements showed no statistically significant effect (p = 0.13). Stringent COVID-19 regulations resulted in improved adherence to r-hGH therapy in patients with growth disorders, supported by connected digital health technologies. Insights into patient behavior during this time are useful to understand potential influences and strategies to improve long-term adherence to r-hGH.

Perceived COVID-19 Severity, Risk of Infection, and Prevention Self-Efficacy in Saudi Arabia During Lockdown: A Population-Based National Study

Evidence shows that the risk perception of humans can significantly affect their response to a threat. This population-based, cross-sectional study explored the determinants of perceived disease seriousness, perceived disease infectiveness, and perceived prevention self-efficacy of coronavirus disease (COVID-19), during the lockdown period, using the health belief model for preventive behavior (HBMPB) among 4423 adults in Saudi Arabia from 13 provinces. Multivariate binary regression was used to analyze the independent factors of three risk perception variables and to measure their effect on adherence to preventive measures. Overall, COVID-19 seriousness was perceived to be higher than that of diabetes and lower than that of a heart attack, while its infectiousness was perceived to be high by 75.3% of the participants. Furthermore, 66.6% had a low perception of their prevention self-efficacy. The HBMPB showed independent effects of all three risk perception parameters on adherence to the preventive measures, including perceived seriousness (Odd's ratio [OR] = 1.26; 95% confidence interval [95% CI] = 1.01-1.56), infectiousness (OR = 1.90; 95% CI = 1.52-2.38), and prevention self-efficacy (OR = 1.51; 95% CI = 1.20-1.91). Authorities should maintain an optimal level of communication on the COVID-19 risk, communicate more about the virus' cycle and the disease to demystify the rationale of the preventive measures, and enhance confidence in their efficiency.

Simulating exposure-related human mobility behavior at the neighborhood-level under COVID-19 in Porto Alegre, Brazil

Modeling experts have been continually researching the interplay of human mobility and COVID-19 transmission since the outbreak of the pandemic. They tried to address this problem and support the control of the pandemic spreading at the national or regional levels. However, these modeling approaches had little success in producing empirically verifiable results at the neighborhood level due to a lack of data and limited representation of low spatial scales in the models. To fill this gap, this research aims to present an agent-based model to simulate human mobility choices in the context of COVID-19, based on social activities of individuals in the neighborhood. We apply the VIABLE model to the decision-making process of heterogeneous agents, who populate the system's environment. The agents adapt their mobility and activities autonomously at each iteration to improve their well-being and respond to exposure risks. The study reveals significant temporal variations in mobility choices between the groups of agents with different vulnerability levels under the Covid-19 pandemic. Agents from the same group with similar economic backgrounds tend to select the same mobility patterns and activities leading to segregation at this low scale. We calibrated the model with a focus on Porto Alegre in Brazil.

Quantifying human mobility resilience to the COVID-19 pandemic: A case study of Beijing, China

Human mobility, as a fundamental requirement of everyday life, has been most directly impacted during the COVID-19 pandemic. Existing studies have revealed its ensuing changes. However, its resilience, which is defined as people's ability to resist such impact and maintain their normal mobility, still remains unclear. Such resilience reveals people's response capabilities to the pandemic and quantifying it can help us better understand the interplay between them. Herein, we introduced an integrated framework to quantify the resilience of human mobility to COVID-19 based on its change process. Taking Beijing as a case study, the resilience of different mobility characteristics among different population groups, and under different waves of COVID-19, were compared. Overall, the mobility range and diversity were found to be less resilient than decisions on whether to move. Females consistently exhibited lower resilience than males; middle-aged people exhibited the lowest resilience under the first wave of COVID-19 while older adult's resilience became the lowest during the COVID-19 rebound. With the refinement of pandemic-control measures, human mobility resilience was enhanced. These findings reveal heterogeneities and variations in people's response capabilities to the pandemic, which can help formulate targeted and flexible policies, and thereby promote sustainable and resilient urban management.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review

BACKGROUND

Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes.

METHODS

A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included.

RESULTS

Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes.

CONCLUSIONS

Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

Impact of new dedicated pediatric operating rooms on surgical volume in Africa: Evidence from Nigeria

BACKGROUND

There is a large unmet children's surgical need in low- and middle-income countries (LMICs). This study examines the impact of installing dedicated pediatric operating rooms (ORs) on surgical volume at National Hospital Abuja, a hospital in Abuja, Nigeria.

METHODS

A Non-Governmental Organization installed two pediatric ORs in August 2019. We assessed changes in volume from July 2018 to September 2021 using interrupted time series analysis.

RESULTS

Total surgical volume increased by 13 cases (p = 0.01) in 1-month post-installation, with elective operations making up 85% (p = 0.02) of cases. There was an increase in elective volume by about 1 case per month (p = 0.01) post-installation and the difference between pre-and post-trends was 1.23 cases per month (p = 0.009). The baseline volume of neonatal surgeries increased by 9 cases per month (p < 0.001) post-installation and this difference between pre- and post-trends was statistically significant (p = 0.001). Similarly, one-month post-installation, the cases classified as ASA class >2 increased by 14 (p < 0.001). There was no significant difference between pre-and post-installation mortality rate at about 2% per month.

CONCLUSIONS

There were significant changes in surgical volume after OR installation, primarily composed of elective operations, reflecting an increased capacity to address surgical backlogs and/or perform more specialized surgeries. Despite a significant increase in volume and higher ASA class, there was no significant difference in mortality. This study supports the installation of surgical infrastructure in LMICs to strengthen capacity without increasing postoperative mortality.

COVID-19 lockdowns and children's health and well-being

This paper studies the health and well-being of children during the COVID-19 lockdowns in a developing country context. Using surveys for low-income households in rural areas of Pakistan, we find that lockdowns are associated with worsened health and well-being of children. Exploring potential economic and noneconomic mechanisms behind this negative association, we find that children participating in the labor market due to extreme poverty suffer the worst impact from lockdowns. These results call for policies that target resources towards households where children's participation in the labor market is more likely since leaving vulnerable children behind will have a lasting economic impact for developing economies.

Exploring the relationship between national governance indicators and speed of initial government response to COVID-19 in low- and middle-income countries

Objectives

This study aimed to explore the relationship between national governance and country response to the COVID-19 pandemic in low- and middle-income countries, to support preparedness for the next pandemic. We conducted a statistical analysis of 116 countries, examining the relationship between speed of initial response and measures of national governance.

Study design

Observational study, with individual countries as the unit of analysis.

Methods

We used logistic regression to look for associations between quicker initial government response and four national governance indicators: Government Effectiveness, Political Stability and Absence of Violence/Terrorism, Voice and Accountability, and Corruption Perceptions Index.

Results

A quicker initial government response was associated with countries with higher Government Effectiveness (OR 13.92 95% CI 3.69-52.48, p < 0.001) and lower Political Stability and Absence of Violence/Terrorism (OR 0.23, 95% CI 0.09-0.57, p = 0.002). There was no relationship observed between speed of initial government response and Voice and Accountability or Corruption Perceptions Index. Other factors associated with quicker initial response were small population size, experiencing first COVID-19 case after the pandemic declaration, not having previous experience with SARS-CoV1 or MERS and not being an island nation.

Conclusions

This study shows that having higher state policy and implementation capacity, and lower political stability was associated with a quicker initial pandemic response. Limitations of this study include the use of crude national level indicators and broad categorisations of countries into quicker and slower responders. Deeper enquiry into the early decision-making processes taken at the national executive level within individual countries may help clarify the observed associations further.

Challenges and difficulties faced in low- and middle-income countries during COVID-19

Objectives

The ongoing COVID-19 pandemic, caused by a novel coronavirus SARS-CoV-2, has created a severe threat to global human health. We are extremely lucky because within the first year of the COVID-19 pandemic, scientists developed a number of vaccines against COVID-19. In this paper, the authors discuss the difficulties and challenges faced in different low-and middle-income countries due to the ongoing pandemic.

Study design and methods

This research is primarily based on secondary data and existing literature reviews. The authors use maps and graphical representations to show information about vaccination coverage.

Results

The lacking vaccination coverage and insufficient supply of oxygen tanks in hospitals of low- and middle-income countries (LMICs) raise the likelihood of death of the critical COVID-19 patients. Developed countries vaccinate their citizens more quickly than LMICs. In comparison to wealthy countries, LMICs usually lack the resources and capacity to obtain the required vaccination doses.

Conclusion

It is frequently observed that hospitals in low- and middle-income nations with a dearth of oxygen tanks result in increased suffering and mortality. To avoid a worldwide disaster, LMICs urgently require COVID-19 vaccinations since viruses have no borders, and no one is safe until every one is protected in our interconnected world. Therefore, more national and international collaborative supports are urgently necessary for LMICs in this regard.

COVID-19 trends, public restrictions policies and vaccination status by economic ranking of countries: a longitudinal study from 110 countries

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has transitioned to a third phase and many variants have been originated. There has been millions of lives loss as well as billions in economic loss. The morbidity and mortality for COVID-19 varies by country. There were different preventive approaches and public restrictions policies have been applied to control the COVID-19 impacts and usually measured by Stringency Index. This study aimed to explore the COVID-19 trend, public restriction policies and vaccination status with economic ranking of countries.

METHODS

We received open access data from Our World in Data. Data from 210 countries were available. Countries (n = 110) data related to testing, which is a key variable in the present study, were included for the analysis and remaining 100 countries were excluded due to incomplete data. The analysis period was set between January 22, 2020 (when COVID-19 was first officially reported) and December 28, 2021. All analyses were stratified by year and the World Bank income group. To analyze the associations among the major variables, we used a longitudinal fixed-effects model.

RESULTS

Out of the 110 countries included in our analysis, there were 9 (8.18%), 25 (22.72%), 31 (28.18%), and 45 (40.90%) countries from low income countries (LIC), low and middle income countries (LMIC), upper middle income countries (UMIC) and high income countries (HIC) respectively. New case per million was similar in LMIC, UMIC and HIC but lower in LIC. The number of new COVID-19 test were reduced in HIC and LMIC but similar in UMIC and LIC. Stringency Index was negligible in LIC and similar in LMIC, UMIC and HIC. New positivity rate increased in LMIC and UMIC. The daily incidence rate was positively correlated with the daily mortality rate in both 2020 and 2021. In 2020, Stringency Index was positive in LIC and HIC but a negative association in LMIC and in 2021 there was a positive association between UMIC and HIC. Vaccination coverage did not appear to change with mortality in 2021.

CONCLUSION

New COVID-19 cases, tests, vaccinations, positivity rates, and Stringency indices were low in LIC and highest in UMIC. Our findings suggest that the available resources of COVID-19 pandemic would be allocated by need of countries; LIC and UMIC.

Impact of the COVID-19 on the Health System and Healthcare Workers: A Systematic Review

Context: The coronavirus disease 2019 (COVID-19) pandemic has affected all sectors of life. The health system and healthcare workers also have been affected by the COVID-19 pandemic. Healthcare workers (HCWs) have faced major challenges in working in the hospitals due to COVID-19 pandemic. There is a need to provide evidence regarding challenges to working during the COVID-19 pandemic, specifically in developing countries. Objectives: The objective of this study was to evaluate the effect of the COVID-19 pandemic on health professionals and the health system. Methods: Ten studies conducted from January 1, 2020, to December 31, 2021were included in this review. Common search terms were impact, health, healthcare, providers, abuses, burden, and system. Different databases, such as Scopus, Web of Science, PubMed, and Google Scholar, were used. Data extraction was performed following the PRISMA recommendations. Results: The results of the systematic review showed that the hospitalization rate and numbers of out-patients have increased, leading to imposing a burden on the health system and healthcare workers (HCWs). A serious type of disease may need hospitalization and ventilatory support. The quality of healthcare institutions is unique and complex. HCWs, in their routine activities, face diverse challenges. The unexpected development of the COVID-19 pandemic was a great challenge faced by the health system and health professionals. Conclusions: The pandemic has altered the healthcare system and healthcare practice with innovative workplaces and social challenges confronted by the HCWs.

Developmental Origins of Health and Disease, resilience and social justice in the COVID era

The COVID-19 pandemic has shone a spotlight on how health outcomes are unequally distributed among different population groups, with disadvantaged communities and individuals being disproportionality affected in terms of infection, morbidity and mortality, as well as vaccine access. Recently, there has been considerable debate about how social disadvantage and inequality intersect with developmental processes to result in a heightened susceptibility to environmental stressors, economic shocks and large-scale health emergencies. We argue that DOHaD Society members can make important contributions to addressing issues of inequality and improving community resilience in response to COVID-19. In order to do so, it is beneficial to engage with and adopt a social justice framework. We detail how DOHaD can align its research and policy recommendations with a social justice perspective to ensure that we contribute to improving the health of present and future generations in an equitable and socially just way.

Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has intensified the urgency in addressing pressing global health access challenges and has also laid bare the pervasive structural and systemic inequities that make certain segments of society more vulnerable to the tragic consequences of the disease. This rapid systematic review analyses the barriers to COVID-19 health products in low-and middle-income countries (LMICs). It does so from the canon of global health equity and access to medicines by proposing an access to health products in low-and middle-income countries framework and typology adapted to underscore the complex interactive and multiplicative nature and effects of barriers to health products and their root cause as they coexist across different levels of society in LMICs.

Methods

Modified versions of the Joanna Briggs Institute (JBI) reviewers' manual for evidence synthesis of systematic reviews and the PRISMA-ScR framework were used to guide the search strategy, identification, and screening of biomedical, social science, and gray literature published in English between 1 January 2020 and 30 April 2021.

Results

The initial search resulted in 5,956 articles, with 72 articles included in this review after screening protocol and inclusion criteria were applied. Thirty one percent of the articles focused on Africa. The review revealed that barriers to COVID-19 health products were commonly caused by market forces (64%), the unavailability (53%), inaccessibility (42%), and unaffordability (35%), of the products, incongruent donors' agenda and funding (33%) and unreliable health and supply systems (28%). They commonly existed at the international and regional (79%), health sectoral (46%), and national cross-sectoral [public policy] (19%) levels. The historical heritage of colonialism in LMICs was a commonly attributed root cause of the barriers to COVID-19 health products in developing countries.

Conclusion

This review has outlined and elaborated on the various barriers to health products that must be comprehensively addressed to mount a successful global, regional, national and subnational response to present and future epidemics and pandemics in LMICs.

Measuring global pandemic governance: how countries respond to COVID-19

Covid-19 is an unprecedented crisis that faces the majority of governments around the world. The pandemic has resulted in substantial changes to government work cultures, financial management, and the implementation of good governance. The paper has shown how these governments react to the crisis caused by Covid-19. We analyse strategy, policy, and financial management when facing Covid-19 and give a result that will contribute to the development of crisis governance field. In this article, we argue that the most successful action in response to the COVID-19 pandemic in high income, upper-middle income, and lower-middle income countries is guided by the implementation of good governance principles. Data used in this research was obtained from the World Health Organization and the World Bank. The results indicate that countries that have been able to manage the COVID-19 pandemic have good governance indicators, such as voice and accountability, political stability and absence of violence/terrorism, government effectiveness, regulatory quality, rule of law, and control of corruption.

Policy responses to the COVID-19 pandemic in the Manitoba grocery sector: a qualitative analysis of media, organizational communications, and key informant interviews

OBJECTIVES

The COVID-19 pandemic has impacted all aspects of the food system, including the retail grocery sector. We sought to (objective 1) document and (objective 2) analyze the policies implemented in the grocery sector during the first wave of the pandemic in Manitoba, Canada.

METHODS

Our qualitative policy analysis draws from organizational communications (websites and social media) (n = 79), news media articles (n = 95), and key informant interviews with individuals (n = 8) working within the grocery sector in urban and rural, Manitoba. Media and communications were extracted between March 9-May 8, 2020 and interviews were conducted in July-August, 2020.

RESULTS

Newly implemented policies due to the pandemic fell under four inter-related themes: Employee health and wellbeing, Safety measures, Operational measures, and Community support. Employee health and wellbeing included sub-themes of financial and social support, health recommendations and protocols, and new employee guidelines. Safety measures encompassed numerous policies pertaining to sanitation, personal protection, transmission prevention, physical distancing, and limiting access. Overall, new policies were discussed as effective in making grocery shopping as safe as possible given the situation. Compliance and enforcement, employee teamwork, and support for employees were key themes related to perceptions of policy success in a challenging and inequitable context. Nevertheless, government support and communication was needed as well to ensure safety within the grocery sector.

CONCLUSIONS

The grocery sector reacted to the pandemic with the swift implementation of policies to address food supply issues, prevent transmission of the virus, support their employees as essential workers, and better serve high-risk populations.

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May-July 2021

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6–31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others.

Challenges to evidence-informed decision-making in the context of pandemics: qualitative study of COVID-19 policy advisor perspectives

INTRODUCTION

The exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mitigate challenges associated with insufficient, evolving and/or conflicting evidence to inform public health decision-making.

OBJECTIVES

To explore critically the challenges for advising evidence-informed decision-making (EIDM) in pandemic contexts, particularly around non-pharmaceutical control measures, from the perspective of experts advising policy-makers during COVID-19 globally.

METHODS

We conducted in-depth qualitative interviews with 27 scientific experts and advisors who are/were engaged in COVID-19 EIDM representing four WHO regions and 11 countries (Australia, Canada, Colombia, Denmark, Ghana, Hong Kong, Nigeria, Sweden, Uganda, UK, USA) from December 2020 to May 2021. Participants informed decision-making at various and multiple levels of governance, including local/city (n=3), state/provincial (n=8), federal or national (n=20), regional or international (n=3) and university-level advising (n=3). Following each interview, we conducted member checks with participants and thematically analysed interview data using NVivo for Mac software.

RESULTS

Findings from this study indicate multiple overarching challenges to pandemic EIDM specific to interpretation and translation of evidence, including the speed and influx of new, evolving, and conflicting evidence; concerns about scientific integrity and misinterpretation of evidence; the limited capacity to assess and produce evidence, and adapting evidence from other contexts; multiple forms of evidence and perspectives needed for EIDM; the need to make decisions quickly and under conditions of uncertainty; and a lack of transparency in how decisions are made and applied.

CONCLUSIONS

Findings suggest the urgent need for global EIDM guidance that countries can adapt for in-country decisions as well as coordinated global response to future pandemics.

Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis

Background

The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals.

Methods

Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis.

Results

6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI − 196 to − 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001).

Conclusions

During the COVID-19 pandemic, children’s surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00268-022-06503-2.

The challenges of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing in low-middle income countries and possible cost-effective measures in resource-limited settings

Diagnostic testing for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains a challenge around the world, especially in low-middle-income countries (LMICs) with poor socio-economic backgrounds. From the beginning of the pandemic in December 2019 to August 2021, a total of approximately 3.4 billion tests were performed globally. The majority of these tests were restricted to high income countries. Reagents for diagnostic testing became a premium, LMICs either cannot afford or find manufacturers unwilling to supply them with expensive analytical reagents and equipment. From March to December 2020 obtaining testing kits for SARS-CoV-2 testing was a challenge. As the number of SARS-CoV-2 infection cases increases globally, large-scale testing still remains a challenge in LMICs. The aim of this review paper is to compare the total number and frequencies of SARS-CoV-2 testing in LMICs and high-income countries (HICs) using publicly available data from Worldometer COVID-19, as well as discussing possible interventions and cost-effective measures to increase testing capability in LMICs. In summary, HICs conducted more SARS-CoV-2 testing (USA: 192%, Australia: 146%, Switzerland: 124% and Canada: 113%) compared to middle-income countries (MICs) (Vietnam: 43%, South Africa: 29%, Brazil: 27% and Venezuela: 12%) and low-income countries (LICs) (Bangladesh: 6%, Uganda: 4% and Nigeria: 1%). Some of the cost-effective solutions to counteract the aforementioned problems includes using saliva instead of oropharyngeal or nasopharyngeal swabs, sample pooling, and testing high-priority groups to increase the number of mass testing in LMICs.

A Large-Scale Screening Responding Sporadic Epidemic of COVID-19 in China by an Integrated Health-Care System

Introduction

In the post-pandemic period of COVID-19, the majority of cities in China try to balance the normalization of epidemic prevention and social-economic development. However, the appearance of asymptomatic infected patients poses threats to public health, which might be infectious without clinical symptoms and only be detected by testing approaches.

Methods

Along with the appearance of one symptomatic case, a regional large-scale screening program was carried out in Shenzhen City charged by a regionally integrated healthcare system. After describing the screening program, a retrospective cross-sectional study for the screening outcome and efficacy was conducted.

Discussion

According to the screening results, the asymptomatic case was infectious and their close contacts should be quarantined cautiously as the close contacts of symptomatic cases. Besides, after integrating medical resources in Luohu district of Shenzhen, the medical capability of Luohu district improved greatly which could be demonstrated in inspection and organization abilities in this screening program.

Conclusion

The large-scale screening contributed to preventing epidemic transmission. In the post-pandemic period, regular surveillance of asymptomatic cases and rapid response capability for emergent screening program are both crucial for the prevention and control of COVID-19 epidemic. The integrated healthcare system coordinating regional medical institutions and optimizing regional medical recourse has advantages to address public health emergencies.

A snapshot of the practicality and barriers to COVID-19 interventions: Public health and healthcare workers' perceptions in high and low- and middle-income countries

BACKGROUND

In response to the COVID-19 pandemic, governments have implemented a range of non-pharmaceutical interventions (NPIs) and pharmaceutical interventions (PIs) to reduce transmission and minimise morbidity and mortality, whilst maintaining social and economic activities. The perceptions of public health workers (PHWs) and healthcare workers (HCWs) are essential to inform future COVID-19 strategies as they are viewed as trusted sources and are at the forefront of COVID-19 response. The objectives of this study were to 1) describe the practicality of implementing NPIs and PIs and 2) identify potential barriers to implementation, as perceived by HCWs and PHWs.

METHODS

We conducted a cross-sectional study of PHWs and HCWs perceptions of the implementation, practicality of, and barriers to implementation of NPIs and PIs using an online survey (28/9/2020-1/11/2020) available in English, French and Portuguese. We used descriptive statistics and thematic analysis to analyse quantitative and qualitative responses.

RESULTS

In total, 226 respondents (67 HCWs and 159 PHWs) from 52 countries completed the survey and 222 were included in the final analysis. Participants from low and middle-income countries (LMICs) accounted for 63% of HCWs and 67% of PHWs, with the remaining from high-income (HICs). There was little difference between the perceptions of PHWs and HCWs in HICs and LMICs, with the majority regarding a number of common NPIs as difficult to implement. However, PHWs in HICs perceived restrictions on schools and educational institutions to be more difficult to implement, with a lack of childcare support identified as the main barrier. Additionally, most contact tracing methods were perceived to be more difficult to implement in HICs than LMICs, with a range of barriers reported. A lack of public support was the most commonly reported barrier to NPIs overall across both country income and professional groups. Similarly, public fear of vaccine safety and lack of vaccine supply were the main reported barriers to implementing a COVID-19 vaccine. However, PHWs and HCWs in LMICs perceived a lack of financial support and the vaccine being manufactured in another country as additional barriers.

CONCLUSION

This snapshot provides insight into the difficulty of implementing interventions as perceived by PHWs and HCWs. There is no one-size-fits-all solution to implementing interventions, and barriers in different contexts do vary. Barriers to implementing a vaccine programme expressed here by HCWs and PHCWs have subsequently come to the fore internationally.

Assistive Technology Provider Experiences during the COVID-19 Pandemic

Globally, health systems face challenges in the delivery of assistive technology (AT) and only 10% of people are currently able to access the assistive products they need. The COVID-19 pandemic presented an uncharted path for AT providers to navigate, placing them under pressure to be agile and rapidly adapt. This article, part of a series, explores the experiences and impacts of the COVID-19 pandemic on AT providers and aims to inform how AT providers can be better prepared and supported in the future. A mixed methods approach was used to gather service data and perspectives from AT providers via a survey. A total of 37 responses were received from 18 countries. Service data showed extensive service disruption throughout 2020. Thematic analysis suggested significant changes to routine AT service delivery including rapid momentum towards home-based, decentralised, and digital services for which many AT providers were not prepared. Providers were required to make difficult decisions and deliver services in new ways to balance meeting demands, complying with government restrictions, and ensuring the safety of staff and clients. Few but important positives were expressed including the belief that expanded capacity to use remote and digital AT service delivery would remain useful in the future.

Separable Microneedle Patch to Protect and Deliver DNA Nanovaccines Against COVID-19

The successful control of coronavirus disease 2019 (COVID-19) pandemic is not only relying on the development of vaccines, but also depending on the storage, transportation, and administration of vaccines. Ideally, nucleic acid vaccine should be directly delivered to proper immune cells or tissue (such as lymph nodes). However, current developed vaccines are normally treated through intramuscular injection, where immune cells do not normally reside. Meanwhile, current nucleic acid vaccines must be stored in a frozen state that may hinder their application in developing countries. Here, we report a separable microneedle (SMN) patch to deliver polymer encapsulated spike (or nucleocapsid) protein encoding DNA vaccines and immune adjuvant for efficient immunization. Compared with intramuscular injection, SMN patch can deliver nanovaccines into intradermal for inducing potent and durable adaptive immunity. IFN-γ+CD4/8+ and IL-2+CD4/8+ T cells or virus specific IgG are significantly increased after vaccination. Moreover, in vivo results show the SMN patches can be stored at room temperature for at least 30 days without decreases in immune responses. These features of nanovaccines-laden SMN patch are important for developing advanced COVID-19 vaccines with global accessibility.

De-escalation strategies for non-pharmaceutical interventions following infectious disease outbreaks: a rapid review and a proposed dynamic de-escalation framework

BACKGROUND

The severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates de-escalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally.

METHODS

We reviewed literature published since 2000 relating to pandemics and infectious disease outbreaks. The searches included Embase.com (includes Embase and Medline), LitCovid, grey literature searching, reference harvesting and citation tracking. Over 1,700 documents were reviewed, with 39 documents reporting de-escalation criteria included in the final analysis. Concepts retrieved through a thematic analysis of the included documents were interlinked to build a conceptual dynamic de-escalation framework.

RESULTS

We identified 52 de-escalation criteria, the most common of which were clustered under surveillance (cited by 43 documents, 10 criteria e.g. ability to actively monitor confirmed cases and contact tracing), health system capacity (cited by 30 documents, 11 criteria, e.g. ability to treat all patients within normal capacity) and epidemiology (cited by 28 documents, 7 criteria, e.g. number or changes in case numbers). De-escalation is a gradual and bi-directional process, and resurgence of infections or emergence of variants of concerns can lead to partial or full re-escalation(s) of response and control measures in place. Hence, it is crucial to rely on a robust public health surveillance system.

CONCLUSIONS

This rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans.

Exploring health workers' experiences of mental health challenges during care of patients with COVID-19 in Uganda: a qualitative study

OBJECTIVES

The aim of this study is to qualitatively investigate the lived experiences of mental health among frontline health workers providing COVID-19-realted care in Uganda. This study provides insights into the contextual realities of the mental health of health workers facing greater challenges given the lack of adequate resources, facilities and health workers to meet the demand brought about by COVID-19.

RESULTS

All in all, our findings suggest that healthcare workers are under enormous stress during this pandemic, however, in order to effectively respond to the COVID-19 pandemic in Uganda, it is important to understand their challenges and sources of these challenges. The government thus has the reasonability to address most of the sources that were highlighted (long working hours, lack of proper equipment, lack of sleep, exhaustion, and experiencing high death rate under their care). Further, the Ugandan social fabric presents an opportunity for coping through its strong communal links and networks. Scaling these forms of local responses is cheap but contextually useful for a country with limited resources like Uganda.

Recommendations for coastal planning and beach management in Caribbean insular states during and after the COVID-19 pandemic

The COVID-19 pandemic has implications for coastal planning and management. Rules for isolation and physical distancing, among other measures for human life protection, have led to the closure of most beaches around the world. The present critical situation has raised the following question: How can some recommendations be designed in sun, sea, and sand tourism-dependent-insular countries to face "the COVID-19 new normality?" We used the content analysis technique to analyze representative publications on a global level to ascertain information on best management practices. A survey of 58 experts provided additional information. We used inferential statistics for sample selection and produced a list of 43 practices and beach planning and management actions to face the COVID-19 pandemic. This led to 27 new recommendations designed for beach planning and management within insular contexts, some of which were tested in the Republic of Cuba. Recommendations aim to guarantee a culture of safety and improvement within the field of beach or coastal planning and management. These recommendations should prove useful for other insular countries, during the COVID-19 period, in the new normality that follows, and in other post-pandemic scenarios.