Effect of easing lockdown and restriction measures on COVID-19 epidemic projection: A case study of Saudi Arabia

Effectiveness of social distancing measures and lockdowns for reducing transmission of COVID-19 in non-healthcare, community-based settings

Social distancing measures (SDMs) are community-level interventions that aim to reduce person-to-person contacts in the community. SDMs were a major part of the responses first to contain, then to mitigate, the spread of SARS-CoV-2 in the community. Common SDMs included limiting the size of gatherings, closing schools and/or workplaces, implementing work-from-home arrangements, or more stringent restrictions such as lockdowns. This systematic review summarized the evidence for the effectiveness of nine SDMs. Almost all of the studies included were observational in nature, which meant that there were intrinsic risks of bias that could have been avoided were conditions randomly assigned to study participants. There were no instances where only one form of SDM had been in place in a particular setting during the study period, making it challenging to estimate the separate effect of each intervention. The more stringent SDMs such as stay-at-home orders, restrictions on mass gatherings and closures were estimated to be most effective at reducing SARS-CoV-2 transmission. Most studies included in this review suggested that combinations of SDMs successfully slowed or even stopped SARS-CoV-2 transmission in the community. However, individual effects and optimal combinations of interventions, as well as the optimal timing for particular measures, require further investigation. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.

Impact of human cooperation on vaccination behaviors

This paper studies a dynamic vaccination game model embedded with vaccine cost-effectiveness and dyadic game during an epidemic, assuming the appearance of cooperation among individuals from an evolutionary perspective. The infection dynamics of the individuals' states follow a modified S/VIS (susceptible/vaccinated-infected-susceptible) dynamics. Initially, we assume that the individuals are unsure about their infection status. Thus, they make decisions regarding their options based on their neighbors' perceptions, the prevalence of the disease, and the characteristics of the available vaccines. We then consider the strategy updating process IBRA (individuals-based risk assessment) concerning an individual's committing vaccination based on a neighbor's decision. In the perspective of social dilemma, it presents the idea of social efficiency deficit to find the gap between social optimum and Nash equilibrium point based on dilemma strength by considering vaccine decision. The cost and cooperative behavior depend on disease severity, neighbor's attitude, and vaccine properties to obtain a reduced-order optimal solution to control infectious diseases. Vaccine factors (efficiency, cost, and benefit) are crucial in changing human vaccine decisions and cooperative behavior. It turns out that, even in the prisoner's dilemma case, where all defection attitude occurs, vaccine uptake (cooperation) increases. Finally, extensive numerical studies were presented that illustrate interesting phenomena and investigate the ultimate extent of the epidemic, vaccination coverage, average social benefits, and the social efficiency deficit concerning optimal strategies and the dynamic vaccine attitudes of individuals. PACS numbers. Theory and modeling; computer simulation, 87.15. Aa; Dynamics of evolution, 87.23. Kg.

Physical Activity and Screen Viewing Behaviors Among Children Aged 6-9 Years During the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic resulted in many restrictions worldwide, including lockdowns and school closures. This may have prevented children from meeting the recommended physical activity (PA) levels and screen time. The aim of this study was to examine the impact of the pandemic on school-age children's PA and screen time in Saudi Arabia.

METHODS

A cross-sectional study where caregivers of children aged 6-9 years living in Saudi Arabia were recruited through convenience sampling to fill out an online survey between July and August 2020. The survey covered demographic information, PAs, and screen time across 3 periods: pre-COVID-19 pandemic, during the COVID-19 lockdown, and the last 7 days preceding the survey during the pandemic where social distancing applied, but no lockdown.

RESULTS

A total of 339 caregivers completed the online survey about their children. The number of active children slightly increased during the lockdown (9.7%) than before COVID-19 and the last days (5.8%); however, the average reported days of PA during the pandemic were fewer than before. The findings indicated that all 3 types of screen time (watch time, screenplay, and device time) were longer during the pandemic (mean [SD]: 9.5 [5.5]) than before the COVID-19 (mean [SD]: 5.8 [5.1]).

CONCLUSION

While the proportion of active children had increased during the lockdown, the COVID-19 pandemic, the COVID-19 pandemic negatively impacted PA days and screen time in school-age children. School-age children in Saudi Arabia were already far from meeting global guidelines even before the pandemic, highlighting this population's need for healthy lifestyle promotion.

Vaccination Intention against COVID-19 among the Unvaccinated in Jordan during the Early Phase of the Vaccination Drive: A Cross-Sectional Survey

Objective: This study assessed the intention and predictors of accepting the corona virus disease 2019 (COVID-19) vaccine in Jordan. Method: A national-level online survey was conducted among adults (≥18 years) in Jordan between June and September 2021. Descriptive analyses were performed to report vaccination intent. In addition, bivariate and multivariate logistic regression analyses were done to evaluate the association between vaccination intent and its predictors. Results: A total of 2307 adults participated. Most of them (83.7%) expressed an intention to receive a COVID-19 vaccine. Their vaccination intention was significantly (p < 0.001) associated with male gender (aOR: 2.6), residence in the Amman region (aOR: 51.8), and no history of COVID-19 infection (aOR: 6.0). In contrast, individuals aged 50-64 years (aOR: 0.2, p < 0.001), Jordanians (aOR: 0.7, p = 0.038), and those with an occupation designated as “other” (unemployed, general workers, housewives) (aOR: 0.2, p < 0.001) were less likely to have a positive vaccination intent. Among the health belief model constructs, perceived future (aOR: 2.8) and present (aOR: 5.0) susceptibility to COVID-19 infection; severity of complications (aOR: 9.9); and benefits (aOR: 100.8) were significantly (p < 0.001) associated with a higher likelihood of having a vaccination intent. On the other hand, individuals who are concerned about the efficacy (aOR: 0.2) and side effects (aOR: 0.2) of the vaccine were less likely to have a positive vaccination intent (p < 0.001). Conclusion: Despite having high rates of intention to receive a COVID-19 vaccine, Jordanians, older adults and housewives, general workers and unemployed individuals were less likely to be vaccinated. These findings highlight that need-based public health campaigns are necessary to ensure maximum COVID-19 vaccination uptake in Jordan.

Analysis of the Complex Network of the Urban Function under the Lockdown of COVID-19: Evidence from Shenzhen in China

In this paper, the complex network of the urban functions in Shenzhen of China under the lockdown of the corona virus disease 2019 (COVID-19) is studied. The location quotient is used to obtain the dominant urban functions of the districts in Shenzhen before and under the lockdown of COVID-19. By using the conditional probability, the interdependencies between the urban functions are proposed to obtain the complex networks of urban functions and their clusters. The relationships between the urban functions, and the overall and cluster characteristics of the urban functions before and under the lockdown of COVID-19 are analyzed based on the complex networks. The mean degree and mean weighted degree of the primary categories of the urban functions are obtained to discuss the classification characteristics of the urban functions before and under the lockdown of COVID-19. Then, the differences and changes of the urban functions before and under the lockdown of COVID-19 are compared, and the corresponding policy implications under the lockdown of COVID-19 are presented. The results show that under the lockdown of COVID-19, the correlation of the urban functions is stronger than that before the lockdown; the common urban functions are more useful and essential, and finance, fine food and medical treatment are important; public service and government departments have the most positive relationship with other urban functions, and finance service has the highest spatial agglomeration distribution trend; and the cluster characteristics of urban functions are more related to people’s livelihood, and the urban functions show incomplete and cannot be operated for long term.

Associations of Clinical Factors and Blood Groups With the Severity of COVID-19 Infection in Makkah City, Saudi Arabia

Context

The possible associations between the different blood groups and clinical factors with COVID-19 infection among patients in Makkah city.

Objective

To investigate the relationship between ABO blood groups and COVID-19 infection in patients who were tested positive and to elucidate the most common ABO blood groups with a higher infectivity of COVID-19 and disease association.

Materials and Methods

This was an observational cross-sectional study that included COVID-19 patients diagnosed with PCR and who were hospitalized in Al-Noor Specialist Hospital (Makkah) during the period between March to November 2020. The ABO and Rhesus blood groups alongside the clinical characteristics were determined and retrieved from medical records and HESN of the Ministry of Health of the Kingdom of Saudi Arabia (KSA).

Results

The overall confirmed COVID-19 cases included in this study were 1,583 patients who underwent positive PCR testing between March and November 2020. The frequencies of blood groups were as follows: group O⁺ (37%), group A⁺ (29.2%), group B⁺ (22.6%), group AB⁺ (5.1%), group O^- (2.8%), group B^- (1.8%), group A^- (1.1%), and group AB^- (0.4%). However, no significant correlations were observed for ABO groups and Rh types with the severity of COVID-19 illness. Conversely, signs and symptoms of respiratory distress syndrome (RDS), pneumonia, and respiratory failure symptoms, alongside a history of diabetes mellitus, hypertension, chronic kidney diseases, and congestive heart failure significantly increased the risk of death from COVID-19 infection. Moreover, the rates of fever, cough, and asthma were markedly lower in the deceased group compared with the recovered group of patients.

Conclusion

The association between the different blood groups with the prevalence and mortality of COVID-19 among infected patients has yet to be elucidated as we found no significant differences in the observed versus expected distribution of ABO phenotypes among the included cases. The prevalence of RDS, pneumonia, and respiratory failure was found higher among hospitalized COVID-19 patients in the deceased group. However, other factors such as fever, cough, and asthma appeared to be more significantly lower than in the recovered group.

Cost-effectiveness of interventions for the prevention and control of COVID-19: Systematic review of 85 modelling studies

Background

We aimed to quantitatively summarise the health economic evaluation evidence of prevention and control programs addressing COVID-19 globally.

Methods

We did a systematic review and meta-analysis to assess the economic and health benefit of interventions for COVID-19. We searched PubMed, Embase, Web of Science, and Cochrane Library of economic evaluation from December 31, 2019, to March 22, 2022, to identify relevant literature. Meta-analyses were done using random-effects models to estimate pooled incremental net benefit (INB). Heterogeneity was assessed using I2 statistics and publication bias was assessed by Egger's test. This study is registered with PROSPERO, CRD42021267475.

Results

Of 16 860 studies identified, 85 articles were included in the systematic review, and 25 articles (10 studies about non-pharmacological interventions (NPIs), five studies about vaccinations and 10 studies about treatments) were included in the meta-analysis. The pooled INB of NPIs, vaccinations, and treatments were $1378.10 (95% CI = $1079.62, $1676.59), $254.80 (95% CI = $169.84, $339.77) and $4115.11 (95% CI = $1631.09, $6599.14), respectively. Sensitivity analyses showed similar findings.

Conclusions

NPIs, vaccinations, and treatments are all cost-effective in combating the COVID-19 pandemic. However, evidence was mostly from high-income and middle-income countries. Further studies from lower-income countries are needed.

Perceived stress and resilience levels during the COVID-19 pandemic among critical care nurses in Saudi Arabia: a correlational cross-sectional study

Background

The continuous spreading of the respiratory coronavirus disease, COVID-19, has been a threat to global health, especially among those fighting directly against it. Nurses who work in critical care have reported very high levels of stress during these extreme circumstances. It is very important to measure the level of stress and resilience among these nurses in order to diminish further psychological distress. This study aims to assess the levels of perceived stress and resilience among critical care nurses.

Methodology

In this correlational cross-sectional study, critical care nurses (n = 139) were recruited by gatekeepers in a governmental university hospital in Riyadh City between 12 March and 8 April 2021 to complete an online questionnaire. The measurement tools used in this study were the Connor-Davidson Resilience Scale 10 (CD-RISC-10) and the Perceived Stress Scale of COVID-19 (PSS-10 items). Data were analyzed using a descriptive and inferential analysis to calculate frequencies to determine the distribution of stress and resilience, and multiple regression was applied to assess the relationship between them.

Results

One hundred and thirty-nine critical care nurse (64%) responded. The perceived levels of stress reported were: no stress (8%; n = 12), mild stress (14%; n = 21), moderate stress (38%; n = 55), high stress (22%; n = 32), and severe stress (18%; n = 26). The levels of resilience reported were: very low (8%; n = 11), low (18%; n = 26), moderate (42%; n = 62), and high (32%; n = 47). The level of stress and resilience reported by the majority of critical care nurses was moderate; there was no significant correlation between COVID-19-related stress and resilience among the critical care nurses. Severe levels of stress were mostly reported among critical care nurses working in the NICU and high levels of stress were reported among those working in the emergency department. The nurses reported being highly confident that they were able to handle personal epidemic related problems with a mean score of 2.36. This reflects having a high level of resilience (42%; n = 62) and was significantly associated with years of experience as a nurse (p < 0.0027).

Conclusion

Although COVID-19 cases had declined significantly during the study period in Saudi Arabia, the majority of nurses were still experiencing moderate to high levels of stress about the epidemic, but were, at the same time, moderately resilient. Continued monitoring of the stress levels of this high-risk group is highly essential. Conducting more research is needed to measure the effectiveness of psychosocial support interventions.

Evidence from Thailand on Easing COVID-19’s International Travel Restrictions: An Impact on Economic Production, Household Income, and Sustainable Tourism Development

Even though international travel restrictions are being used to keep the COVID-19 pandemic under control, these measures cannot be considered as long-term solutions to the ongoing crisis. Limitations on traveling activities have tremendous adverse consequences on a country’s economy, particularly leading in radically expanding economic downturn and a shrinking tourism industry. To overcome this hardship, several countries have eased COVID-19 travel restrictions. However, there are still questions concerning the benefit to society as the impact assessment of this implementation transmitting to an economy has not been explicitly investigated. In response to this, we aim to assess the impacts of this implementation as to provide a guideline to global countries for their future adoption. By calculating the output and household income multipliers from the tourism input–output table, this study utilizes a case study from Thailand to indicate that prolonging the full mobility restrictions of international tourists, which results in a yearly loss of revenue in Thai tourism industry, would cost country production up to 144.97 billion USD and up to 45.4 billion USD for loss of household income. When international travel limitations were relaxed, production and household damage would fall to 142.24 billion USD (+1.88%) and 44.7 billion USD (+1.54%), respectively. At individual sectors level, our calculation identified that the most damage of production activities would exist in public utility, agriculture, and food manufacturing sectors. In the perspective of household income, those in the agricultural sector would have greatest impact. This impact results from the Thai tourism industry positioned as a buyer in an economy, having most impact on sectors selling their products or inputs to the tourism industry. As suggested by the input–output multipliers, we emphasize that strengthening the resilience of tourism-related sectors and reforming the tourism industry in relation to potential consumption and production patterns are critical for sustainable tourism development.

Transmission dynamics and mutational prevalence of the novel SARS‐CoV‐2 Omicron Variant of Concern

The novel Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) variant, Omicron (PANGO lineage B.1.1.529) is being reported from all around the world. The WHO has categorized Omicron as a Variant of Concern (VOC) considering its higher transmissibility and infectivity, vaccine breakthrough cases. As of January 6, 2022, Omicron has been reported in at least 149 countries. Therefore, this study was planned to investigate the transmission dynamics and mutational prevalence of the novel SARS‐CoV‐2 Omicron variant. The transmission dynamics and Omicron SARS‐CoV‐2 divergence was studied using GISAID and Nextstrain which provides information about the genetic sequences, epidemiological, geographical, and species‐specific data of human, avian, and animal viruses. Further, the mutation prevalence in spike glycoprotein of Omicron was studied, and the frequency of the crucial mutations was compared with the other prevalent VOCs. The transmission dynamics suggest that the Omicron was first identified in South Africa and then it was reported in the United Kingdom followed by the United States and Australia. Further, our phylogenetic analysis suggests that Omicron (BA.1) was clustered distinctly from the other VOCs. In the Spike glycoprotein, the Omicron (B.1.1.529) demonstrates critical 32 amino acid changes. This study may help us to understand mutational hotspots, transmission dynamics, phylogenetic divergence, effect on testing and immunity, which shall promote the progress of the clinical application and basic research.

First report showing the transmissibility of the novel sSevere acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) Omicron (B.1.1.529) Variant of Concern.

Transmission dynamics analysis suggests that Omicron is more transmissible than other Variant of Concerns (VOCs).

Omicron (BA.1) is clustered distinctly from the other VOCs in a monophyletic clade.

The K417N, N440K, and G446S are the less prevalent mutations identified in the RBD of the Omicron SARS‐CoV‐2.

Did the National Lockdown in Saudi Arabia Reduce Lower Respiratory Illnesses in Children?

Objectives: This study aims to explore the effect of lockdown and early precautionary measures implemented in Saudi Arabia on number of pediatric hospitalizations due to lower respiratory illnesses (bronchiolitis, asthma, and pneumonia). Methods: This is a retrospective cross-sectional study aims to review patients from four major hospitals in Saudi Arabia. All pediatric hospitalizations secondary to asthma, bronchiolitis, and pneumonia during the months of the lockdown (March, April, and May) in 2020 were documented. Then, they were compared to the previous 2 years. Variables like number of hospitalizations, oxygen requirement, mechanical ventilation, admission to the intensive care unit (ICU), length of stay, and results of viral studies were collected. Results: We included 1,003 children from four different centers. Males were slightly higher than females (55.8% vs. 44.2%). Total number of hospitalizations in 2020 was 201, significantly lower than 399 and 403 hospitalizations in 2019 and 2018, respectively (P < 0.01). The major drop happened on the months of April and May. Although bronchiolitis hospitalizations' dropped by more than half in 2020 compared to the previous 2 years, it was not statistically significant (P = 0.07). But, asthma hospitalizations were significantly less in 2020 compared to the previous 2 years (49-65% reduction, P = 0.003). Number of pneumonia cases were lowered in 2020 compared to the previous 2 years. However, proportion of pneumonia diagnosis to total hospitalizations increased in 2020 (55% compared to 50% and 35%). There was a surge of viral testing during a period of uncertainty in the early phase of the pandemic. This total reduction in hospitalization was not associated with higher oxygen requirements, mechanical ventilation, ICU admissions or longer hospital stay. Conclusions: Lockdown and precautionary measures executed during the early phase of COVID-19 pandemic helped decrease the number of hospitalizations due to lower respiratory illnesses in Saudi Arabia. Reduction in hospitalizations seems less likely to be secondary to hospital avoidance or delayed presentations as number of ICU admission and oxygen requirements did not increase. The post pandemic pattern of respiratory illnesses among children needs further research.