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Artna E, Abi-Jaoudé A, Sockalingam S, Perry C, Johnson A, Wun C, Kozloff N, Henderson J, Levinson A, Buchman DZ. Understanding attitudes and beliefs regarding COVID-19 vaccines among transitional-aged youth with mental health concerns: a youth-led qualitative study. BMJ Open 2024; 14:e080707. [PMID: 38238177 PMCID: PMC10806589 DOI: 10.1136/bmjopen-2023-080707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Transitional-aged youth (16-29 years) with mental health concerns have experienced a disproportionate burden of the COVID-19 pandemic. Vaccination is limited in this population; however, determinants of its vaccine hesitancy are not yet thoroughly characterised. OBJECTIVES This study aimed to answer the following research question: What are the beliefs and attitudes of youth with mental illness about COVID-19 vaccines, and how do these perspectives affect vaccine acceptance? The study aims to generate findings to inform the development of vaccine resources specific to youth with mental health concerns. METHODS A qualitative methodology with a youth engagement focus was used to conduct in-depth semistructured interviews with transitional-aged youth aged 16-29 years with one or more self-reported mental health diagnoses or concerns. Mental health concerns encompassed a wide range of symptoms and diagnoses, including mood disorders, anxiety disorders, neurodevelopmental disorders and personality disorders. Participants were recruited from seven main mental health clinical and support networks across Canada. Transcripts from 46 youth and 6 family member interviews were analysed using thematic analysis. RESULTS Two major themes were generated: (1) factors affecting trust in COVID-19 vaccines and (2) mental health influences and safety considerations in vaccine decision-making. Subthemes included trust in vaccines, trust in healthcare providers, trust in government and mistreatment towards racialised populations, and direct and indirect influences of mental health. CONCLUSIONS Our analysis suggests how lived experiences of mental illness affected vaccine decision-making and related factors that can be targeted to increase vaccine uptake. Our findings provide new insights into vaccine attitudes among youth with mental health concerns, which is highly relevant to ongoing vaccination efforts for new COVID-19 strains as well as other transmissible diseases and future pandemics. Next steps include cocreating youth-specific public health and clinical resources to encourage vaccination in this population.
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Affiliation(s)
- Erin Artna
- University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Alexxa Abi-Jaoudé
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Claire Perry
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrew Johnson
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charlotte Wun
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jo Henderson
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrea Levinson
- Health & Wellness Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Palermo S, Stanziano M, Nigri A, Civilotti C, Celeghin A. Parkinson's Disease, SARS-CoV-2, and Frailty: Is There a Vicious Cycle Related to Hypovitaminosis D? Brain Sci 2023; 13:brainsci13040528. [PMID: 37190492 DOI: 10.3390/brainsci13040528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 05/17/2023] Open
Abstract
The literature has long established the association between aging and frailty, with emerging evidence pointing to a relationship between frailty and SARS-CoV-2 contagion. The possible neurological consequences of SARS-CoV-2 infection, associated with physical and cognitive frailty, could lead to a worsening of Parkinson's disease (PD) in infected patients or-more rarely-to an increase in the Parkinsonian symptomatology. A possible link between those clinical pictures could be identified in vitamin D deficiency, while the whole process would appear to be associated with alterations in the microbiota-intestine-brain axis that fall within the α-Synuclein Origin site and Connectome (SOC) model, and allow for the identification of a body-first PD and a brain-first PD. The model of care for this condition must consider intrinsic and extrinsic variables so that care by a multidisciplinary team can be successfully predicted. A multidimensional screening protocol specifically designed to identify people at risk or in the early stages of the disease should begin with the investigation of indices of frailty and microbiota-intestine-brain axis alterations, with a new focus on cases of hypovitaminosis D.
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Affiliation(s)
- Sara Palermo
- Department of Psychology, University of Turin, 10124 Turin, Italy
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Neurosciences Department "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy
| | - Anna Nigri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | | | - Alessia Celeghin
- Department of Psychology, University of Turin, 10124 Turin, Italy
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Rodríguez-Avial I, García-Salguero C, Bermejo L, Teja J, Pérez-Cecilia E, Delgado-Iribarren A, Vigara M, Gil P, Culebras E. Evolution of antibody titers after two doses of mRNA Pfizer-BioNTech vaccine and effect of the third dose in nursing home residents. PLoS One 2023; 18:e0282388. [PMID: 36888608 PMCID: PMC9994681 DOI: 10.1371/journal.pone.0282388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES We evaluated the IgG antibody titer against SARS-CoV-2 in 196 residents of a Spanish nursing home after the second dose of the BNT162b2 vaccine and the evolution of this titer over time. The role of the third dose of the vaccine on immune-response is also analysed in 115 of participants. METHODS Vaccine response was evaluated 1, 3 and 6 months after second dose of Pfizer-BioNTech COVID-19 Vaccine and 30 days after booster vaccination. Total anti-RBD (receptor binding domain) IgG immunoglobulins were measured to assess response. Six month after the second dose of vaccine and previously to the booster, T-cell response was also measured in 24 resident with different antibody levels. T-spot Discovery SARS-CoV-2 kit was used to identify cellular immunogenicity. RESULTS As high as 99% of residents demonstrated a positive serological response after second dose. Only two patients showed no serologic response, two men without records of previous SARS-CoV-2 infection. A higher immune response was associated with prior SARS-CoV-2 infection regardless of the gender or age. The anti-S IgG titers decreased significantly in almost all the participants (98.5%) after six months of vaccination whatever previous COVID-infection. The third dose of vaccine increased antibody titers in all patients, although initial vaccination values were not restored in the majority of cases. CONCLUSION The main conclusion of the study is that vaccine resulted in good immunogenicity in this vulnerable population. Nevertheless more data are needed on the long-term maintenance of antibody response after booster vaccination.
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Affiliation(s)
- Iciar Rodríguez-Avial
- Department of Clinical Microbiology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | - Laura Bermejo
- Department of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Juan Teja
- R.PP.MM. Gran Residencia, Servicio Regional de Bienestar Social, Consejería de Familia y Asuntos Sociales, Madrid, Spain
| | - Elisa Pérez-Cecilia
- Department of Clinical Microbiology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto Delgado-Iribarren
- Department of Clinical Microbiology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Marta Vigara
- Department of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Pedro Gil
- Department of Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Esther Culebras
- Department of Clinical Microbiology, IML and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- * E-mail:
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Ates Bulut E, Badak SO, Aksoy H, Fadiloglu A, Isik AT. The Awareness and Attitude of Physicians to Older Adult Routine Vaccination Scheme. Clin Interv Aging 2022; 17:1581-1588. [PMID: 36338873 PMCID: PMC9635550 DOI: 10.2147/cia.s382311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Immunization is one of the main components of preventive medicine measures. Influenza, pneumococcal, tetanus, and shingles vaccines are recommended for older adults routinely. This study aimed to show the knowledge and attitudes of the physicians to older adults’ vaccination schemes. Patients and Methods An electronic self-reported questionnaire was sent to physicians between March and July 2021 in Turkey. Sociodemographic characteristics, professional experience, area of expertise, and practice setting of the participants were recorded. As multiple-choice questions; the routinely recommended vaccines, and vaccines suggested in their daily practice before and after the COVID-19 pandemic were enquired. Results A total of 435 participants were included in the study. 43.9% of the patients were primary family physicians, and 36.8% were internists. 63.4% of the participants had reported reviewing the National Vaccination Scheme. 94.5% of the medical doctors indicated that they had recommended any vaccination to their patients. 20.9% of the practitioners could select four or five of the routinely recommended vaccines. Reviewing the National Adult Vaccination Scheme and being an internist were positively related to predicting the recommended vaccines. The recommendation rates of influenza and pneumococcal conjugate (PCV13) were seen at 88% and 78%, respectively. Except for PCV13, recommendation rates of other routine vaccines were decreased after the pandemic. Conclusion Awareness of routine vaccination schedules should be improved among health-care professionals, and reminders for immunization should be provided periodically in each health-care setting.
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Affiliation(s)
- Esra Ates Bulut
- Division of Geriatric Medicine, Department of Internal Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Suade Ozlem Badak
- Division of Rheumatology, Department of Internal Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Huseyin Aksoy
- Department of Family Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Ayse Fadiloglu
- Division of Geriatric Medicine, Department of Internal Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Ahmet Turan Isik
- Division of Geriatric Medicine, Department of Internal Medicine, Dokuz Eylul University, School of Medicine, Izmir, Turkey
- Correspondence: Ahmet Turan Isik, Email ;
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Wu G, Zhang M, Xie X, Zhu Y, Tang H, Zhu X, Liang Y, Chen T, Zhu K, Zhang D, Jiang S, Jiang Z, Ke S. A survey on the safety of the SARS-CoV-2 vaccine among a population with stroke risk in China. Front Med (Lausanne) 2022; 9:859682. [PMID: 36213663 PMCID: PMC9532547 DOI: 10.3389/fmed.2022.859682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe safety of the COVID-19 vaccine in patients at stroke risk is poorly understood.MethodsA survey was conducted on risk factors related to stroke and adverse reactions to vaccines. The participants were divided into low-, medium-, and high-risk groups, according to the stroke risk scorecard recommended by the Stroke Prevention and Control Engineering Committee of the National Health and Family Planning Commission. Factors associated with adverse reactions were analyzed. Reasons for non-vaccination and the aggravation of underlying diseases after vaccination were investigated.Results1747 participants participated (138 unvaccinated) and 36.8, 22.1, 41.1% of the vaccinated participants had low, medium, high risk of stroke, respectively. The incidence of adverse reactions after the first and second injection was 16.6, 13.7%, respectively. There was no difference in the incidence of adverse reactions among different risk groups. Sex, vaccine type, sleep quality, worry of adverse reactions, age, and education level were significantly related to adverse reactions to vaccination. The most popular reason for non-vaccination for medium- or high risk-participants was the aggravation of the existing disease. Only 0.3% of vaccinated participants reported slight changes in blood pressure, sugar levels, and lipid levels. No aggravation of stroke sequelae, atrial fibrillation, or transient ischemic attack was reported.ConclusionsVaccination against COVID-19 (inactive virus) is safe for people at risk of stroke when the existing disease condition is stable. It is suggested to strengthen vaccine knowledge and ensure good sleep before vaccination.
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Affiliation(s)
- Gang Wu
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Meixian Zhang
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Xiaomei Xie
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Yanwu Zhu
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Hongxia Tang
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Xinmiao Zhu
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Yifan Liang
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Tao Chen
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Kuangyao Zhu
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Danfeng Zhang
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Sujun Jiang
- Department of Prevention and Health Care, Health Service Center of Gucheng Community, Linhai, China
| | - Zhengli Jiang
- Department of Pharmacy, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- Zhengli Jiang
| | - Shaofa Ke
- Department of Neurology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- *Correspondence: Shaofa Ke
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Morese R, Palermo S. Feelings of loneliness and isolation: Social brain and social cognition in the elderly and Alzheimer's disease. Front Aging Neurosci 2022; 14:896218. [PMID: 35936772 PMCID: PMC9353216 DOI: 10.3389/fnagi.2022.896218] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rosalba Morese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
- Neuroradiology Unit, Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Amanzio M, Palermo S, Prigatano G, Litvan I. Editorial: Neuro-covid: neuropsychological implications of the pandemic. Front Psychol 2022; 13:971780. [PMID: 35923734 PMCID: PMC9340774 DOI: 10.3389/fpsyg.2022.971780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Sara Palermo
- Department of Psychology, University of Turin, Turin, Italy
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Neurologico Carlo Besta, Milan, Italy
- *Correspondence: Sara Palermo
| | - George Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Irene Litvan
- Parkinson and Other Movement Disorders Center, University of California, San Diego, San Diego, CA, United States
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Morese R, Carassa A, Palermo S. Editorial: Affective, Cognitive and Social Neuroscience: New Knowledge in Normal Aging, Minor and Major Neurocognitive Disorders. Front Psychol 2022; 13:857475. [PMID: 35310253 PMCID: PMC8924440 DOI: 10.3389/fpsyg.2022.857475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosalba Morese
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Antonella Carassa
- Faculty of Communication, Culture and Society, Università della Svizzera italiana, Lugano, Switzerland
| | - Sara Palermo
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,European Commission Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
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Liang CK, Lee WJ, Peng LN, Meng LC, Hsiao FY, Chen LK. COVID-19 Vaccines in Older Adults: Challenges in Vaccine Development and Policy-Making. Clin Geriatr Med 2022; 38:605-620. [PMID: 35868676 PMCID: PMC8934735 DOI: 10.1016/j.cger.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chih-Kuang Liang
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ju Lee
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Lan, Taiwan
| | - Li-Ning Peng
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Chieh Meng
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan.
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10
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Pandolfo G, Genovese G, Iannuzzo F, Bruno A, Pioggia G, Gangemi S. COVID-19 Vaccination and Mental Disorders, What Has Been Accomplished and Future Direction. Brain Sci 2022; 12:brainsci12020292. [PMID: 35204055 PMCID: PMC8870203 DOI: 10.3390/brainsci12020292] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 12/26/2022] Open
Abstract
The consequences of the pandemic on mental health are among the most important side effects of COVID-19. Wide concerns have emerged both regarding vaccine hesitation in the general population, and the vaccine's implementation plan. The aim of this study is to evaluate how the scientific community has investigated the relationship between the COVID-19 vaccine and mental disorders. Contrary to expectations, having a full-blown psychiatric pathology seems to positively affect the attitude towards the vaccine, except for PTSD. The intense fear that accompanied the current world emergency has made this pandemic unique; we discuss how it might be one of the factors involved in this result. Further experimental investigations are needed to estimate how personality traits, hyperarousal, and negative emotions influence vaccine compliance both in the general population and in people living with mental disorders.
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Affiliation(s)
- Gianluca Pandolfo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (F.I.); (A.B.)
| | - Giovanni Genovese
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (F.I.); (A.B.)
- Correspondence:
| | - Fiammetta Iannuzzo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (F.I.); (A.B.)
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98121 Messina, Italy; (G.P.); (F.I.); (A.B.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), 98125 Messina, Italy;
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
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11
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Danenberg R, Shemesh S, Tzur Bitan D, Maoz H, Saker T, Dror C, Hertzberg L, Bloch Y. Attitudes of patients with severe mental illness towards COVID-19 vaccinations: A preliminary report from a public psychiatric hospital. J Psychiatr Res 2021; 143:16-20. [PMID: 34438198 PMCID: PMC8376832 DOI: 10.1016/j.jpsychires.2021.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND As patients with severe mental illness are at increased risk for COVID-19 mortality, the issue of willingness to be vaccinated is of extreme importance. METHODS During February 2021 Shalvata Mental Health hospital provided Covid-19 vaccines to its patients. Fifty one patients suffering from severe mental illness, out of 196 patients hospitalized in closed, open or day wards during that period, signed the informed consent and were assessed for their clinical condition (OQ-45), fear of Covid-19 (FCV-19S) and approach to the vaccine (C19-VHS). All patients who were not vaccinated in February 2021 (baseline) were re-approached a month later to assess whether they had gotten vaccinated since. RESULTS Patients who were not vaccinated at baseline had an oppositional approach to the vaccine, and did not significantly differ in their fear of Covid-19 levels or in levels of clinical severity (t(49) = 2.51, p = 0.02) from those who were vaccinated. From the 29 patients who were not vaccinated at baseline approach to the vaccine was a good predictor to getting vaccinated after one month (79% positive predictive value). CONCLUSIONS The majority of patients suffering from a severe mental illness are willing to get vaccinated, and their decision of whether or not to get vaccinated is based on their viewpoint on the vaccine rather than being an outcome of their level of distress (OQ-45). It is important to allow vaccine accessibility to hospitalized patients, to consider their opinions and to provide useful information to lower vaccine hesitancy and improve vaccination rates.
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Affiliation(s)
- Renana Danenberg
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Israel.
| | - Sharon Shemesh
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel.
| | - Dana Tzur Bitan
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel; Department of Behavioral Sciences, Ariel University, Israel.
| | - Hagai Maoz
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Israel.
| | - Talia Saker
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Israel.
| | - Chen Dror
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Israel.
| | - Libi Hertzberg
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel,Tel Aviv University Sackler Faculty of Medicine, Israel
| | - Yuval Bloch
- Laboratory of Cognitive and Affective Research, Shalvata Mental Health Center, Israel; Tel Aviv University Sackler Faculty of Medicine, Israel.
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Nafilyan V, Dolby T, Razieh C, Gaughan CH, Morgan J, Ayoubkhani D, Walker S, Khunti K, Glickman M, Yates T. Sociodemographic inequality in COVID-19 vaccination coverage among elderly adults in England: a national linked data study. BMJ Open 2021; 11:e053402. [PMID: 34301672 PMCID: PMC8313303 DOI: 10.1136/bmjopen-2021-053402] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine inequalities in COVID-19 vaccination rates among elderly adults in England. DESIGN Cohort study. SETTING People living in private households and communal establishments in England. PARTICIPANTS 6 655 672 adults aged ≥70 years (mean 78.8 years, 55.2% women) who were alive on 15 March 2021. MAIN OUTCOME MEASURES Having received the first dose of a vaccine against COVID-19 by 15 March 2021. We calculated vaccination rates and estimated unadjusted and adjusted ORs using logistic regression models. RESULTS By 15 March 2021, 93.2% of people living in England aged 70 years and over had received at least one dose of a COVID-19 vaccine. While vaccination rates differed across all factors considered apart from sex, the greatest disparities were seen between ethnic and religious groups. The lowest rates were in people of black African and black Caribbean ethnic backgrounds, where only 67.2% and 73.8% had received a vaccine, with adjusted odds of not being vaccinated at 5.01 (95% CI 4.86 to 5.16) and 4.85 (4.75 to 4.96) times greater than the white British group. The proportion of individuals self-identifying as Muslim and Buddhist who had received a vaccine was 79.1% and 84.1%, respectively. Older age, greater area deprivation, less advantaged socioeconomic position (proxied by living in a rented home), being disabled and living either alone or in a multigenerational household were also associated with higher odds of not having received the vaccine. CONCLUSION Research is now urgently needed to understand why disparities exist in these groups and how they can best be addressed through public health policy and community engagement.
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Affiliation(s)
- Vahe Nafilyan
- Health Analysis and Life Event, Office for National Statistics, Newport, UK
- Faculty of Public Health, Environment and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Ted Dolby
- Health Analysis and Life Event, Office for National Statistics, Newport, UK
| | - Cameron Razieh
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leceister, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Jasper Morgan
- Health Analysis and Life Event, Office for National Statistics, Newport, UK
| | | | - Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leceister, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Myer Glickman
- Health Analysis and Life Event, Office for National Statistics, Newport, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leceister, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
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13
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Affiliation(s)
- Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming Chiao Tung University Yangming Campus, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Dan-Dau Hospital, Taipei, Taiwan.
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14
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Amanzio M, Palermo S. Editorial: Physical and Cognitive Frailty in the Elderly: An Interdisciplinary Approach. Front Psychol 2021; 12:698819. [PMID: 34149581 PMCID: PMC8206481 DOI: 10.3389/fpsyg.2021.698819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martina Amanzio
- Department of Psychology, University of Turin, Turin, Italy.,Neuroradiology Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Sara Palermo
- Neuroradiology Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
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15
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Andrew MK, Schmader KE, Rockwood K, Clarke B, McElhaney JE. Considering Frailty in SARS-CoV-2 Vaccine Development: How Geriatricians Can Assist. Clin Interv Aging 2021; 16:731-738. [PMID: 33953551 PMCID: PMC8088982 DOI: 10.2147/cia.s295522] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/02/2021] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted frail older adults, especially residents of long-term care (LTC) facilities. This has appropriately led to prioritization of frail older adults and LTC residents, and those who care for them, in the vaccination effort against COVID-19. Older adults have distinct immunological, clinical, and practical complexity, which can be understood through a lens of frailty. Even so, frailty has not been considered in studies of COVID-19 vaccines to date, leading to concerns that the vaccines have not been optimally tailored for and evaluated in this population even as vaccination programs are being implemented. This is an example of how vaccines are often not tested in Phase 1/2/3 clinical trials in the people most in need of protection. We argue that geriatricians, as frailty specialists, have much to contribute to the development, testing and implementation of COVID-19 vaccines in older adults. We discuss roles for geriatricians in ten stages of the vaccine development process, covering vaccine design, trial design, trial recruitment, establishment and interpretation of illness definitions, safety monitoring, consideration of relevant health measures such as frailty and function, analysis methods to account for frailty and differential vulnerability, contributions in regulatory and advisory roles, post-marketing surveillance, and program implementation and public health messaging. In presenting key recommendations pertinent to each stage, we hope to contribute to a dialogue on how to push the field of vaccinology to embrace the complexity of frailty. Making vaccines that can benefit frail older adults will benefit everyone in the fight against COVID-19.
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Affiliation(s)
- Melissa K Andrew
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada
| | - Kenneth E Schmader
- Division of Geriatrics, Duke University Medical Center and GRECC, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Kenneth Rockwood
- Department of Medicine, Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Barry Clarke
- Department of Family Medicine, Dalhousie University, Halifax, Canada
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16
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Salmerón Ríos S, Mas Romero M, Cortés Zamora EB, Tabernero Sahuquillo MT, Romero Rizos L, Sánchez-Jurado PM, Sánchez-Nievas G, Señalada JJB, García Nogueras I, Estrella Cazalla JDD, Andrés-Pretel F, Murillo Romero A, Lauschke VM, Stebbing J, Abizanda P. Immunogenicity of the BNT162b2 vaccine in frail or disabled nursing home residents: COVID-A study. J Am Geriatr Soc 2021; 69:1441-1447. [PMID: 33768521 PMCID: PMC8250586 DOI: 10.1111/jgs.17153] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Background/Objectives The safety and immunogenicity of the BNT162b2 coronavirus disease 2019 (COVID‐19) vaccine in older adults with different frailty and disability profiles have not been well determined. Our objective was to analyze immunogenicity of the BNT162b2 mRNA COVID‐19 vaccine in older adults across frailty and disability profiles. Design Multicenter longitudinal cohort study. Setting and participants A total of 134 residents aged ≥65 years with different frailty and disability profiles in five long‐term care facilities (LTCFs) in Albacete, Spain. Intervention and measurements Residents were administered two vaccine doses as per the label, and antibody levels were determined 21.9 days (SD 9.3) after both the first and second dose. Functional variables were assessed using activities of daily living (Barthel Index), and frailty status was determined with the FRAIL instrument. Cognitive status and comorbidity were also evaluated. Results Mean age was 82.9 years (range 65–99), and 71.6% were female. The mean antibody titers in residents with and without previous COVID‐19 infection were 49,878 AU/ml and 15,274 AU/ml, respectively (mean difference 34,604; 95% confidence interval [CI]: 27,699–41,509). No severe adverse reactions were observed, after either vaccine dose. Those with prevaccination COVID‐19 had an increased antibody level after the vaccine (B = 31,337; 95% CI: 22,725–39,950; p < 0.001). Frailty, disability, older age, sex, cognitive impairment, or comorbidities were not associated with different antibody titers. Conclusions The BNT162b2 mRNA COVID‐19 vaccine in older adults is safe and produces immunogenicity, independently of the frailty and disability profiles. Older adults in LTCFs should receive a COVID‐19 vaccine.
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Affiliation(s)
- Sergio Salmerón Ríos
- Residencia de Mayores San Vicente de Paúl, Diputación de Albacete, Albacete, Spain
| | - Marta Mas Romero
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Luis Romero Rizos
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Pedro Manuel Sánchez-Jurado
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Ginés Sánchez-Nievas
- Department of Rheumatology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Juan de Dios Estrella Cazalla
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Spain.,Diputación de Albacete, Vasco Núñez de Balboa Facility, Albacete, Spain
| | - Fernando Andrés-Pretel
- Department of Statistics, Foundation of the National Paraplegics Hospital of Toledo, Toledo, Spain
| | - Antonio Murillo Romero
- Long-Term Care Facilities Coordination, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, ICTEM building, London, United Kingdom
| | - Pedro Abizanda
- Department of Geriatrics, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.,CIBERFES, Ministerio de Economía y Competitividad, Spain.,Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, Spain
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17
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Murukesu RR, Singh DKA, Shahar S, Subramaniam P. Physical Activity Patterns, Psychosocial Well-Being and Coping Strategies Among Older Persons with Cognitive Frailty of the "WE-RISE" Trial Throughout the COVID-19 Movement Control Order. Clin Interv Aging 2021; 16:415-429. [PMID: 33692620 PMCID: PMC7939500 DOI: 10.2147/cia.s290851] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/26/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Older persons have been identified as a vulnerable population with respect to the novel coronavirus outbreak, COVID-19. Aiming to "flatten the curve" a strict Movement Control Order (MCO) was implemented in Malaysia. Older adults with cognitive frailty are prone to physical, cognitive and psychosocial decline. This study aims to compare physical activity patterns, psychological wellbeing and coping strategies of older persons with cognitive frailty in the "WE-RISE" trial (intervention versus control) throughout this period. MATERIALS AND METHODS This study was conducted as a sub-analysis of the ongoing "WE-RISE" randomized controlled trial. This study included 42 community-dwelling older adults, aged 60 years and above, with cognitive frailty, stratified into intervention (n=21) and control (n=21) groups who are receiving a multi-domain intervention and usual care, respectively, within the Klang Valley, Malaysia. Phone call interviews were conducted during the MCO period. Physical activity patterns were assessed using International Physical Activity Questionnaire (IPAQ) and Functional Activities Questionnaire (FAQ). Psychological wellbeing was assessed using Flourishing Scale (FS) and General Health Questionnaire (GHQ-12), while the Brief Coping Orientation to Problems Experienced (COPE) assessed coping strategies. Data were analysed descriptively and with independent samples t-test. RESULTS The WE-RISE intervention group had significantly higher levels of estimated resting energy expenditure (MET) for "walking activity" (I:μ=1723.1±780.7;C:μ=537.4±581.9)(p<0.001), "moderate activity" (I:μ=1422.8±1215.1;C:μ=405.7±746.9)(p=0.002) and "total physical activity" (I: μ=3625.9±3399.3;C:μ=994.6±1193.9)(p=0.002). The intervention group was also significantly more independent in functional activities (μ=1.76±1.73) as compared to the control group (μ=5.57±8.31) (p<0.05). Moreover, significant higher self-perception of living a meaningful life and feeling respected (p<0.05) was demonstrated in regard to psychological well-being in the intervention group. Regarding coping strategies, the intervention group relied significantly on the domains of religion (I:μ=6.43±0.99;C:μ=6.09±1.09)(p<0.05) and planning (I:μ=4.81±0.75; C:μ=4.04±1.28)(p<0.05) whilst the control group relied on humour (C:μ=3.14±1.19; I:μ=2.38±0.74)(p<0.05). CONCLUSION Participants of the WE-RISE intervention group were more physically active, functionally independent and had higher self-perceived social-psychological prosperity regarding living a meaningful life and feeling respected; whilst both groups relied on positive coping strategies during the MCO. These results indicate that it is vital to ensure older persons with cognitive frailty remain physically active and preserve their psychosocial wellbeing to be more resilient in preventing further decline during a crisis such as the COVID-19 pandemic.
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Affiliation(s)
- Resshaya Roobini Murukesu
- Physiotherapy Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Devinder Kaur Ajit Singh
- Physiotherapy Programme, Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetic Programme and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Health Psychology Programme and Centre for Healthy Ageing and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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18
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Yuan B, Li J, Zhao H, Zeng G. Global Population Aging, National Development Level, and Vulnerability to the Pandemic. Risk Manag Healthc Policy 2021; 14:705-717. [PMID: 33658872 PMCID: PMC7917308 DOI: 10.2147/rmhp.s292440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/01/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE This study examined the roles of population aging and national development level in affecting different phases of novel coronavirus disease development with a view to advancing preparedness and corresponding policy. METHODS Regression analysis was conducted using multisource data from the World Bank and Johns Hopkins COVID-19 Dashboard. RESULTS Population aging is positively associated with confirmed cases of day-10, day-20, and day-30. The positive association between population aging and death does not emerge until day-20. Countries with a higher proportion of older males face higher risks of death.. Countries with a higher proportion of males aged 70-74 years are at the highest risk of confirmed cases. National development level is not associated with confirmed cases, but developing countries face significantly higher risks of death of day-10 and day-20. CONCLUSION Prevention and control policies for older adults and underdeveloped areas and sex differences need to be studied.
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Affiliation(s)
- Bocong Yuan
- School of Tourism Management, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Jiannan Li
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Beijing, People’s Republic of China
| | - Hairong Zhao
- School of Tourism Management, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Guojun Zeng
- School of Tourism Management, Sun Yat-Sen University, Guangzhou, People’s Republic of China
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19
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Expressive Flexibility and Dispositional Optimism Contribute to the Elderly's Resilience and Health-Related Quality of Life during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041698. [PMID: 33578873 PMCID: PMC7916547 DOI: 10.3390/ijerph18041698] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 outbreak had a negative impact on psychological status among elderly subjects, negatively affecting their health-related quality of life (HRQoL). Psychological factors that promote resilience might beneficially contribute also to promoting a better HRQoL among elderly subjects. The main purpose of the present study was to investigate the contribution of dispositional optimism and expressive flexibility on the HRQoL of elderly outpatients during the COVID-19 outbreak. The outpatients were recruited from October 2018 to October 2019, and then followed-up during April 2020, by evaluating their HRQoL. The baseline sample consisted of 141 elderly outpatients (mean age 80.31 ± 6.84 years); the final number of outpatients included in the follow-up evaluation was 104 (mean age 80.26 ± 6.39). Univariate and multivariate linear regressions were developed to explore significant associations with the physical and mental component of HRQoL. Baseline dispositional optimism was a predictor of the mental component of HRQoL at follow-up; the flexible suppression of emotional expression was a predictor of the physical component of HRQoL at follow-up. From a psychogeriatric perspective, the accurate assessment of psychological factors, such as dispositional optimism and expressive flexibility, might help physicians and psychologists to recognize additional patients' vulnerabilities during the current emergency.
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