The Importance of Behavioral and Native Factors on COVID-19 Infection and Severity: Insights from a Preliminary Cross-Sectional Study

A behaviour and disease transmission model: incorporating the Health Belief Model for human behaviour into a simple transmission model

The health and economic impacts of infectious diseases such as COVID-19 affect all levels of a community from the individual to the governing bodies. However, the spread of an infectious disease is intricately linked to the behaviour of the people within a community since crowd behaviour affects individual human behaviour, while human behaviour affects infection spread, and infection spread affects human behaviour. Capturing these feedback loops of behaviour and infection is a well-known challenge in infectious disease modelling. Here, we investigate the interface of behavioural science theory and infectious disease modelling to explore behaviour and disease (BaD) transmission models. Specifically, we incorporate a visible protective behaviour into the susceptible-infectious-recovered-susceptible (SIRS) transmission model using the socio-psychological Health Belief Model to motivate behavioural uptake and abandonment. We characterize the mathematical thresholds for BaD emergence in the BaD SIRS model and the feasible steady states. We also explore, under different infectious disease scenarios, the effects of a fully protective behaviour on long-term disease prevalence in a community, and describe how BaD modelling can investigate non-pharmaceutical interventions that target-specific components of the Health Belief Model. This transdisciplinary BaD modelling approach may reduce the health and economic impacts of future epidemics.

A weapon to fight against pervasive Omicron: systematic actions transiting to pre-COVID normal

The Coronavirus Disease-2019 (COVID-19) pandemic is not just a health crisis but also a social crisis. Confronted with the resurgence of variants with massive infections, the triggered activities from personal needs may promote the spread, which should be considered in risk management. Meanwhile, it is important to ensure that the policy responses on citizen life to a lower level. In the face of Omicron mutations, we need to sum up the control experience accumulated, adapting strategies in the dynamic coevolution process while balancing life resumption and pandemic control, to meet challenges of future crises. We collected 46 cases occurring between 2021 and 2022, mainly from China, but also including five relevant cases from other countries around the world. Based on case studies, we combine micro-view individual needs/behaviors with macro-view management measures linking Maslow's hierarchy of needs with the transmission chain of Omicron clusters. The proposed loophole chain could help identify both individual and management loopholes in the spread of the virus. The systematic actions that were taken have effectively combated these ubiquitous vulnerabilities at lower costs and lesser time. In the dynamic coevolution process, the Chinese government has made effective and more socially acceptable prevention policies while meeting the divergent needs of the entire society at the minimum costs. Systematic actions do help maintain the balance between individuals' satisfaction and pandemic containment. This implies that risk management policies should reasonably consider individual needs and improve the cooperation of various stakeholders with targeted flexible measures, securing both public health and life resumption.

The role of blood groups, vaccine type and gender in predicting the severity of side effects among university students receiving COVID-19 vaccines

On March 11^th, 2020, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) a pandemic. To control the pandemic, billions of vaccine doses have been administered worldwide. Predictors of COVID-19 vaccine-related side effects are inconsistently described in the literature. This study aimed to identify the predictors of side effects' severity after COVID-19 vaccination among young adult students at Taif University (TU) in Saudi Arabia. An online, anonymous questionnaire was used. Descriptive statistics were calculated for numerical and categorical variables. Possible correlations with other characteristics were identified using the chi-square test. The study included 760 young adult participants from TU. Pain at the injection site (54.7%), headache (45.0%), lethargy and fatigue (43.3%), and fever (37.5%) were the most frequently reported COVID-19 vaccine-related side effects after the first dose. The most frequent side effects were reported among the 20-25-year-old age group for all doses of all vaccines. Females experienced remarkably more side effects after the second (p < 0.001) and third doses (p = 0.002). Moreover, ABO blood groups significantly correlated with vaccine-related side effects after the second dose (p = 0.020). The participants' general health status correlated with the side effects after the first and second doses (p < 0.001 and 0.022, respectively). The predictors of COVID-19 vaccine-related side effects in young, vaccinated people were blood group B, female gender, vaccine type, and poor health status.

The pattern from the first three rounds of vaccination: declining vaccination rates

Introduction

Vaccination rates for the COVID-19 vaccine have recently been stagnant worldwide. We aim to analyze the potential patterns of vaccination development from the first three doses to reveal the possible trends of the next round of vaccination and further explore the factors influencing vaccination in the selected populations.

Methods

On July 2022, a stratified multistage random sampling method in the survey was conducted to select 6,781 people from 4 provinces China, who were above the age of 18 years. Participants were divided into two groups based on whether they had a chronic disease. The data were run through Cochran-Armitage trend test and multivariable regression analyses.

Results

A total of 957 participants with chronic disease and 5,454 participants without chronic disease were included in this survey. Vaccination rates for the first, second and booster doses in chronic disease population were93.70% (95% CI: 92.19-95.27%), 91.12% (95%CI: 94.43-95.59%), and 83.18% (95%CI: 80.80-85.55%) respectively. By contrast, the first, second and booster vaccination rates for the general population were 98.02% (95% CI: 97.65-98.39%), 95.01% (95% CI: 94.43-95.59%) and 85.06% (95% CI: 84.11-86.00%) respectively. The widening gap in vaccination rates was observed as the number of vaccinations increases. Higher self-efficacy was a significant factor in promoting vaccination, which has been observed in all doses of vaccines. Higher education level, middle level physical activity and higher public prevention measures play a positive role in vaccination among the general population, while alcohol consumption acts as a significant positive factor in the chronic disease population (p < 0.05).

Conclusion

As the number of vaccinations increases, the trend of decreasing vaccination rate is becoming more pronounced. In future regular vaccinations, we may face low vaccination rates as the increasing number of infections and the fatigue associated with the prolonged outbreak hamper vaccination. Measures need to be found to counter this downward trend such as improving the self-efficacy of the population.

Nature visits during the COVID-19 pandemic in Norway: Facilitators, motives, and associations with sociodemographic characteristics

Introduction

The COVID-19 pandemic has been linked to increased mental health issues and reduced well-being. Researchers also reports increased frequency of nature visits during the pandemic, proposing it may mitigate some of these negative consequences. Using the case of Norway, a country with ample access to nature and relatively low levels of pandemic-related restrictions, this study sought to (i) understand how the COVID-19 crisis impacted patterns of nature visits and specific nature-based activities, (ii) examine how these patterns varied among different population groups and levels of restrictions, and (iii) explore the motives and facilitators for increased frequency of nature visits.

Methods

The data were retrieved from a national cross-sectional survey conducted in June 2021, which was designed to assess participants (n = 1,005, age &gt; 15 years) habits in relation to nature visits and outdoor recreation since the beginning of the COVID-19 crisis, and associated factors.

Results

The results showed that 32 % of participants increased their frequency of nature visits during the crisis, while 11 % experienced a decrease. Multivariate logistic regression revealed significant positive associations between increased frequency of nature visits and longer duration of lockdown restrictions (OR [95% CI] = 2.35 [1.28–4.29] and 4.92 [2.77–8.74] for a few weeks and several months of lockdown, respectively). Increased frequency of nature visits was also more likely among women, younger respondents, and individuals from high-income households. A Cochran's Q test showed that the most common motive for increased frequency of nature visits was “To be physically active” (74%). The most commonly reported facilitators were the possibility of using natural environments as an alternative to gyms and organized sports alongside having more time available (58 and 49%, respectively).

Conclusion

These findings suggest that nature visits provided important opportunities for physical activity during the COVID-19 crisis, but also that the mental health benefits of nature visits during such times may be under-communicated. This highlights the importance of access to natural environments to promote physical activity and health, but also suggests that campaigns that specifically communicate the beneficial effects of nature visits during lockdowns or similar stressful situations might help people cope with the situation.

Public awareness, specific knowledge, and worry about mpox (monkeypox): A preliminary community-based study in Shenzhen, China

Background

The mpox (monkeypox) outbreak has been declared to be a public health emergency of international concern by the Director-General of World Health Organization in July 2022. However, evidence regarding the awareness, knowledge, and worry about mpox in the general population remains scant.

Methods

A community-based survey targeting community residents was preliminarily conducted in Shenzhen, China in August 2022 by using a convenience sampling method. Information on mpox-related awareness, knowledge, and worry was collected from each participant. Binary logistic regression analyses with the stepwise procedure were applied to explore the factors associated with awareness, knowledge, and worry about mpox.

Results

A total of 1028 community residents were included in the analysis (mean age: 34.70 years). Among these participants, 77.9% had ever heard of mpox, and 65.3% were aware of the global outbreak of mpox. However, only about half of them had a high level of knowledge regarding mpox (56.5%) and related symptoms (49.7%). More than one-third of them (37.1%) expressed a high level of worry about mpox. Having high knowledge levels of mpox and related symptoms were positively associated with a high level of worry (OR: 1.79, 95%CI: 1.22~2.63 for a single high knowledge level; OR: 1.98, 95%CI: 1.47~2.66 for both high knowledge levels).

Conclusions

This study identified the gaps in public awareness and specific knowledge of mpox in Chinese people, providing scientific evidence for the prevention and control network of mpox at the community level. Targeted health education programs are of urgent need, which should be implemented along with psychological interventions to release public worry if necessary.

Did the COVID-19 pandemic impact urticaria information-seeking behavior in China? A retrospective longitudinal study

Purpose

To investigate information-seeking behavior related to urticaria before and during the COVID-19 pandemic in China.

Methods

Search query data for terms related to urticaria were retrieved using Baidu Index database from October 23, 2017 to April 23, 2022, and daily COVID-19 vaccination doses data were obtained from the website of the Chinese Center for Disease Control and Prevention. Among the 23 eligible urticaria search terms, four urticaria themes were generated as classification, symptom, etiology, and treatment of urticarial, respectively. Baidu Search Index (BSI) value for each term were extracted to analyze and compare the spatial and temporal distribution of online search behavior for urticaria before and after the COVID-19 pandemic, and to also explore the correlation between search query and daily COVID-19 vaccination doses.

Results

The classification of urticaria accounted for nearly half of the urticaria queries on the internet. Regular seasonal patterns of BSI were observed in urticaria-related online search, by attaining its highest level in spring and summer and lowest level in winter. The BSIs of all urticaria themes significantly increased after the COVID-19 pandemic than that before the pandemic (all P<0.05). Xizang, Qinghai and Ningxia are the most active geographical areas for increased urticaria-searching activities after the COVID-19 pandemic. There was also a significant positive correlation between daily BSIs and daily COVID-19 vaccination doses in each urticaria theme. Cross-correlation analysis found that the search of symptom, etiology, and treatment attained their strongest correlation with daily COVID-19 vaccination doses at 11-27 days before the injection of vaccine, imply vaccination hesitation related to concerns of urticaria.

Conclusions

This study used the internet as a proxy to provide evidence of public search interest and spatiotemporal characteristics of urticaria, and revealed that the search behavior of urticaria have increased significantly after the COVID-19 pandemic and COVID-19 vaccination. It is anticipated that the findings about such increase in search behavior, as well as the behavior of urticaria-related vaccine-hesitancy, will help guide public health education and policy regulation.

Clinical characteristics associated with mortality of COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

BACKGROUND

Over 130 million people have been diagnosed with Coronavirus disease 2019 (COVID-19), and more than one million fatalities have been reported worldwide. South Africa is unique in having a quadruple disease burden of type 2 diabetes, hypertension, human immunodeficiency virus (HIV) and tuberculosis, making COVID-19-related mortality of particular interest in the country. The aim of this study was to investigate the clinical characteristics and associated mortality of COVID-19 patients admitted to an intensive care unit (ICU) in a South African setting.

METHODS AND FINDINGS

We performed a prospective observational study of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to the ICU of a South African tertiary hospital in Cape Town. The mortality and discharge rates were the primary outcomes. Demographic, clinical and laboratory data were analysed, and multivariable robust Poisson regression model was used to identify risk factors for mortality. Furthermore, Cox proportional hazards regression model was performed to assess the association between time to death and the predictor variables. Factors associated with death (time to death) at p-value < 0.05 were considered statistically significant. Of the 402 patients admitted to the ICU, 250 (62%) died, and another 12 (3%) died in the hospital after being discharged from the ICU. The median age of the study population was 54.1 years (IQR: 46.0-61.6). The mortality rate among those who were intubated was significantly higher at 201/221 (91%). After adjusting for confounding, multivariable robust Poisson regression analysis revealed that age more than 48 years, requiring invasive mechanical ventilation, HIV status, procalcitonin (PCT), Troponin T, Aspartate Aminotransferase (AST), and a low pH on admission all significantly predicted mortality. Three main risk factors predictive of mortality were identified in the analysis using Cox regression Cox proportional hazards regression model. HIV positive status, myalgia, and intubated in the ICU were identified as independent prognostic factors.

CONCLUSIONS

In this study, the mortality rate in COVID-19 patients admitted to the ICU was high. Older age, the need for invasive mechanical ventilation, HIV status, and metabolic acidosis were found to be significant predictors of mortality in patients admitted to the ICU.

Body Mass Index and Clinical Outcomes in Adult COVID-19 Patients of Diverse Ethnicities

(1) Background: Body mass index (BMI) was observed to affect COVID-19 outcomes; however, the complete spectrum of clinical outcomes concerning BMI remains unexplored. The current study aimed to investigate the correlation between BMI and the severity and mortality of COVID-19, as well as ICU admission, radiological findings, clinical presentation, and time to viral clearance. (2) Methods: This retrospective study included 1796 multiethnic patients with COVID-19 treated at NMC Royal Hospital, Abu Dhabi, UAE. (3) Results: COVID-19’s adjusted odds of severity increased by 3.7- and 21.5-fold in classes I and III, respectively (p = 0.001). The odds of mortality were not significantly different after adjustment for age, sex, and race. The adjusted odds of ICU admission increased significantly by 3-fold and non-significantly by 4-fold in obesity classes I and II, respectively. Pneumonia was significantly higher in patients who were overweight and class I, II, and III obese. Furthermore, class III obese patients had a greater risk of presenting with combined respiratory and gastrointestinal manifestations (p < 0.001). The median time to viral clearance with a BMI > 40 kg/m2 was moderately higher than that with a BMI < 40 kg/m2. (4) Conclusions: High BMI was associated with pneumonia, ICU admission, severity, and mortality due to COVID-19.

Most Common Long COVID Physical Symptoms in Working Age Adults Who Experienced Mild COVID-19 Infection: A Scoping Review

BACKGROUND

One-third of patients who recover from COVID-19 present with long COVID. Their symptoms are broad, affecting their physical functioning and, ultimately, their quality of life. Many of those individuals who develop long COVID, possibly from a mild COVID-19 infection, are in the 18-65 age group. This prolongation of malaise directly influences national workforce economies.

OBJECTIVES

To summarise the commonly reported physical symptoms of long COVID in order to inform potential adjustments in healthcare for the employable population.

METHODS

The Embase, CINAHL, Medline, SCOPUS, and WHO COVID-19 databases were searched. The study selection process was based on the PRISMA guidelines. The extracted data were synthesised and presented narratively.

RESULTS

7403 studies were accessed, comprising 60 cohort studies and 10 case series/studies, representing 289,213 patients who met our criteria. The most frequently reported physical symptoms were fatigue (92%), shortness of breath (SOB) (81.8%), muscle pain (43.6%), and joint pain (34.5%).

CONCLUSIONS

The range of reported physical symptoms was broad and varied; the main ones being fatigue, breathlessness/SOB, and pain. Similarities observed between long COVID and other post-acute infection syndromes may help formulate protocols to manage and promote recovery for long COVID patients. Inconsistencies were evident, particularly with a lack of adherence to the standardised definitions of long COVID.

Research on the Impact of Regular Exercise Behavior of College Students on Academic Stress and Sleep Quality during the COVID-19 Pandemic

When college students face the COVID-19 pandemic and new learning challenges simultaneously, how to reduce or alleviate their own academic stress has become a topic of concern to students and their parents. The psychological and physiological benefits of regular exercise have been confirmed by related studies. This study aimed to explore the impact of college students' regular exercise behavior on academic stress and sleep quality during the COVID-19 pandemic. This study used a purposive sampling method to collect data through online questionnaires posted to relevant college student groups in northern, central, southern, and eastern Taiwan and the outlying islands. A total of 320 questionnaires were collected, with a response rate of 91.4%; based on 304 valid questionnaires. The validity rate was 95%. The obtained data were entered in SPSS 24.0 statistical software, and the correlation between variables was analyzed with AMOS 24.0 statistical software. The results show that hypothesis 1 is established, that is, regular exercise behavior of college students during the COVID-19 pandemic has a significant negative impact on academic stress, meaning that during the COVID-19 pandemic, if college students can use their spare time to make exercise part of their life, such a regular schedule will help reduce their academic stress. In addition, the empirical results show that hypothesis 2 is established, that is, regular exercise behavior of college students during the COVID-19 pandemic has a significant positive impact on sleep quality. A possible reason is that under the COVID-19 pandemic, the efficiency of the body to absorb oxygen is increased through regular exercise, which reduces pressure and improves sleep quality. Hypothesis 3 is also confirmed, that is, the academic stress of college students during the COVID-19 pandemic has a significant negative impact on sleep quality. The reason may be that many leisure and social activities have been suspended during the COVID-19 pandemic, and thus college students exercised and studied during the time they originally intended for leisure and social activities, which reduced their academic stress, stabilized their mood, and improved their sleep quality.

Ribavirin aerosol in hospitalized adults with respiratory distress and COVID-19: An open-label trial

There is an unmet medical need for effective treatments for hospitalized patients with coronavirus disease 2019 (COVID-19). Ribavirin is a broad-spectrum antiviral with demonstrated in vitro activity against multiple viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This trial evaluated the potential of ribavirin inhalation solution (ribavirin aerosol) to reduce COVID-19 disease severity in adults with confirmed SARS-CoV-2 infection and a diagnosis of respiratory distress. This phase I, multicenter, open-label, nonrandomized trial was conducted from February 2021 through August 2021. Patients received ribavirin aerosol (100 mg/ml for 30 min or 50 mg/ml for 60 min) twice daily for up to 6 days. The primary end point was change from baseline in clinical status severity, rated on a 7-point scale (1 [death]; 7 [not hospitalized; no limitations on activities]), at day 7 (or end-of-treatment/early termination) and day 30 (follow-up). Fifty-one patients were treated with ribavirin aerosol (mean age, 51.5 years; 78.4% men); mean number of doses was 9.7 (range, 1-12). Improvement of ≥1 level in clinical status severity was observed in 31.4% (16/51) and 78.4% (40/51) of patients at end-of-treatment and day 30, respectively. Of 21 patients who required a ventilator, 16 (76.2%) were able to discontinue ventilator use. Five patients (9.8%) died between end-of-treatment and day 30. Three patients (5.9%) discontinued study treatment due to adverse events. No deaths were considered related to study treatment. These data provide preliminary evidence that ribavirin aerosol may be an efficacious treatment for respiratory distress in adults with COVID-19.

Prevalence and associated factors of COVID-19 among Moroccan physicians: A cross-sectional study

BACKGROUND

Coronavirus disease (COVID-19) has emerged and spread rapidly worldwide and established a global public health crisis in early 2020. The first Moroccan case was reported on March 2, 2020. Since then, healthcare workers (HCWs) played a major role in saving human lives threatened by COVID-19. This study aimed to assess the prevalence of COVID-19 infection among Moroccan physicians and to report associated risk factors prior vaccination campaign.

METHODS

A cross-sectional study was carried out in the Fez-Meknes region of Morocco, 545 physicians' data was collected using a self-reported online questionnaire. The data collection was done between December 1, 2020, and February 1, 2021.

RESULTS

The prevalence of COVID-19 among physicians was 27.3%. The mean age of the confirmed COVID-19 group was 38.4±12.9 years old. There was no association between COVID-19 infection and preventive measures compliance by physicians and healthcare authorities in the workplace. However, multivariate analysis strengthened the following factors such as increased risk of COVID-19 infection within men ☯aOR:1.896; 95% IC 1.272-2.828; p = 0.002]; the presence of at least one comorbidity ☯aOR:2.268; 95%IC 1.414-3.637; p = 0.001]; and working at a university or military hospitals ☯aOR:2.578; 95%IC 1.667-3.989; p = 0.001].

CONCLUSION

This study allows comparing COVID-19 prevalence among healthcare workers before and after vaccination programs. This should support better preparation strategy for any future pandemics with appropriate and increased awareness for men, carrying comorbidity, and working environment with high COVID-19 disease management.

Short-Term Adverse Effects Following Booster Dose of Inactivated-Virus vs. Adenoviral-Vector COVID-19 Vaccines in Algeria: A Cross-Sectional Study of the General Population

COVID-19 booster vaccines have been adopted in almost all countries to enhance the immune response and combat the emergence of new variants. Algeria adopted this strategy in November 2021. This study was conducted to consider the self-reported side effects of COVID-19 booster vaccines by Algerians who were vaccinated with a booster dose of one of the approved inactivated-virus vaccines, such as BBIBP-CorV and CoronaVac, or one of the adenoviral-vector-based vaccines, such as Gam-COVID-Vac, AZD1222 and Ad26.COV2.S, and to determine the eventual risk factors. A cross-sectional study using an online self-administered questionnaire (SAQ) was conducted in Algeria between 28 April 2022, and 20 July 2022. A descriptive analysis of the 196 individuals who were included showed a nearly equal distribution of adenoviral- (52%) and inactivated-virus vaccines (48%) and of males (49.5%) and females (50.5%). The results showed that 74.7% of the studied population reported at least one local or systemic side effect. These side effects were more frequent among adenoviral-vector vaccinees (87.3%) than inactivated-virus vaccinees (60.6%) (sig. < 0.001). Injection site pain (40.3%), heat at the injection site (21.4%), and arm pain (16.3%) were the most common local side effects. These signs generally appeared in the first 12 h (73.3%) and generally lasted less than 24 h (32.8%). More interestingly, these signs differed from those that followed the administration of primer doses (48.5%) and were generally more severe (37%). The same observation was reported for systemic side effects, where the signs were especially most severe in the adenoviral-vaccinated group (49.4% vs. 20.8%; sig. = 0.001). These signs generally appeared within the first day (63.6%) and mostly disappeared before two days (50.8%), with fatigue (41.8%), fever (41.3%), and headache (30.1%) being the most common. Adenoviral-vector vaccinees (62.7%) were more likely to use medications to manage these side effects than were inactivated-virus vaccinees (45.7%) (sig. = 0.035) and paracetamol (48.5%) was the most used medication. Adenoviral-based vaccines were the types of vaccines that were most likely to cause side effects. In addition, being female increased the risk of developing side effects; regular medication was associated with local side effects among inactivated-virus vaccinees; and previous infection with COVID-19 was associated with systemic and local side effects among adenovirus-based vaccinees. These results support the short-term safety of booster vaccines, as has been reported for primer doses.

Bayesian Modeling of COVID-19 to Classify the Infection and Death Rates in a Specific Duration: The Case of Algerian Provinces

COVID-19 causes acute respiratory illness in humans. The direct consequence of the spread of the virus is the need to find appropriate and effective solutions to reduce its spread. Similar to other countries, the pandemic has spread in Algeria, with noticeable variation in mortality and infection rates between regions. We aimed to estimate the proportion of people who died or became infected with SARS-CoV-2 in each provinces using a Bayesian approach. The estimation parameters were determined using a binomial distribution along with an a priori distribution, and the results had a high degree of accuracy. The Bayesian model was applied during the third wave (1 January–15 August 2021), in all Algerian’s provinces. For spatial analysis of duration, geographical maps were used. Our findings show that Tissemsilt, Ain Defla, Illizi, El Taref, and Ghardaia (Mean = 0.001) are the least affected provinces in terms of COVID-19 mortality. The results also indicate that Tizi Ouzou (Mean = 0.0694), Boumerdes (Mean = 0.0520), Annaba (Mean = 0.0483), Tipaza (Mean = 0.0524), and Tebessa (Mean = 0.0264) are more susceptible to infection, as they were ranked in terms of the level of corona infections among the 48 provinces of the country. Their susceptibility seems mainly due to the population density in these provinces. Additionally, it was observed that northeast Algeria, where the population is concentrated, has the highest infection rate. Factors affecting mortality due to COVID-19 do not necessarily depend on the spread of the pandemic. The proposed Bayesian model resulted in being useful for monitoring the pandemic to estimate and compare the risks between provinces. This statistical inference can provide a reasonable basis for describing future pandemics in other world geographical areas.