COVID-19 Trends and Forecast in the Eastern Mediterranean Region With a Particular Focus on Pakistan

COVID-19 vaccine acceptance and hesitancy among the general population of Pakistan: a population-based survey

OBJECTIVES

This study aims to determine the COVID-19 vaccination coverage and the factors associated with vaccine acceptance and hesitancy in the general population of Pakistan.

SETTING

This population-based study covers all major areas of Pakistan, including Sindh, Punjab, Khyber Pakhtunkhwa and Baluchistan provinces and the capital Islamabad.

PARTICIPANTS

A total of 541 male and female Pakistani adults above 18 years were interviewed to determine the COVID-19 vaccination coverage and understand the factors associated with vaccine acceptance and hesitancy.

OUTCOME

The outcome was COVID-19 vaccination status (not vaccinated or vaccinated).

RESULTS

Of 541 participants, 227 (41.96%) were non-vaccinated and 314 (58.04%) were vaccinated. Two-thirds of the participants from both the non-vaccinated and vaccinated groups (185 (81.50%) vs 236 (75.16%), p=0.008) reside in Sindh. Nearly one-third of participants from both groups were ever infected with COVID-19 (77 (33.92%) and 90 (28.66%)). The odds of COVID-19 vaccination among the age group 34-42 years were 1.75 times higher (95% CI 1.35 to 2.09, p=0.008) than the other age groups. The odds of COVID-19 vaccination among those with COVID-19 ever-infected family members were 1.87 times higher (95% CI 1.56 to 2.34, p=0.032) than those with uninfected family members.

CONCLUSIONS

Targeted interventions for subsets of populations reluctant to vaccination can improve vaccine coverage. Moreover, advocacy and explaining the public health benefits of vaccination can enhance the coverage in Pakistan.

Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study

BACKGROUND

The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.

OBJECTIVE

This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.

METHODS

This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.

RESULTS

A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.

CONCLUSIONS

The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.

Upregulated type I interferon responses in asymptomatic COVID-19 infection are associated with improved clinical outcome

Understanding key host protective mechanisms against SARS-CoV-2 infection can help improve treatment modalities for COVID-19. We used a blood transcriptome approach to study biomarkers associated with differing severity of COVID-19, comparing severe and mild Symptomatic disease with Asymptomatic COVID-19 and uninfected Controls. There was suppression of antigen presentation but upregulation of inflammatory and viral mRNA translation associated pathways in Symptomatic as compared with Asymptomatic cases. In severe COVID-19, CD177 a neutrophil marker, was upregulated while interferon stimulated genes (ISGs) were downregulated. Asymptomatic COVID-19 cases displayed upregulation of ISGs and humoral response genes with downregulation of ICAM3 and TLR8. Compared across the COVID-19 disease spectrum, we found type I interferon (IFN) responses to be significantly upregulated (IFNAR2, IRF2BP1, IRF4, MAVS, SAMHD1, TRIM1), or downregulated (SOCS3, IRF2BP2, IRF2BPL) in Asymptomatic as compared with mild and severe COVID-19, with the dysregulation of an increasing number of ISGs associated with progressive disease. These data suggest that initial early responses against SARS-CoV-2 may be effectively controlled by ISGs. Therefore, we hypothesize that treatment with type I interferons in the early stage of COVID-19 may limit disease progression by limiting SARS-CoV-2 in the host.

COVID-19 Vaccination Behavior of People Living with HIV: The Mediating Role of Perceived Risk and Vaccination Intention

The COVID-19 vaccination behavior of people living with HIV (PLWH) was examined via a cross-sectional web-based survey of PLWH aged 18 years and older. The survey was conducted from l May to 20 June 2021. The survey included social demographic information; vaccination behavior (B); and questions related to perceived usefulness (PU), perceived risk (PR), subjective norms (SNs), perceived behavior control (PBC), and behavior intention (BI). The associations between the questionnaire variables and COVID-19 vaccination behavior were assessed by calculating the descriptive data, correlation analysis, and structural equation modeling. In total, 43.71% of the 350 eligible respondents had received a COVID-19 vaccine. The differences in COVID-19 vaccination behavior according to age, gender, religious belief, marital status, income, education level, and occupation were not obvious (p > 0.05). PU had a significantly negative effect on PR (p < 0.05). PR had a significantly negative effect on BI (p < 0.05). SNs had a significantly positive effect on BI (p < 0.05). BI had a significantly positive effect on B (p < 0.05). PR fully mediated the effects of PU on BI, BI fully mediated the effects of PR on B, and BI fully mediated the effects of SNs on B (p < 0.05). Health policymakers and medical workers should provide more information about the risks of vaccine application to improve the vaccination behavior of PLWH.

A simulated measurement for COVID-19 pandemic using the effective reproductive number on an empirical portion of population: epidemiological models

COVID-19 as a global pandemic has had an unprecedented impact on the entire world. Projecting the future spread of the virus in relation to its characteristics for a specific suite of countries against a temporal trend can provide public health guidance to governments and organizations. Therefore, this paper presented an epidemiological comparison of the traditional SEIR model with an extended and modified version of the same model by splitting the infected compartment into asymptomatic mild and symptomatic severe. We then exposed our derived layered model into two distinct case studies with variations in mitigation strategies and non-pharmaceutical interventions (NPIs) as a matter of benchmarking and comparison. We focused on exploring the United Arab Emirates (a small yet urban centre (where clear sequential stages NPIs were implemented). Further, we concentrated on extending the models by utilizing the effective reproductive number (R t) estimated against time, a more realistic than the static R 0, to assess the potential impact of NPIs within each case study. Compared to the traditional SEIR model, the results supported the modified model as being more sensitive in terms of peaks of simulated cases and flattening determinations.

Higher entropy observed in SARS-CoV-2 genomes from the first COVID-19 wave in Pakistan

BACKGROUND

We investigated the genome diversity of SARS-CoV-2 associated with the early COVID-19 period to investigate evolution of the virus in Pakistan.

MATERIALS AND METHODS

We studied ninety SARS-CoV-2 strains isolated between March and October 2020. Whole genome sequences from our laboratory and available genomes were used to investigate phylogeny, genetic variantion and mutation rates of SARS-CoV-2 strains in Pakistan. Site specific entropy analysis compared mutation rates between strains isolated before and after June 2020.

RESULTS

In March, strains belonging to L, S, V and GH clades were observed but by October, only L and GH strains were present. The highest diversity of clades was present in Sindh and Islamabad Capital Territory and the least in Punjab province. Initial introductions of SARS-CoV-2 GH (B.1.255, B.1) and S (A) clades were associated with overseas travelers. Additionally, GH (B.1.255, B.1, B.1.160, B.1.36), L (B, B.6, B.4), V (B.4) and S (A) clades were transmitted locally. SARS-CoV-2 genomes clustered with global strains except for ten which matched Pakistani isolates. RNA substitution rates were estimated at 5.86 x10-4. The most frequent mutations were 5' UTR 241C > T, Spike glycoprotein D614G, RNA dependent RNA polymerase (RdRp) P4715L and Orf3a Q57H. Strains up until June 2020 exhibited an overall higher mean and site-specific entropy as compared with sequences after June. Relative entropy was higher across GH as compared with GR and L clades. More sites were under selection pressure in GH strains but this was not significant for any particular site.

CONCLUSIONS

The higher entropy and diversity observed in early pandemic as compared with later strains suggests increasing stability of the genomes in subsequent COVID-19 waves. This would likely lead to the selection of site-specific changes that are advantageous to the virus, as has been currently observed through the pandemic.

Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study (Preprint).. [DOI: 10.2196/preprints.32831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19.

OBJECTIVE

This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality.

METHODS

This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors.

RESULTS

A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity.

CONCLUSIONS

The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases.

Knowledge, Attitude, and Perceived Risks Towards COVID-19 Pandemic and the Impact of Risk Communication Messages on Healthcare Workers in Saudi Arabia

Purpose

To investigate knowledge, attitude, and perceived risks towards COVID-19 pandemic among healthcare workers (HCWs) in Saudi Arabia. Besides, the impact of risk communication strategy on the attitude and practice of HCWs was investigated.

Patients and Methods

We conducted a cross-sectional study that targeted HCWs from various Saudi health facilities. We utilized a self-administrated, online-based questionnaire designed to assess basic knowledge of COVID-19, attitude and disease perception, and the impact of risk communication messages among HCWs.

Results

A total of 1691 responses were received in the study. The HCWs exhibited good levels of knowledge (total maximum score is 1) of COVID-19 concerning the modes of transportation of COVID-19 (0.82±0.16), sample collection method for COVID-19 diagnosis (0.98±0.08), transmission of infection from asymptomatic individuals (0.99±0.11), and that antibiotics are not effective against the new COVID-19 (0.83±0.38). Nearly one-third of the participants considered a high/very high possibility of acquiring COVID-19 infection. HCWs had good attitude scores concerning their willingness to deal with new COVID-19 patients (0.87±0.33) and their beliefs in being educated on COVID-19 (0.99±0.11). Almost all participants strongly agree/agree that it is important to take action to prevent the spread of COVID-19 within healthcare facilities and received health information messages. Notably, 93.4% of the participants stated that the received messages changed their attitude towards COVID-19 and its preventive measures. Good knowledge scores were significantly associated with age > 49 years old, higher educational level, and physician occupation. Similarly, good attitude scores were higher among males, HCWs aged 40–49 years old, non-Saudi nationals, and physician and nurse occupations.

Conclusion

HCWs have fair knowledge and attitude towards the COVID-19 pandemic. The risk communication is an effective strategy to improve the attitude and practice of HCWs towards COVID-19 in Saudi Arabia.

The Combined Effect of Safety Specific Transformational Leadership and Safety Consciousness on Psychological Well-Being of Healthcare Workers

Occupational health researchers have begun to realize that the psychological well-being of healthcare workers who are providing treatment against COVID-19 is deteriorating. However, there is minimal research conducted on it, particularly in the context of leadership. The current study aims to fill this important gap by identifying critical factors that can enhance the psychological well-being of healthcare workers. We proposed that safety specific transformational leadership enhances psychological well-being among healthcare workers, and COVID-19 perceived risk mediates this relationship. Furthermore, the safety conscientiousness of healthcare workers was proposed to be a boundary condition that enhances the negative relationship between safety-specific transformational leadership and COVID-19 perceived risk. Data were collected from healthcare workers (N = 232) treating COVID-19 patients in the hospitals of Pakistan through well-established adopted questionnaires. The discriminant and convergent validity of the data was tested through confirmatory factor analysis by using AMOS statistical package. The mediation and moderation hypotheses were tested by using PROCESS Macro by Hayes. The results showed that safety specific transformational leadership enhances psychological well-being among healthcare workers, and COVID-19 perceived risk mediates this relationship. Moderation results also confirmed that safety conscientiousness moderates the relationship between safety specific transformational leadership and COVID-19 perceived risk. This study offers implications for both researchers and practitioners.

Estimation of novel coronavirus (COVID-19) reproduction number and case fatality rate: A systematic review and meta-analysis

BACKGROUND AND AIMS

Realizing the transmission potential and the magnitude of the coronavirus disease 2019 (COVID-19) aids public health monitoring, strategies, and preparation. Two fundamental parameters, the basic reproduction number (R 0) and case fatality rate (CFR) of COVID-19, help in this understanding process. The objective of this study was to estimate the R 0 and CFR of COVID-19 and assess whether the parameters vary in different regions of the world.

METHODS

We carried out a systematic review to find the reported estimates of the R 0 and the CFR in articles from international databases between January 1 and August 31, 2020. Random-effect models and Forest plots were implemented to evaluate the mean effect size of R 0 and the CFR. Furthermore, R 0 and CFR of the studies were quantified based on geographic location, the tests/thousand population, and the median population age of the countries where the studies were conducted. To assess statistical heterogeneity among the selected articles, the I 2 statistic and the Cochran's Q test were used.

RESULTS

Forty-five studies involving R 0 and 34 studies involving CFR were included. The pooled estimation of R 0 was 2.69 (95% CI: 2.40, 2.98), and that of the CFR was 2.67 (2.25, 3.13). The CFR in different regions of the world varied significantly, from 2.49 (2.08, 2.94) in Asia to 3.40 (2.81, 4.04) in North America. We observed higher mean CFR values for the countries with lower tests (3.15 vs 2.16) and greater median population age (3.13 vs 2.27). However, R 0 did not vary significantly in different regions of the world.

CONCLUSIONS

An R 0 of 2.69 and a CFR of 2.67 indicate the severity of the COVID-19. Although R 0 and CFR may vary over time, space, and demographics, we recommend considering these figures in control and prevention measures.

Data-Driven and Machine-Learning Methods to Project Coronavirus Disease 2019 Pandemic Trend in Eastern Mediterranean

Background: The coronavirus disease 2019 (COVID-19) pandemic has become a major public health crisis worldwide, and the Eastern Mediterranean is one of the most affected areas. Materials and Methods: We use a data-driven approach to assess the characteristics, situation, prevalence, and current intervention actions of the COVID-19 pandemic. We establish a spatial model of the spread of the COVID-19 pandemic to project the trend and time distribution of the total confirmed cases and growth rate of daily confirmed cases based on the current intervention actions. Results: The results show that the number of daily confirmed cases, number of active cases, or growth rate of daily confirmed cases of COVID-19 are exhibiting a significant downward trend in Qatar, Egypt, Pakistan, and Saudi Arabia under the current interventions, although the total number of confirmed cases and deaths is still increasing. However, it is predicted that the number of total confirmed cases and active cases in Iran and Iraq may continue to increase. Conclusion: The COVID-19 pandemic in Qatar, Egypt, Pakistan, and Saudi Arabia will be largely contained if interventions are maintained or tightened. The future is not optimistic, and the intervention response must be further strengthened in Iran and Iraq. The aim of this study is to contribute to the prevention and control of the COVID-19 pandemic.

Sensitivity analysis and optimal control of COVID-19 dynamics based on SEIQR model

It is of great curiosity to observe the effects of prevention methods and the magnitudes of the outbreak including epidemic prediction, at the onset of an epidemic. To deal with COVID-19 Pandemic, an SEIQR model has been designed. Analytical study of the model consists of the calculation of the basic reproduction number and the constant level of disease absent and disease present equilibrium. The model also explores number of cases and the predicted outcomes are in line with the cases registered. By parameters calibration, new cases in Pakistan are also predicted. The number of patients at the current level and the permanent level of COVID-19 cases are also calculated analytically and through simulations. The future situation has also been discussed, which could happen if precautionary restrictions are adopted.

A review on COVID-19 forecasting models

The novel coronavirus (COVID-19) has spread to more than 200 countries worldwide, leading to more than 36 million confirmed cases as of October 10, 2020. As such, several machine learning models that can forecast the outbreak globally have been released. This work presents a review and brief analysis of the most important machine learning forecasting models against COVID-19. The work presented in this study possesses two parts. In the first section, a detailed scientometric analysis presents an influential tool for bibliometric analyses, which were performed on COVID-19 data from the Scopus and Web of Science databases. For the above-mentioned analysis, keywords and subject areas are addressed, while the classification of machine learning forecasting models, criteria evaluation, and comparison of solution approaches are discussed in the second section of the work. The conclusion and discussion are provided as the final sections of this study.

Attitude, Perception, and Knowledge of COVID-19 Among General Public in Pakistan

The World Health Organization has acknowledged coronavirus disease 2019 (COVID-19) disease as a pandemic. Efforts are being made all over the world to raise awareness to prevent the spread of the disease. The goal of this study was to assess the attitude, perception, and knowledge of Pakistani people toward COVID-19 disease. We conducted a cross-sectional survey in which a questionnaire of 17 questions was transformed online on Google forms and was sent to random individuals online. A total of 1,000 questionnaires from individuals throughout Pakistan were evaluated. The results revealed that 42.9% of the participants knew about COVID-19 through social media, the largest source of information. Most of the participants (48.3%) started working from home amid the lockdown; 39.9% of the participants reported that they wash their hands every hour, and 56.9% participants are using a surgical mask. About thermal scanners, 30.5% of the people answered they may be effective, and 46.0% of the people think COVID-19 is a bioweapon; 59% of the participants think everyone is susceptible, whereas 83.9% of the people recognize fever as a primary symptom; 65.2% of the people are practicing social distancing, whereas 85.1% of the people think social gatherings causes spread of the disease. In general, participants had a good knowledge about the disease and a positive attitude toward protective measures. The effective measures are being taken by the government and the public; still, there remains a need for further awareness campaigns and knowledge of safe interventions to combat the spread of disease.