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Objectives: Clinical characterisation studies have been essential in helping inform research, diagnosis and clinical management efforts, particularly early in a pandemic. This systematic review summarises the early literature on clinical characteristics of patients admitted to hospital, and evaluates the quality of evidence produced during the initial stages of the pandemic. Methods: MEDLINE, EMBASE and Global Health databases were searched for studies published from January 1st 2020 to April 28th 2020. Studies which reported on at least 100 hospitalised patients with Covid-19 of any age were included. Data on clinical characteristics were independently extracted by two review authors. Study design specific critical appraisal tools were used to evaluate included studies: the Newcastle Ottawa scale for cohort and cross sectional studies, Joanna Briggs Institute checklist for case series and the Cochrane collaboration tool for assessing risk of bias in randomised trials. Results: The search yielded 78 studies presenting data on 77,443 people. Most studies (82%) were conducted in China. No studies included patients from low- and middle-income countries. The overall quality of included studies was low to moderate, and the majority of studies did not include a control group. Fever and cough were the most commonly reported symptoms early in the pandemic. Laboratory and imaging findings were diverse with lymphocytopenia and ground glass opacities the most common findings respectively. Clinical data in children and vulnerable populations were limited. Conclusions: The early Covid-19 literature had moderate to high risk of bias and presented several methodological issues. Early clinical characterisation studies should aim to include different at-risk populations, including patients in non-hospital settings. Pandemic preparedness requires collection tools to ensure observational studies are methodologically robust and will help produce high-quality data early on in the pandemic to guide clinical practice and public health policy. Review registration: Available at https://osf.io/mpafn [ABSTRACT FROM AUTHOR]

Background & aim: The coronavirus disease 2019 (COVID-19) pandemic has affected the life and work of people worldwide. The present study aimed to evaluate the rhythm disruptions of life, work, and entertainment, and their associations with the psychological impacts during the initial phase of the COVID-19 pandemic. Method: A cross-sectional study was conducted from the 10th to 17th March 2020 in China. A structured e-questionnaire containing general information, the Chinese version of Brief Social Rhythm Scale, and Zung's self-rating scales of depression and anxiety (SDS and SAS) was posted and collected online through a public media (i.e. EQxiu online questionnaire platform). Scores in sleeping, getting up, and socializing (SGS) rhythm and eating, physical practice, and entertainment (EPE) rhythm were compared among and between participants with different sociodemographic backgrounds including gender, age, education, current occupation, annual income, health status, and chronic disease status. Correlations of SDS and SAS with SGS-scale and EPE-scale were also analyzed. Results: Overall, 5854 participants were included. There were significant differences in the scores of SGS-scale and EPE-scale among people with different sociodemographic backgrounds. The scores were significantly higher in the groups with female gender, low education level, lower or higher than average income, poor health status, ages of 26–30 years or older than 61 years, nurses and subjects with divorce or widow status. There were also significant differences in SAS and SDS scores among people with different sociodemographic backgrounds (all P< 0.05). The overall prevalence of depression and anxiety was 24.3% and 12.6%, respectively, with nurses having the highest rates of depression (32.94%) and anxiety (18.98%) among the different occupational groups. SGS-scale was moderately correlated with SDS and SAS, and disruption of SGS rhythm was an independent risk factor for depression and anxiety. Conclusion: Social rhythm disruption was independently associated with depression and anxiety. Interventions should be applied to people vulnerable to the rhythm disruption during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) declared coronavirus disease-2019 (COVID-19) a global pandemic on 11 March 2020. In Ecuador, the first case of COVID-19 was recorded on 29 February 2020. Despite efforts to control its spread, SARS-CoV-2 overran the Ecuadorian public health system, which became one of the most affected in Latin America on 24 April 2020. The Hospital General del Sur de Quito (HGSQ) had to transition from a general to a specific COVID-19 health center in a short period of time to fulfill the health demand from patients with respiratory afflictions. Here, we summarized the implementations applied in the HGSQ to become a COVID-19 exclusive hospital, including the rearrangement of hospital rooms and a triage strategy based on a severity score calculated through an artificial intelligence (AI)-assisted chest computed tomography (CT). Moreover, we present clinical, epidemiological, and laboratory data from 75 laboratory tested COVID-19 patients, which represent the first outbreak of Quito city. The majority of patients were male with a median age of 50 years. We found differences in laboratory parameters between intensive care unit (ICU) and non-ICU cases considering C-reactive protein, lactate dehydrogenase, and lymphocytes. Sensitivity and specificity of the AI-assisted chest CT were 21.4% and 66.7%, respectively, when considering a score >70%; regardless, this system became a cornerstone of hospital triage due to the lack of RT-PCR testing and timely results. If health workers act as vectors of SARS-CoV-2 at their domiciles, they can seed outbreaks that might put 1,879,047 people at risk of infection within 15 km around the hospital. Despite our limited sample size, the information presented can be used as a local example that might aid future responses in low and middle-income countries facing respiratory transmitted epidemics. [ABSTRACT FROM AUTHOR]

We investigate the effectiveness of business shutdowns to contain the Covid-19 disease. In March 2020, Italy shut down operations in selected sectors of its economy. Using a difference-in-differences approach, we find that municipalities with higher exposure to closed sectors experienced subsequently lower mortality rates. The implied life savings exceed 9,400 people over a period of less than a month. We also find that business closures exhibited rapidly diminishing returns and had large effects outside the closed businesses themselves, including spillovers to other municipalities. Overall, the results suggest business shutdowns are effective, but should be selectively implemented and centrally coordinated. [ABSTRACT FROM AUTHOR]

Background: A year after the COVID-19 pandemic started, there are still few scientific reports on COVID-19 in Africa. This study explores the clinical profiles and factors associated with COVID-19 in Cameroon. Materials and methods: In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk. Findings: A total of 313 patients were admitted during the study period; 259 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (26.2%; n = 68) to moderate (59%; n = 153) to severe (14.7%; n = 38); the case fatality rate was 1% (n = 4). Dysgusia (46%; n = 119) and hyposmia/anosmia (37.8%; n = 98) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; n = 53), of which hypertension was the most common (18.9%; n = 49). Participation in mass gatherings (Odds Ratio (OR) = 2.37; P = 0.03) and dysgusia (OR = 2.09, P = 0.02) were predictive of diagnosis of COVID-19. Age groups 60 to 69 (OR = 7.41; P = 0.0001), 50 to 59 (OR = 4.09; P = 0.03), 40 to 49 (OR = 4.54; P = 0.01), male gender (OR = 2.53; P = 0.04), diabetes (OR = 4.05; P = 0.01), HIV infection (OR = 5.57; P = 0.03), lung disease (OR = 6.29; P = 0.01), dyspnoea (OR = 3.70; P = 0.008) and fatigue (OR = 3.35; P = 0.02) significantly predicted COVID-19 severity. Conclusions: Most COVID-19 cases in this study were benign with low fatality. Age (40–70), male gender, HIV infection, lung disease, dyspnoea and fatigue are associated with severe COVID-19. Such findings may guide public health decision-making. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is the largest viral pandemic of the 21st century. We aimed to study COVID-19 knowledge, attitudes, and practices (KAP) among medical and health sciences students in the United Arab Emirates (UAE). We performed a cross-sectional study between 2 June and 19 August 2020. The survey was distributed online using Survey Monkey. It was conducted in English and comprised two parts: socio-demographic characteristics, and KAP towards COVID-19. 712 responses to the questionnaire were collected. 90% of respondents (n = 695) were undergraduate students, while 10% (n = 81) were postgraduates. The majority (87%, n = 647) stated that they obtained COVID-19 information from multiple reliable sources. They were highly knowledgeable about the COVID-19 pandemic, but 76% (n = 539) did not recognize its routes of transmission. Medical students were significantly more knowledgeable compared with allied health students (P<0.0001, Mann Whitney U test) but there was no difference in knowledge between undergraduate and postgraduate students (P = 0.14, Mann Whitney U test). Medical students thought that more could be done to mitigate the COVID-19 situation compared with the allied health students (66.2% compared with 51.6%, p = 0.002 Fisher's Exact test). 63% (n = 431) were worried about getting COVID-19 infection, while 92% (n = 633)) were worried that a family member could be infected with the virus. 97% (n = 655) took precautions when accepting home deliveries, 94% (n = 637) had been washing their hands more frequently, and 95% (n = 643) had been wearing face masks. In conclusion, medical and health sciences students in the UAE showed high levels of knowledge and good attitudes and practices towards the COVID-19 pandemic. Nevertheless, they were worried about themselves or their family members becoming infected. Medical students had more knowledge about COVID-19 pandemic which was reflected in their opinion that more can be done to mitigate its effects. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the impact of the coronavirus disease 2019 epidemic on ongoing and upcoming drug clinical trials. Qualitative semi-structured interviews were conducted with clinical trial staff and clinical trial subjects were surveyed by questionnaire in this study. The results of interviews and questionnaire showed that coronavirus disease 2019 pandemic has led to many changes in the implementation of drug clinical trials, including: a variety of meetings being held online webinars using various platforms, telemedicine and follow-up by video, A large number of deviations from protocol and losses of follow-up, delivery of clinical trial drugs by express, additional workload caused by screening for coronavirus, and anxiety of subjects. These results suggest that the coronavirus disease 2019 outbreak has hindered the progress and damaged the quality of clinical trials. The online meeting, remote follow-up, express delivery of drugs and remote monitoring in the epidemic environment can ensure the progress of clinical trials to a certain extent, but they cannot fully guarantee the quality as before. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome–Coronavirus 2 (SARS-CoV2), is the defining global health crisis of this time. It is responsible for significant morbidity and has had severe socioeconomic consequences. This study aims to assess the knowledge, preparedness and attitudes of medical students, physicians and faculty members in the United Arab Emirates (UAE) on COVID-19 and their perspective on the roles of educational and healthcare institution towards improving pandemic preparedness and enabling optimal care. Methodology: An exploratory, descriptive cross-sectional study was conducted with 444 participants, using a non-probability convenience sampling method. English-speaking participants from the medical field aged 18 and above were included in the study. The validated questionnaire was administered online and distributed across social media platforms from May-July 2020. T-test, ANOVA, Kruskal-Wallis test and Mann-Whitney-U test were used when appropriate. Responses were analysed and statistical tests applied using IBM SPSS, version 25. Results: The knowledge scores were calculated amongst different ages and professional status, and the mean was 59.08% (SD = 12.848%). Almost half of the participants obtained poor knowledge scores (less than 60%). Most of the participants followed the latest updates on COVID-19 (86.7%). The majority opted to obtain information from the national health authorities (63.4%). The mean preparedness score among the participants was 68.65% (SD = 17.456%). Being in contact with patients significantly increased the preparedness score (p < 0.001). Only 27.9% of the participants believed their college education provided adequate knowledge to deal with epidemics or pandemics. Several barriers affect willingness to work in a pandemic, with 80.6% of participants worried about posing a risk to family members. Conclusion: This study highlights the importance of establishing tailored COVID-19 related education programs to improve knowledge levels, especially in medical students. Efforts are still needed to promote effective control measures and address the barriers affecting willingness to work in a pandemic. [ABSTRACT FROM AUTHOR]

On March 2019 the World Health Organization declared Coronavirus disease (COVID-19) pandemic. Several recent reports disclose that the outcome of the infection is related to age, sex and can be influenced by underlying clinical conditions. Parkinson's disease (PD) and other parkinsonisms are the most common chronic disease which can cause, directly or indirectly, the patient to be more exposed to other diseases, mostly respiratory system's ones. Our primary outcome is to evaluate if PD patients are more susceptible than non-PD to take COVID-19 infection. Second, to detect if the infection course is worse in PD-COVID+ patients versus non-PD. This is a retrospective observational study on a cohort of 18 patients (13 PD– 5 non-PD), hospitalized in a Rehabilitative Unit during the occurrence of SARS-CoV2 epidemic outbreak. All patients performed laboratory tests, lung Computed Tomography (CT) and have been tested for COVID-19 thorough pharyngeal swab. PD and non-PD groups were comparable for age, gender and Hoehn and Yahr stage. Seventy-seven (77)% of PD and 60% of non-PD resulted positive for COVID-19. PD-COVID+ and PD-COVID- did not differ for age, disease duration and L-dopa daily dose. PD COVID-19+ subjects were mainly asymptomatic (50%) while non-PD ones were all symptomatic, mostly with respiratory difficulties. PD doesn't seem to be a risk factor to take SARS-COV2 infection, even if our study is related to a limited sample size. Our results, together with those of other recent studies, highlight the need to evaluate the actual susceptibility of patients with Parkinson's disease to develop COVID-19 disease, and how the infection may influence the risk of clinical worsening and increase of mortality. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global pandemic, including Indonesia. However, there are only limited data regarding the precise prevalence of the COVID-19 pandemic in Indonesia. Here, to estimate the magnitude of SARS-CoV-2 infection in East Java, Indonesia, we investigated the prevalence of immunoglobulin G (IgG) antibodies. We enrolled 1,819 individuals from June to December 2020 and observed that the subjects' overall prevalence of IgG antibody to SARS-CoV-2 was 11.4% (207/1,819). The prevalence of anti-SARS-CoV-2 antibodies differed significantly between the job/occupation groups (P = 0.0001). A greater prevalence of IgG was detected in laboratory technicians (who take samples from suspected cases and deal with polymerase chain reaction [PCR] procedures, 22.2%) compared to medical personnel who see and take direct care of patients with COVID-19 (e.g., physicians and nurses, 6.0%), other staff in medical facilities (2.9%), general population (12.1%) and non-COVID-19 patients (14.6%). The highest prevalence among age groups was in the 40–49-year-olds (14.8%), and the lowest prevalence was in the 20–29-year-olds (7.4%). However, the younger population still showed a higher prevalence than generally reported, suggesting greater exposure to the virus but less susceptibility to the disease. A geographical difference was also observed: a higher prevalence in Surabaya (13.1%) than in Jombang (9.9%). In conclusion, the COVID-19 outbreak among asymptomatic populations was characterized by a high prevalence of infection in East Java, Indonesia. [ABSTRACT FROM AUTHOR]

Demographic, health, and socioeconomic factors significantly inform COVID-19 outcomes. This article analyzes the association of these factors and outcomes in Chile during the first five months of the pandemic. Using the municipalities Metropolitan Region's municipalities as the unit of analysis, the study looks at the role of time dynamics, space, and place in cases and deaths over a 100-day period between March and July 2020. As a result, common and idiosyncratic elements explain the prevalence and dynamics of infections and mortality. Social determinants of health, particularly multidimensional poverty index and use of public transportation play an important role in explaining differences in outcomes. The article contributes to the understanding of the determinants of COVID-19 highlighting the need to consider time-space dynamics and social determinants as key in the analysis. Structural factors are important to identify at-risk populations and to select policy strategies to prevent and mitigate the effects of COVID-19. The results are especially relevant for similar research in unequal settings. [ABSTRACT FROM AUTHOR]

We present two different approaches for modeling the spread of the COVID-19 pandemic. Both approaches are based on the population classes susceptible, exposed, infectious, quarantined, and recovered and allow for an arbitrary number of subgroups with different infection rates and different levels of testing. The first model is derived from a set of ordinary differential equations that incorporates the rates at which population transitions take place among classes. The other is a particle model, which is a specific case of crowd simulation model, in which the disease is transmitted through particle collisions and infection rates are varied by adjusting the particle velocities. The parameters of these two models are tuned using information on COVID-19 from the literature and country-specific data, including the effect of restrictions as they were imposed and lifted. We demonstrate the applicability of both models using data from Cyprus, for which we find that both models yield very similar results, giving confidence in the predictions. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 pandemic, social and traditional media have disseminated predictions from experts and nonexperts about its expected magnitude. How accurate were the predictions of 'experts'—individuals holding occupations or roles in subject-relevant fields, such as epidemiologists and statisticians—compared with those of the public? We conducted a survey in April 2020 of 140 UK experts and 2,086 UK laypersons; all were asked to make four quantitative predictions about the impact of COVID-19 by 31 Dec 2020. In addition to soliciting point estimates, we asked participants for lower and higher bounds of a range that they felt had a 75% chance of containing the true answer. Experts exhibited greater accuracy and calibration than laypersons, even when restricting the comparison to a subset of laypersons who scored in the top quartile on a numeracy test. Even so, experts substantially underestimated the ultimate extent of the pandemic, and the mean number of predictions for which the expert intervals contained the actual outcome was only 1.8 (out of 4), suggesting that experts should consider broadening the range of scenarios they consider plausible. Predictions of the public were even more inaccurate and poorly calibrated, suggesting that an important role remains for expert predictions as long as experts acknowledge their uncertainty. [ABSTRACT FROM AUTHOR]

Background: The emergence of a pandemic presents challenges and opportunities for healthcare, health promotion interventions, and overall improvement in healthcare seeking behaviour. This study explored the impact of COVID-19 on health knowledge, lifestyle, and healthcare seeking behaviour among residents of a resource-limited setting in Ghana. Methods: This qualitative study adopted an exploratory design to collect data from 20 adult residents in the Cape Coast Metropolis using face-to-face in-depth interviews. Data collected were analysed thematically and statements from participants presented verbatim to illustrate the themes realised. Results: Health knowledge has improved due to COVID–19 in terms of access to health information and increased understanding of health issues. There were reductions in risky health-related lifestyles (alcohol intake, sharing of personal items, and consumption of junk foods) while improvements were observed in healthy lifestyles such as regular physical exercise and increased consumption of fruits and vegetables. COVID–19 also positively impacted health seeking behaviour through increased health consciousness and regular check-ups. However, reduced healthcare utilization was prevalent. Conclusion: The COVID–19 pandemic has presented a positive cue to action and helped improved health knowledge, lifestyle, and care seeking behaviour although existing health system constrains and low economic status reduced healthcare utilization. To improve health systems, health-related lifestyles and healthcare seeking behaviour as well as overall health outcomes even after the pandemic wades off, COVID–19 associated conscious and unconscious reforms should be systematically harnessed. [ABSTRACT FROM AUTHOR]

During the COVID-19 lockdown in the US, many businesses were shut down temporarily. Essential businesses, most prominently grocery stores, remained open to ensure access to food and household essentials. Grocery shopping presents increased potential for COVID-19 infection because customers and store employees are in proximity to each other. This study investigated shoppers' perceptions of COVID-19 infection risks and put them in context by comparing grocery shopping to other activities outside home, and examined whether a proactive preventive action by grocery stores influence shoppers' perceived risk of COVID-19 infection. Our data were obtained via an anonymous online survey distributed between April 2 and 10, 2020 to grocery shoppers in New York State (the most affected by the pandemic at the time of the study) and Washington State (the first affected by the pandemic). We found significant factors associated with high levels of risk perception on grocery shoppers. We identified some effective preventive actions that grocery stores implement to alleviate anxiety and risk perception. We found that people are generally more concerned about in-store grocery shopping relative to other out-of-home activities. Findings suggest that a strict policy requiring grocery store employees to use facemasks and gloves greatly reduced shoppers' perceived risk rating of infection of themselves by 37.5% and store employees by 51.2%. Preventive actions by customers and businesses are critical to reducing the unwitting transmission of COVID-19 as state governments prepare to reopen the economy and relax restrictions on activities outside home. [ABSTRACT FROM AUTHOR]

Backgrounds: Data on how lifestyle changes due to the coronavirus disease 2019 (COVID-19) pandemic have influenced the clinical features of kidney disease patients remain scarce. Methods: This study retrospectively analyzed clinical variables in patients with stage G1–G4 chronic kidney disease (CKD) with complete or incomplete remission of proteinuria, who were managed in a nephrology outpatient clinic of a university hospital in Tokyo. The clinical variables during the COVID-19 pandemic (term 1, June–July 2020) were compared to those one year before the pandemic (term 0, June–July 2019). The urinary protein excretion (UPE) was used as the primary outcome measure. Results: This study included 325 patients with stage G1–G4 CKD (mean age 58.5 years old, 37.5% female, 80.6% on renin-angiotensin aldosterone system inhibitors [RAASis], 12.0% on maintenance dose immunosuppression therapy) evaluated at term 0. The UPE at terms 0 and 1 was 247 (92–624) and 203 (84–508) mg/day [median (25th–75th percentile)], respectively; the value in term 1 was 18% lower than that in term 0 (p<0.001), with no marked difference in body weight, blood pressure, protein intake or urinary salt excretion. In multivariable analyses, incomplete remission of proteinuria in term 0 (odds ratio [OR] = 2.70, p = <0.001), RAASi use (OR = 2.09, p = 0.02) and decreased urinary salt excretion in term 1 vs. term 0 (OR = 1.94, p = 0.002) were identified as independent variables associated with reduced UPE in term 1 vs. term 0. No significant interactions between the variables were observed. Conclusion: In kidney disease patients receiving standard medical care from nephrologists, the UPE after the emergency declaration in relation to the COVID-19 pandemic was lower than before the declaration. The UPE reduction may be associated with reduced dietary salt intake during the pandemic in patients treated with RAASi for insufficient control of proteinuria. Our results support the current proposal to continue therapeutic approaches to these patients, which involve RAASi therapy along with optimizing dietary habits, even while dealing with the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has unleashed multiple public health, socio-economic, and institutional crises. Measures taken to slow the spread of the virus have fostered significant strain between authorities and citizens, leading to waves of social unrest and anti-government demonstrations. We study the temporal nature of pandemic-related disorder events as tallied by the "COVID-19 Disorder Tracker" initiative by focusing on the three countries with the largest number of incidents, India, Israel, and Mexico. By fitting Poisson and Hawkes processes to the stream of data, we find that disorder events are inter-dependent and self-excite in all three countries. Geographic clustering confirms these features at the subnational level, indicating that nationwide disorders emerge as the convergence of meso-scale patterns of self-excitation. Considerable diversity is observed among countries when computing correlations of events between subnational clusters; these are discussed in the context of specific political, societal and geographic characteristics. Israel, the most territorially compact and where large scale protests were coordinated in response to government lockdowns, displays the largest reactivity and the shortest period of influence following an event, as well as the strongest nationwide synchrony. In Mexico, where complete lockdown orders were never mandated, reactivity and nationwide synchrony are lowest. Our work highlights the need for authorities to promote local information campaigns to ensure that livelihoods and virus containment policies are not perceived as mutually exclusive. [ABSTRACT FROM AUTHOR]

The Covid-19 disease has caused a world-wide pandemic with more than 60 million positive cases and more than 1.4 million deaths by the end of November 2020. As long as effective medical treatment and vaccination are not available, non-pharmaceutical interventions such as social distancing, self-isolation and quarantine as well as far-reaching shutdowns of economic activity and public life are the only available strategies to prevent the virus from spreading. These interventions must meet conflicting requirements where some objectives, like the minimization of disease-related deaths or the impact on health systems, demand for stronger counter-measures, while others, such as social and economic costs, call for weaker counter-measures. Therefore, finding the optimal compromise of counter-measures requires the solution of a multi-objective optimization problem that is based on accurate prediction of future infection spreading for all combinations of counter-measures under consideration. We present a strategy for construction and solution of such a multi-objective optimization problem with real-world applicability. The strategy is based on a micro-model allowing for accurate prediction via a realistic combination of person-centric data-driven human mobility and behavior, stochastic infection models and disease progression models including micro-level inclusion of governmental intervention strategies. For this micro-model, a surrogate macro-model is constructed and validated that is much less computationally expensive and can therefore be used in the core of a numerical solver for the multi-objective optimization problem. The resulting set of optimal compromises between counter-measures (Pareto front) is discussed and its meaning for policy decisions is outlined. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccines are approved, vaccination campaigns are launched, and worldwide return to normality seems within close reach. Nevertheless, concerns about the safety of COVID-19 vaccines arose, due to their fast emergency approval. In fact, the problem of antibody-dependent enhancement was raised in the context of COVID-19 vaccines. Methods and findings: We introduce a complex extension of the model underlying the pandemic preparedness tool CovidSim 1.1 (http://covidsim.eu/) to optimize vaccination strategies with regard to the onset of campaigns, vaccination coverage, vaccination schedules, vaccination rates, and efficiency of vaccines. Vaccines are not assumed to immunize perfectly. Some individuals fail to immunize, some reach only partial immunity, and—importantly—some develop antibody-dependent enhancement, which increases the likelihood of developing symptomatic and severe episodes (associated with higher case fatality) upon infection. Only a fraction of the population will be vaccinated, reflecting vaccination hesitancy or contraindications. The model is intended to facilitate decision making by exploring ranges of parameters rather than to be fitted by empirical data. We parameterized the model to reflect the situation in Germany and predict increasing incidence (and prevalence) in early 2021 followed by a decline by summer. Assuming contact reductions (curfews, social distancing, etc.) to be lifted in summer, disease incidence will peak again. Fast vaccine deployment contributes to reduce disease incidence in the first quarter of 2021, and delay the epidemic outbreak after the summer season. Higher vaccination coverage results in a delayed and reduced epidemic peak. A coverage of 75%–80% is necessary to prevent an epidemic peak without further drastic contact reductions. Conclusions: With the vaccine becoming available, compliance with contact reductions is likely to fade. To prevent further economic damage from COVID-19, high levels of immunization need to be reached before next year's flu season, and vaccination strategies and disease management need to be flexibly adjusted. The predictive model can serve as a refined decision support tool for COVID-19 management. [ABSTRACT FROM AUTHOR]

Studies of citizens' compliance with COVID-19 preventive measures routinely rely on survey data. While such data are essential, public health restrictions provide clear signals of what is socially desirable in this context, creating a potential source of response bias in self-reported measures of compliance. In this research, we examine whether the results of a guilt-free strategy recently proposed to lessen this constraint are generalizable across twelve countries, and whether the treatment effect varies across subgroups. Our findings show that the guilt-free strategy is a useful tool in every country included, increasing respondents' proclivity to report non-compliance by 9 to 16 percentage points. This effect holds for different subgroups based on gender, age and education. We conclude that the inclusion of this strategy should be the new standard for survey research that aims to provide crucial data on the current pandemic. [ABSTRACT FROM AUTHOR]

Background: Given the economic and social divide that exists in South Africa, it is critical to manage the health response of its residents to the Covid-19 pandemic within the different socio-economic contexts that define the lived realities of individuals. Objective: The objective of this study is to analyse the Covid-19 preventive behaviour and the socio-economic drivers behind the health-response behaviour. Data: The study employs data from waves 1 and 2 of South Africa's nationally representative National Income Dynamics Study (NIDS)—Coronavirus Rapid Mobile Survey (CRAM). The nationally representative panel data has a sample of 7073 individuals in Wave 1 and 5676 individuals in Wave 2. Methods: The study uses bivariate statistics, concentration indices and multivariate estimation techniques, ranging from a probit, control-function approach, special-regressor method and seemingly unrelated regression to account for endogeneity while identifying the drivers of the response behaviour. Findings: The findings indicate enhanced behavioural responsiveness to Covid-19. Preventive behaviour is evolving over time; the use of face mask has overtaken handwashing as the most utilised preventive measure. Other measures, like social distancing, avoiding close contact, avoiding big groups and staying at home, have declined between the two periods of the study. There is increased risk perception with significant concentration among the higher income groups, the educated and older respondents. Our findings validate the health-belief model, with perceived risk, self-efficacy, perceived awareness and barriers to preventive strategy adoption identified as significant drivers of health-response behaviour. Measures such as social distancing, avoiding close contact, and the use of sanitisers are practised more by the rich and educated, but not by the low-income respondents. Conclusion: The respondents from lower socio-economic backgrounds are associated with optimism bias and face barriers to the adoption of preventive strategies. This requires targeted policy attention in order to make response behaviour effective. [ABSTRACT FROM AUTHOR]

The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49–2.95), nurse (OR 1.38; 95% CI 1.04–1.84), and 'other clinical' (OR 2.02; 95% CI 1.45–2.82); being redeployed (OR 1.27; 95% CI 1.02–1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98–2.99), anxiety (OR 4.87; 95% CI 3.92–6.06) and depression (OR 4.06; 95% CI 3.04–5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51–0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22–0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers. [ABSTRACT FROM AUTHOR]

After a decade of civil war and the 2014–2016 West African Ebola outbreak, Sierra Leone now faces the COVID-19 pandemic with a fragile health system. As was demonstrated during Ebola, preparedness is key to limiting a health crisis' spread and impact on health systems and ensuring continued care for vulnerable populations including people living with HIV (PLHIV). To assess COVID-19 preparedness and inform interventions to ensure continuity of HIV services at health facilities (HFs) and community service points (CSPs), we conducted site readiness assessments in Freetown, the epicenter of COVID-19 in Sierra Leone. Data were collected at nine high-volume HIV HFs and seven CSPs in April 2020, a month after COVID-19 was declared a pandemic. CSPs comprised three community drop-in centers providing HIV counseling and testing services as well as HIV prevention services (e.g., condoms and lubricants) for key and priority populations and four community-based support groups serving PLHIV. At the time of assessment, CSPs did not provide antiretroviral therapy (ART) but were considered potential sites for expansion of differentiated service delivery (DSD)—a client-centered approach to HIV care—in the context of COVID-19. Overall, 5/9 HFs had trained staff on use of personal protective equipment (PPE) and prevention of COVID-19 transmission. Most had access to masks (5/9) and gloves (7/9) for management of suspected/confirmed COVID-19 cases, and 4/9 HFs had triage procedures for isolation of suspected cases. Conversely, few CSPs had access to masks (2/7) or gloves (2/7) and no staff were trained on PPE use or COVID-19 transmission. 7/9 HFs had adequate ART stock for multi-month dispensing though few had procedures for (3/9) or had trained staff in providing DSD (2/9). Among CSPs where measures were applicable, 2/4 had procedures for DSD, 1/3 had staff trained on DSD and none had adequate ART stock. Identification of gaps in COVID-19 preparedness is a critical step in providing support for infection control and modified service delivery. Findings from this assessment highlight gaps in COVID-19 preparedness measures at sites supporting PLHIV in Sierra Leone and indicate CSPs may require intensive supervision and training to ensure HIV services are uninterrupted while minimizing COVID-19 risk, especially if used as sites to scale up DSD. [ABSTRACT FROM AUTHOR]

Effective and rapid decision making during a pandemic requires data not only about infections, but also about human behavior. Mobile phone surveys (MPS) offer the opportunity to collect real-time data on behavior, exposure, knowledge, and perception, as well as care and treatment to inform decision making. The surveys aimed to collect coronavirus disease 2019 (COVID-19) related information in Ecuador and Sri Lanka using mobile phones. In Ecuador, a Knowledge, Attitudes and Practices (KAP) survey was conducted. In Sri Lanka, an evaluation of a novel medicine delivery system was conducted. Using the established mobile network operator channels and technical assistance provided through The Bloomberg Philanthropies Data for Health Initiative (D4H), Ministries of Health fielded a population-based COVID-19-specific MPS using Surveda, the open source data collection tool developed as part of the initiative. A total of 1,185 adults in Ecuador completed the MPS in 14 days. A total of 5,001 adults over the age of 35 in Sri Lanka completed the MPS in 44 days. Both samples were adjusted to the 2019 United Nations Population Estimates to produce population-based estimates by age and sex. The Ecuador COVID-19 MPS found that there was compliance with the mitigation strategies implemented in that country. Overall, 96.5% of Ecuadorians reported wearing a face mask or face covering when leaving home. Overall, 3.8% of Sri Lankans used the service to receive medicines from a government clinic. Among those who used the medicine delivery service in Sri Lanka, 95.8% of those who used a private pharmacy received their medications within one week, and 69.9% of those using a government clinic reported the same. These studies demonstrate that MPS can be conducted quickly and gather essential data. MPS can help monitor the impact of interventions and programs, and rapidly identify what works in mitigating the impact of COVID-19. [ABSTRACT FROM AUTHOR]

During the first wave of the global COVID-19 pandemic the clinical utility and indications for SARS-CoV-2 serological testing were not clearly defined. The urgency to deploy serological assays required rapid evaluation of their performance characteristics. We undertook an internal validation of a CE marked lateral flow immunoassay (LFIA) (SureScreen Diagnostics) using serum from SARS-CoV-2 RNA positive individuals and pre-pandemic samples. This was followed by the delivery of a same-day named patient SARS-CoV-2 serology service using LFIA on vetted referrals at central London teaching hospital with clinical interpretation of result provided to the direct care team. Assay performance, source and nature of referrals, feasibility and clinical utility of the service, particularly benefit in clinical decision-making, were recorded. Sensitivity and specificity of LFIA were 96.1% and 99.3% respectively. 113 tests were performed on 108 participants during three-week pilot. 44% participants (n = 48) had detectable antibodies. Three main indications were identified for serological testing; new acute presentations potentially triggered by recent COVID-19 e.g. pulmonary embolism (n = 5), potential missed diagnoses in context of a recent COVID-19 compatible illness (n = 40), and making infection control or immunosuppression management decisions in persistently SARS-CoV-2 RNA PCR positive individuals (n = 6). We demonstrate acceptable performance characteristics, feasibility and clinical utility of using a LFIA that detects anti-spike antibodies to deliver SARS-CoV-2 serology service in adults and children. Greatest benefit was seen where there is reasonable pre-test probability and results can be linked with clinical advice or intervention. Experience from this pilot can help inform practicalities and benefits of rapidly implementing new tests such as LFIAs into clinical service as the pandemic evolves. [ABSTRACT FROM AUTHOR]

Background: An appropriate specimen is of paramount importance in Real Time reverse transcription-polymerase chain reaction (rRT-PCR) based diagnosis of novel coronavirus (nCoV) disease (COVID-19). Thus, it's pertinent to evaluate various diversified clinical specimens' diagnostic utility in both diagnosis and follow-up of COVID-19. Methods: A total of 924 initial specimens from 130 COVID-19 symptomatic cases before initiation of treatment and 665 follow up specimens from 15 randomly selected cases comprising of equal number of nasopharyngeal swab (NPS), oropharyngeal swab (OPS), combined NPS and OPS (Combined swab), sputum, plasma, serum and urine were evaluated by rRT-PCR. Results: Demographic analysis showed males (86) twice more affected by COVID-19 than females (44) (p = 0.00001). Combined swabs showed a positivity rate of 100% followed by NPS (91.5%), OPS (72.3%), sputum (63%), while nCoV was found undetected in urine, plasma and serum specimens. The lowest cycle threshold (Ct) values of targeted genes E, ORF1b and RdRP are 10.56, 10.14 and 12.26 respectively and their lowest average Ct values were found in combined swab which indicates high viral load in combined swab among all other specimen types. Analysis of 665 follow-up multi-varied specimens also showed combined swab as the last specimen among all specimen types to become negative, after an average 6.6 (range 4–10) days post-treatment, having lowest (15.48) and average (29.96) Ct values of ORF1b respectively indicating posterior nasopharyngeal tract as primary nCoV afflicted site with high viral load. Conclusion: The combined swab may be recommended as a more appropriate specimen for both diagnosis and monitoring of COVID-19 treatment by rRT-PCR for assessing virus clearance to help physicians in taking evidence-based decision before discharging patients. Implementing combined swabs globally will definitely help in management and control of the pandemic, as it is the need of the hour. [ABSTRACT FROM AUTHOR]

Objective: Emergency Department (ED) attendances with chest pain reduced during the COVID-19 lockdown. We performed a service evaluation project in NHS Lothian to explore how and why the COVID-19 pandemic and public health advice had affected chest pain presentations and help-seeking behaviour at an individual patient level using a qualitative interview approach. Methods: We carried out 28 semi-structured telephone interviews with a convenience sample of patients who presented with chest pain during lockdown and in patients with known coronary heart disease under the outpatient care of a cardiologist in April and May 2020. Interviews were audio recorded and voice files listened to while making detailed notes. Salient themes and issues were documented as verbatim extracts. Interviews were analysed thematically. Results: Patient interviews revealed three main themes. 1) pandemic help-seeking behaviour; describing how participants made the decision to seek professional healthcare assessment. 2) COVID-19 exposure concerns; describing how the subthemes of perceived vulnerability, wishing to protect others and adding pressure to the health service shaped their decision making for an episode of acute chest pain. 3) hospital experience; describing the difference between the imagined and actual experience in hospital. Conclusions: Qualitative interviews revealed how the pandemic shaped help-seeking practices, how patients interpreted their personal vulnerability to the virus, and described patient experience of attending hospital for assessment during this time. As patient numbers presenting to hospital appeared to mirror public health messaging, dynamic monitoring of this messaging should evaluate public response to healthcare campaigns to ensure the net impact on health, pandemic and non-pandemic related, is optimised. [ABSTRACT FROM AUTHOR]

International scientific collaborations have always been regarded as critical actions to address global pandemics, however, there was an obvious uncertainty between international collaboration and the COVID-19 control. We aim to combine digital data-based strategies to produce meaningful and advanced insights into the imbalance between COVID-19 and international collaboration, as well as reveal possible influencing factors, and ultimately enhance global collaboration. We conducted three retrospective cohort studies using respectively COVID-19 data from WHO, a complete dataset of scientific publications on coronavirus-related research from WoS, and daily data from Google Trends (GT). The results of geovisualization and spatiotemporal analysis revealed that the global COVID19 pandemic still remains serious. The global issue of imbalance between international collaborations and pandemic does exit, and the nations with good pandemic control had their own characteristics in above-mentioned correlation. Digital epidemiology provides, at least in part, evidence-based assessment and scientific advice to understand the imbalance between international collaborations and COVID-19. Our investigation demonstrates that transdisciplinary conversation through digital data-based strategies can help us fully understand the complex factors influencing the effectiveness of international scientific collaboration, thus facilitating the global response to COVID-19. [ABSTRACT FROM AUTHOR]

Background: On January 30th 2020, the World Health Organization (WHO) declared a international health emergency due to the unprecedented phenomenon of COVID-19. After this declaration countries swiftly implemented a variety of health policies. In this work we examine how rapid countries responded to this pandemic using two events: the day in which the first case of COVID-19 was reported, and first day in which countries used school closure as one of the measures to avoid outbreaks. We also assessed how countries' health systems, globalization, economic development, political systems, and economic integration to China, Republic of Korea and Italy increased the speed of adoption. Methods: We compiled information from multiple sources, from December 31st 2019 to June 1st 2020, to trace when 172 countries reported their first COVID-19 case and implemented school closure to contain outbreaks. We applied cross-national Weibull survival analysis to evaluate the global speed of detection of first COVID-19 reported cases and school closure. Results: Ten days after WHO declared COVID-19 to be an international emergency, relative to seven days from this declaration, countries were 28 (95% CI: 12–77) times more likely to report first COVID-19 cases and 42 (95% CI: 22–90) times more likely to close schools. One standard deviation increase in the epidemic security index rises the rate of report first cases by 37% (Hazard Ratio (HR) 1.37 (95% CI: 1.09–1.72) and delays the adoption for school closures by 36% (HR 0.64 (95% CI:0.50–0.82). One standard deviation increase in the globalization index augments the adoption for school closures by 74% (HR 1.74 (95% CI:1.34–2.24). Conclusion: After the WHO declared a global emergency, countries were unprecedently acting very rapidly. While countries more globally integrated were swifter in closing schools, countries with better designed health systems to tackle epidemics were slower in adopting it. More studies are needed to assess how the speed of school closures and other policies will affect the development of the pandemic. [ABSTRACT FROM AUTHOR]

The distinct ways the COVID-19 pandemic has been unfolding in different countries and regions suggest that local societal and governmental structures play an important role not only for the baseline infection rate, but also for short and long-term reactions to the outbreak. We propose to investigate the question of how societies as a whole, and governments in particular, modulate the dynamics of a novel epidemic using a generalization of the SIR model, the reactive SIR (short-term and long-term reaction) model. We posit that containment measures are equivalent to a feedback between the status of the outbreak and the reproduction factor. Short-term reaction to an outbreak corresponds in this framework to the reaction of governments and individuals to daily cases and fatalities. The reaction to the cumulative number of cases or deaths, and not to daily numbers, is captured in contrast by long-term reaction. We present the exact phase space solution of the controlled SIR model and use it to quantify containment policies for a large number of countries in terms of short and long-term control parameters. We find increased contributions of long-term control for countries and regions in which the outbreak was suppressed substantially together with a strong correlation between the strength of societal and governmental policies and the time needed to contain COVID-19 outbreaks. Furthermore, for numerous countries and regions we identified a predictive relation between the number of fatalities within a fixed period before and after the peak of daily fatality counts, which allows to gauge the cumulative medical load of COVID-19 outbreaks that should be expected after the peak. These results suggest that the proposed model is applicable not only for understanding the outbreak dynamics, but also for predicting future cases and fatalities once the effectiveness of outbreak suppression policies is established with sufficient certainty. Finally, we provide a web app (https://itp.uni-frankfurt.de/covid-19/) with tools for visualising the phase space representation of real-world COVID-19 data and for exporting the preprocessed data for further analysis. [ABSTRACT FROM AUTHOR]

As the world grapples with the ongoing COVID-19 pandemic, a particularly thorny set of questions surrounds the reopening of primary and secondary (K-12) schools. The benefits of in-person learning are numerous, in terms of education quality, mental health, emotional well-being, equity and access to food and shelter. Early reports suggested that children might have reduced susceptibility to COVID-19, and children have been shown to experience fewer complications than older adults. Over the past few months, our understanding of COVID-19 has been further shaped by emerging data, and it is now understood that children are as susceptible to infection as adults and have a similar viral load during infection, even if asymptomatic. Based on this updated understanding of the disease, we have used epidemiological modeling to explore the feasibility and consequences of school reopening in the face of differing rates of COVID-19 prevalence and transmission. We focused our analysis on the United States, but the results are applicable to other countries as well. We demonstrate the potential for a large discrepancy between detected cases and true infections in schools due to the combination of high asymptomatic rates in children coupled with delays in seeking testing and receiving results from diagnostic tests. Our findings indicate that, regardless of the initial prevalence of the disease, and in the absence of robust surveillance testing and contact-tracing, most schools in the United States can expect to remain open for 20–60 days without the emergence of sizeable disease clusters. At this point, even if schools choose to close after outbreaks occur, COVID-19 cases will be seeded from these school clusters and amplified into the community. Thus, our findings suggest that the debate between the risks to student safety and benefits of in-person learning frames a false dual choice. Reopening schools without surveillance testing and contact tracing measures in place will lead to spread within the schools and within the communities that eventually forces a return to remote learning and leaves a trail of infection in its wake. [ABSTRACT FROM AUTHOR]

Background: We sought to investigate the impact of the COVID-19 pandemic and the Tele-HF Clinic (Tele-HFC) program on cardiovascular death, heart failure (HF) rehospitalization, and heart transplantation rates in a cohort of ambulatory HF patients during and after the peak of the pandemic. Methods: Using the HF clinic database, we compared data of patients with HF before, during, and after the peak of the pandemic (January 1 to March 17 [pre-COVID], March 17 to May 31 [peak-COVID], and June 1 to October 1 [post-COVID]). During peak-COVID, all patients were managed by Tele-HFC or hospitalization. After June 1, patients chose either a face-to-face clinic visit or a continuous tele-clinic visit. Results: Cardiovascular death and medical titration rates were similar in peak-COVID compared with all other periods. HF readmission rates were significantly lower in peak-COVID (8.7% vs. 2.5%, p<0.001) and slightly increased (3.5%) post-COVID. Heart transplant rates were substantially increased in post-COVID (4.5% vs. peak-COVID [0%], p = 0.002). After June 1, 38% of patients continued with the Tele-HFC program. Patients managed by the Tele-HFC program for <6 months were less likely to have HF with reduced ejection fraction (73% vs. 54%, p = 0.005) and stage-D HF (33% vs. 14%, p = 0.001), and more likely to achieve the target neurohormonal blockade dose (p<0.01), compared with the ≥6-month Tele-HFC group. Conclusions: HF rehospitalization and transplant rates significantly declined during the pandemic in ambulatory care of HF. However, reduction in these rates did not affect subsequent 5-month hospitalization and cardiovascular mortality in the setting of Tele-HFC program and continuum of advanced HF therapies. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic forced healthcare services organization to adjust to mutating healthcare needs. Not exhaustive data are available on the consequences of this on non-COVID-19 patients. The aim of this study was to assess the impact of the pandemic on non-COVID-19 patients living in a one-million inhabitants' area in Northern Italy (Bologna Metropolitan Area-BMA), analyzing time trends of Emergency Department (ED) visits, hospitalizations and mortality. We conducted a retrospective observational study using data extracted from BMA healthcare informative systems. Weekly trends of ED visits, hospitalizations, in- and out-of-hospital, all-cause and cause-specific mortality between December 1st, 2019 to May 31st, 2020, were compared with those of the same period of the previous year. Non-COVID-19 ED visits and hospitalizations showed a stable trend until the first Italian case of COVID-19 has been recorded, on February 19th, 2020, when they dropped simultaneously. The reduction of ED visits was observed in all age groups and across all severity and diagnosis groups. In the lockdown period a significant increase was found in overall out-of-hospital mortality (43.2%) and cause-specific out-of-hospital mortality related to neoplasms (76.7%), endocrine, nutritional and metabolic (79.5%) as well as cardiovascular (32.7%) diseases. The pandemic caused a sudden drop of ED visits and hospitalizations of non-COVID-19 patients during the lockdown period, and a concurrent increase in out-of-hospital mortality mainly driven by deaths for neoplasms, cardiovascular and endocrine diseases. As recurrencies of the COVID-19 pandemic are underway, the scenario described in this study might be useful to understand both the population reaction and the healthcare system response at the early phases of the pandemic in terms of reduced demand of care and systems capability in intercepting it. [ABSTRACT FROM AUTHOR]

The coronavirus pandemic has seen a marked rise in medical disinformation across social media. A variety of claims have garnered considerable traction, including the assertion that COVID is a hoax or deliberately manufactured, that 5G frequency radiation causes coronavirus, and that the pandemic is a ruse by big pharmaceutical companies to profiteer off a vaccine. An estimated 30% of some populations subscribe some form of COVID medico-scientific conspiracy narratives, with detrimental impacts for themselves and others. Consequently, exposing the lack of veracity of these claims is of considerable importance. Previous work has demonstrated that historical medical and scientific conspiracies are highly unlikely to be sustainable. In this article, an expanded model for a hypothetical en masse COVID conspiracy is derived. Analysis suggests that even under ideal circumstances for conspirators, commonly encountered conspiratorial claims are highly unlikely to endure, and would quickly be exposed. This work also explores the spectrum of medico-scientific acceptance, motivations behind propagation of falsehoods, and the urgent need for the medical and scientific community to anticipate and counter the emergence of falsehoods. [ABSTRACT FROM AUTHOR]

Purpose: The Covid-19 pandemic has brought unprecedented stress to students and educational institutions across the world. We aimed to estimate the effect of the pandemic on the mental health of college students. Methods: We used data on 419 first-year students (ages 18–20) at a large public university in North Carolina both before (October 2019-February 2020) and after (June/July 2020) the start of the Covid-19 pandemic. After evaluating descriptive data on mental health and stressors by students' demographic characteristics, we estimated the associations between Covid-19 stressors (including work reductions, health, distanced learning difficulties and social isolation) and mental health symptoms and severity controlling for students' pre-pandemic mental health, psychosocial resources, and demographic characteristics. Results: We found that the prevalence of moderate-severe anxiety increased from 18.1% before the pandemic to 25.3% within four months after the pandemic began; and the prevalence of moderate-severe depression increased from 21.5% to 31.7%. White, female and sexual/gender minority (SGM) students were at highest risk of increases in anxiety symptoms. Non-Hispanic (NH) Black, female, and SGM students were at highest risk of increases in depression symptoms. General difficulties associated with distanced learning and social isolation contributed to the increases in both depression and anxiety symptoms. However, work reductions as well as Covid-19 diagnosis and hospitalization of oneself, family members or friends were not associated with increases in depression or anxiety symptoms. Conclusion: Colleges may be able to reduce the mental health consequences of Covid-19 by investing in resources to reduce difficulties with distance learning and reduce social isolation during the pandemic. [ABSTRACT FROM AUTHOR]

Introduction: With over 500 000 infections and nearly 12 000 deaths, South Africa (SA) is the African epicenter of the current Coronavirus (COVID-19) pandemic. SA has implemented a 5-stage Risk-Adjusted Strategy which includes a phased national lockdown, requiring social distancing, frequent hand washing and wearing face masks. Strict adherence to this strategy is crucial to reducing COVID-19 transmission, flattening the curve, and preventing resurgence. As part of the 22-country International Citizens Project COVID-19 (ICPcovid), this study aimed to describe the SA adherence to the Risk-Adjusted Strategy and identify determinants of adherence. Method: During 24 April-15 May 2020, people were electronically invited, through social media platforms and a text blast, to complete an online survey, accessible via www.icpcovid.com. The survey investigated COVID-19 testing and preventative adherence measures, then used logistic regression analysis to identify predictors of adherence. Results: There were 951 participants, with 731(76.9%) 25 to 54 years. Most (672;70.7%) were female, and 705(74.1%) had a university degree. Since the epidemic started, 529(55.6%) and 436(45.9%) participants stated they were eating healthier and taking more vitamins, respectively. Only 82(8.6%) had been COVID-19 tested, and 1(1.2%) tested positive. In public, 905(95.2%) socially distanced, however 99(10.4%) participants had recently attended meetings with over ten people. Regular hand washing was practiced by 907(95.4%) participants, 774(81.4%) wore face masks and 854(89.8%) stayed home when they experienced flu-like symptoms. The odds of adhering to the guidelines were lower among men versus women (AOR 0.72, 95% confidence interval [CI] = 0.528, 0.971) and those who had flu-like symptoms (AOR 0.42, 95% CI = 0.277, 0.628). In contrast, increased odds were reported for those who reported increased vitamin intake (AOR 1.37, 95% CI = 1.044,1.798), and were either cohabiting or married (AOR 1.39, 95% CI = 1.042,1.847). Conclusion: Despite high reported adherence, face mask use and symptomatic individuals not self-isolating, were areas for improvement. However, these factors cannot solely account for SA's increasing COVID-19 cases. Larger general population studies are needed to identify other adherence predictors for a strengthened SA COVID-19 response. While the government must continue to educate the entire population on preventative measures, provide personal protective equipment and stress the importance of adherence, there also needs to be implementation of prioritised prevention strategies for men and single individuals to address their demonstrated lower adherence. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus-19 is a global health challenge and need an immediate action. Thus, understanding client's knowledge about SARS-COV2 causes, roots of transmissions, and prevention strategies are urgently warranted. Although there were global studies reported knowledge and preventive practices of COVID-19, but the information is not representative and inclusive for Ethiopia. Thus, the current study is done to identify the knowledge and the prevention strategies for COVID-19 among clients in South Wollo, Ethiopia. Methods: An institutional based cross-sectional study was conducted from May 21 to 30, 2020 among clients seeking service in Dessie town health facilities. A total of 81 clients were included from the selected health facilities with simple random sampling technique. We developed measuring tools by adopting from World Health Organization and center for disease prevention recommendation manual for assessing service providers' knowledge and preventive practices. For data entry Epi-data 3.1 version was employed and further data management and analysis was performed using STATA Version 14. Student T-test and one way ANOVA were computed to see the mean difference in knowledge and practice between and among the group. Chi-square test was also done to portray the presence of association between different co-variants with client's knowledge and preventive practices. Results: Findings of the study showed that more than half (56.8%) of the participants had good knowledge about its symptoms, way of spread and prevention of the virus. Furthermore, 65.4% of clients demonstrated five or more preventive practice measures of COVID-19. The mean preventive practice score with standard deviation was (4.75±1.28 from 6 components). In the current study, knowledge had no significant difference among sex, education status, and monthly income. However, COVID-19 transmission knowledge was significantly higher among urban residents. Thus, clients who were knowledgeable about way of transmission and symptoms of COVID-19 had significantly higher COVID-19 preventive practice. Conclusion: Our findings revealed that clients' knowledge and preventive practice of COVID-19 were not optimal. Clients with good knowledge and urban residents had practiced better prevention measures of the pandemic, signifying that packages and programs directed in enhancing knowledge about the virus is useful in combating the pandemic and continuing safe practices. [ABSTRACT FROM AUTHOR]

The first case of Coronavirus Disease 2019 in Italy was detected on February the 20th in Lombardy region. Since that date, Lombardy has been the most affected Italian region by the epidemic, and its healthcare system underwent a severe overload during the outbreak. From a public health point of view, therefore, it is fundamental to provide healthcare services with tools that can reveal possible new health system stress periods with a certain time anticipation, which is the main aim of the present study. Moreover, the sequence of law decrees to face the epidemic and the large amount of news generated in the population feelings of anxiety and suspicion. Considering this whole complex context, it is easily understandable how people "overcrowded" social media with messages dealing with the pandemic, and emergency numbers were overwhelmed by the calls. Thus, in order to find potential predictors of possible new health system overloads, we analysed data both from Twitter and emergency services comparing them to the daily infected time series at a regional level. Particularly, we performed a wavelet analysis in the time-frequency plane, to finely discriminate over time the anticipation capability of the considered potential predictors. In addition, a cross-correlation analysis has been performed to find a synthetic indicator of the time delay between the predictor and the infected time series. Our results show that Twitter data are more related to social and political dynamics, while the emergency calls trends can be further evaluated as a powerful tool to potentially forecast new stress periods. Since we analysed aggregated regional data, and taking into account also the huge geographical heterogeneity of the epidemic spread, a future perspective would be to conduct the same analysis on a more local basis. [ABSTRACT FROM AUTHOR]

The spread of Covid-19 has resulted in worldwide health concerns. Social media is increasingly used to share news and opinions about it. A realistic assessment of the situation is necessary to utilize resources optimally and appropriately. In this research, we perform Covid-19 tweets sentiment analysis using a supervised machine learning approach. Identification of Covid-19 sentiments from tweets would allow informed decisions for better handling the current pandemic situation. The used dataset is extracted from Twitter using IDs as provided by the IEEE data port. Tweets are extracted by an in-house built crawler that uses the Tweepy library. The dataset is cleaned using the preprocessing techniques and sentiments are extracted using the TextBlob library. The contribution of this work is the performance evaluation of various machine learning classifiers using our proposed feature set. This set is formed by concatenating the bag-of-words and the term frequency-inverse document frequency. Tweets are classified as positive, neutral, or negative. Performance of classifiers is evaluated on the accuracy, precision, recall, and F1 score. For completeness, further investigation is made on the dataset using the Long Short-Term Memory (LSTM) architecture of the deep learning model. The results show that Extra Trees Classifiers outperform all other models by achieving a 0.93 accuracy score using our proposed concatenated features set. The LSTM achieves low accuracy as compared to machine learning classifiers. To demonstrate the effectiveness of our proposed feature set, the results are compared with the Vader sentiment analysis technique based on the GloVe feature extraction approach. [ABSTRACT FROM AUTHOR]

This article investigates the effects of the COVID-19 outbreak on electoral participation. We study the French municipal elections that took place at the very beginning of the ongoing pandemic and held in over 9,000 municipalities on March 15, 2020. In addition to the simple note that turnout rates decreased to a historically low level, we establish a robust relationship between the depressed turnout rate and the disease. Using various estimation strategies and employing a large number of potential confounding factors, we find that the participation rate decreases with city proximity to COVID-19 clusters. Furthermore, the proximity has conditioned impacts according to the proportion of elderly –who are the most threatened– within the city. Cities with higher population density, where the risk of infection is higher, and cities where only one list ran at the election, which dramatically reduces competitiveness, experienced differentiated effects of distance. [ABSTRACT FROM AUTHOR]

This work is motivated by the recent worldwide pandemic of the novel coronavirus disease (COVID-19). When an epidemiological disease is prevalent, estimating the case fatality rate, the proportion of deaths out of the total cases, accurately and quickly is important as the case fatality rate is one of the crucial indicators of the risk of a disease. In this work, we propose an alternative estimator of the case fatality rate that provides more accurate estimate during an outbreak by reducing the downward bias (underestimation) of the naive CFR, the proportion of deaths out of confirmed cases at each time point, which is the most commonly used estimator due to the simplicity. The proposed estimator is designed to achieve the availability of real-time update by using the commonly reported quantities, the numbers of confirmed, cured, deceased cases, in the computation. To enhance the accuracy, the proposed estimator adapts a stratification, which allows the estimator to use information from heterogeneous strata separately. By the COVID-19 cases of China, South Korea and the United States, we numerically show the proposed stratification-based estimator plays a role of providing an early warning about the severity of a epidemiological disease that estimates the final case fatality rate accurately and shows faster convergence to the final case fatality rate. [ABSTRACT FROM AUTHOR]

Background: The World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) a global pandemic on 11th March, 2020. In Ethiopia, more than 90,490 and 1,300 confirmed cases and deaths were reported by the Federal Ministry of Health at the time of writing up this project. As health care providers are frontline workers managing the COVID-19 pandemic, this systematic review and meta-analysis aimed to assess the pooled level of knowledge, attitude, and practice towards COVID-19 among health professionals in Ethiopia. Methods: PubMed, Google Scholar, Excerpta Medica database (EMBASE), Cochrane Library, Web of Science, and African Journal of Online (AJOL) were searched. The data were extracted using Microsoft Excel and analyzed using STATA version 14. Publication bias was checked by funnel plot and more objectively through Egger's regression test, with P < 0.05 considered to indicate potential publication bias. The heterogeneity of studies was checked using I2 statistics. Pooled analysis was conducted using a weighted inverse variance random-effects model. Subgroup analysis was done related to geographic region and time. A leave-one-out sensitivity analysis was also employed. Result: A total of 11 studies with 3,843 study participants for knowledge, eight studies with 2,842 study participants for attitude and 10 studies with 3, 435 study participants for practice were used to estimate the pooled level of good knowledge, positive attitude and poor practice among health professionals. The overall estimated good level of knowledge, positive attitude and poor practice towards COVID-19 was found to be 79.4% (95% CI: 73.5%-85.2%; I2 = 96%), 73.7% (95%CI: 63.09%-84.4%; I2 = 98.3%) and 40.3% (95%CI: 31.1%-49.6%; I2 = 97.1%) respectively. Conclusion: Study findings showed that there were significant gaps in COVID-19 related knowledge, attitude and practice with respect to World Health Organization recommendations on COVID-19 management and personal protection practices. This study therefore recommends that institutions provide with immediate effect accurate and up-to-date information on COVID-19 and training that encourages improved knowledge, attitude and practice to mitigate this pandemic. [ABSTRACT FROM AUTHOR]

Societal responses to crises require coordination at multiple levels of organization. Exploring early efforts to contain COVID-19 in the U.S., we argue that local governments can act to ensure systemic resilience and recovery when higher-level governments fail to do so. Event history analyses show that large, more urban areas experience COVID-19 more intensely due to high population density and denser socioeconomic networks. But metropolitan counties were also among the first to adopt shelter-in-place orders. Analyzing the statistical predictors of when counties moved before their states, we find that the hierarchy of counties by size and economic integration matters for the timing of orders, where both factors predict earlier shelter-in-place orders. In line with sociological theories of urban governance, we also find evidence of an important governance dimension to the timing of orders. Liberal counties in conservative states were more than twice as likely to adopt a policy and implement one earlier in the pandemic, suggesting that tensions about how to resolve collective governance problems are important in the socio-temporal dynamic of responses to COVID-19. We explain this behavior as a substitution effect in which more urban local governments, driven by risk and necessity, step up into the action vacuum left by higher levels of government and become national policy leaders and innovators. [ABSTRACT FROM AUTHOR]

A novel infectious respiratory disease was recognized in Wuhan (Hubei Province, China) in December 2019. In February 2020, the disease was named "coronavirus disease 2019" (COVID-19). COVID-19 became a pandemic in March 2020, and, since then, different countries have implemented a broad spectrum of policies. Thailand is considered to be among the top countries in handling its first wave of the outbreak—12 January to 31 July 2020. Here, we illustrate how Thailand tackled the COVID-19 outbreak, particularly the effects of public health interventions on the epidemiological spread. This study shows how the available data from the outbreak can be analyzed and visualized to quantify the severity of the outbreak, the effectiveness of the interventions, and the level of risk of allowed activities during an easing of a "lockdown." This study shows how a well-organized governmental apparatus can overcome the havoc caused by a pandemic. [ABSTRACT FROM AUTHOR]

Background: A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures. Methods and findings: In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study registration: PROSPERO CRD42020178654. We identified 45 RCTs and 13 non-randomised controlled trials; none were conducted during the COVID-19 pandemic. The nature, type, and potential effectiveness of interventions varied greatly. Effective interventions for loneliness include psychological therapies such as mindfulness, lessons on friendship, robotic pets, and social facilitation software. Few interventions improved social isolation. Overall, 37 of 58 studies were of "Fair" quality, as measured by the Downs & Black checklist. The main study limitations identified were the inclusion of studies of variable quality; the applicability of our findings to the entire population; and the current poor understanding of the types of loneliness and isolation experienced by different groups affected by the COVID-19 pandemic. Conclusions: Many effective interventions involved cognitive or educational components, or facilitated communication between peers. These interventions may require minor modifications to align with COVID-19 shielding/social distancing measures. Future high-quality randomised controlled trials conducted under shielding/social distancing constraints are urgently needed. [ABSTRACT FROM AUTHOR]

During the Covid-19 pandemic, universities in the UK used social media to raise awareness and provide guidance and advice about the disease to students and staff. We explain why some universities used social media to communicate with stakeholders sooner than others. To do so, we identified the date of the first Covid-19 related tweet posted by each university in the country and used survival models to estimate the effect of university-specific characteristics on the timing of these messages. In order to confirm our results, we supplemented our analysis with a study of the introduction of coronavirus-related university webpages. We find that universities with large numbers of students are more likely to use social media and the web to speak about the pandemic sooner than institutions with fewer students. Universities with large financial resources are also more likely to tweet sooner, but they do not introduce Covid-19 webpages faster than other universities. We also find evidence of a strong process of emulation, whereby universities are more likely to post a coronavirus-related tweet or webpage if other universities have already done so. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has unhinged the lives of people across the globe. In particular, more than 30 million Chinese college students are home-schooling, yet there is little understanding of how academic workload, separation from school, and fears of contagion lead to a decrease in their health. This study examined the relationships between Chinese college students' three critical stressors and two types of health in the COVID‐19 pandemic context. We used a three-wave lagged design with a one-week interval. All the constructs were assessed by self-report in anonymous surveys during the COVID‐19 pandemic. College students were asked to report their demographic information, academic workload, separation from school, fears of contagion, perceived stress, and health. The results of this study showed that academic workload, separation from school, and fears of contagion had negative effects on college students' health via perceived stress. In the COVID-19 crisis, multiple prevention and control measures focusing on college students may lead them to have different degrees of stress and health problems. Our results enrich the literature on stress and health and offer novel practical implications for all circles of the society to ensure students' health under the context of the COVID-19 epidemic. [ABSTRACT FROM AUTHOR]

We present findings from three waves of a population-representative, UK time-use diary survey conducted both pre- and in real time during full 'lockdown', and again following the easing of social restrictions. We used an innovative online diary instrument that has proved both reliable and quick-to-field. Combining diary information on activity, location, and co-presence to estimate infection risks associated with daily behavior, we show clear changes in risk-associated behavior between the pre, full-lockdown and post full-lockdown periods. We document a shift from more to less risky daily behavior patterns (combinations of activity/location/co-presence categories) between the pre-pandemic pattern and full lockdown in May/June 2020, followed by a reversion (although not a complete reversal) of those patterns in August 2020 following the end of the first lockdown. Because, in general, a populations' time use changes relatively slowly, the behavioral changes revealed may be interpreted as a consequence of the UK COVID-19 lockdown social restrictions and their subsequent relaxation. [ABSTRACT FROM AUTHOR]

The outbreak of Coronavirus disease 2019(COVID-19) necessitated an abrupt transition from on campus, face-to-face sessions to online, distance learning in higher education institutions. The purpose of this study was to investigate the perceptions of postgraduate dental learners and instructors about the transition to distance learning, including the changes to the learning and teaching and its efficaciousness. A convergent mixed methods approach to research was utilized. All the instructors and postgraduate learners in a dental college were invited to participate in an online survey. Quantitative data was analyzed using descriptive and inferential analyses on SPSS for Windows version 25.0, and for the responses to the open-ended questions, multi-staged thematic analysis was utilized. Both groups of stakeholders: learners and instructors, were satisfied with the rapid transition to distance learning due to COVID-19. Instructors were significantly more satisfied than the learners. The stakeholders adapted well to the change. The perception of the stakeholders regarding the case-based scenarios significantly influenced their level of satisfaction. As perceived by the stakeholders, the transition to distance learning entailed advantages and challenges. Going through the experience enabled the stakeholders to develop informed opinions of how best to sustain learning and teaching irrespective of how matters unfold in relation to the pandemic. In conclusion, the worldwide dental education community faced unprecedented challenges due to the onset of COVID-19. From a macro perspective, decision-makers must not miss out on the valuable opportunities, inherent in the experience, to reinforce curriculums, and maximize learning and teaching. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has yielded an unprecedented quantity of new publications, contributing to an overwhelming quantity of information and leading to the rapid dissemination of less stringently validated information. Yet, a formal analysis of how the medical literature has changed during the pandemic is lacking. In this analysis, we aimed to quantify how scientific publications changed at the outset of the COVID-19 pandemic. Methods: We performed a cross-sectional bibliometric study of published studies in four high-impact medical journals to identify differences in the characteristics of COVID-19 related publications compared to non-pandemic studies. Original investigations related to SARS-CoV-2 and COVID-19 published in March and April 2020 were identified and compared to non-COVID-19 research publications over the same two-month period in 2019 and 2020. Extracted data included publication characteristics, study characteristics, author characteristics, and impact metrics. Our primary measure was principal component analysis (PCA) of publication characteristics and impact metrics across groups. Results: We identified 402 publications that met inclusion criteria: 76 were related to COVID-19; 154 and 172 were non-COVID publications over the same period in 2020 and 2019, respectively. PCA utilizing the collected bibliometric data revealed segregation of the COVID-19 literature subset from both groups of non-COVID literature (2019 and 2020). COVID-19 publications were more likely to describe prospective observational (31.6%) or case series (41.8%) studies without industry funding as compared with non-COVID articles, which were represented primarily by randomized controlled trials (32.5% and 36.6% in the non-COVID literature from 2020 and 2019, respectively). Conclusions: In this cross-sectional study of publications in four general medical journals, COVID-related articles were significantly different from non-COVID articles based on article characteristics and impact metrics. COVID-related studies were generally shorter articles reporting observational studies with less literature cited and fewer study sites, suggestive of more limited scientific support. They nevertheless had much higher dissemination. [ABSTRACT FROM AUTHOR]