Search

The latest outbreak of a coronavirus disease in 2019 (COVID‐19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), evolved into a worldwide pandemic with massive effects on health, quality of life, and economy. Given the short period of time since the outbreak, there are several knowledge gaps on the comparative and zoonotic aspects of this new virus. Within the One Health concept, the current EAACI position paper dwells into the current knowledge on SARS‐CoV‐2’s receptors, symptoms, transmission routes for human and animals living in close vicinity to each other, usefulness of animal models to study this disease and management options to avoid intra‐ and interspecies transmission. Similar pandemics might appear unexpectedly and more frequently in the near future due to climate change, consumption of exotic foods and drinks, globe‐trotter travel possibilities, the growing world population, the decreasing production space, declining room for wildlife and free‐ranging animals, and the changed lifestyle including living very close to animals. Therefore, both the society and the health authorities need to be aware and well prepared for similar future situations, and research needs to focus on prevention and fast development of treatment options (medications, vaccines).

Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a second and even third generation of vaccines has already been acknowledged by the WHO and governments. Perspectives There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organizations (i.e., telemedicine, e-Health, artificial intelligence, and machine-learning technology) is of major importance for the preservation of citizens' health and life world-wide.

The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.

The COVID-19 pandemic has tested the resilience of health systems broadly and primary care (PC) specifically. This paper begins by distinguishing the technical and political aspects of resilience and then draws on a documentary analysis and qualitative interviews with health system and PC stakeholders to examine competing resilience-focused responses to the pandemic in Alberta, Canada. We describe the pre-existing linkages between the province's central service delivery agency and its independent PC clinics. Together, these central and independent elements make up Alberta's broader health system, with the focus of this paper being on PC's particular vision of how resilience ought to be achieved. We describe two specific, pandemic-affected areas of activity by showing how competing visions of resilience emerged in the central service delivery agency and independent PC responses as they met at the system's points of linkage. At the first point of linkage, we describe the centralized activation of an incident management system and the replies made by independent PC stakeholders. At the second point of linkage, we describe central efforts to disseminate infection prevention and control guidance to PC clinics and the improvisational efforts of staff at those independent clinics to operationalize the guidance and ensure continuity of operations. We identify gaps between the resilience visions of the central agency and independent PC, drawing broadly applicable policy lessons for improving responses in present and future public health emergencies. Finding ways to include PC in centralized resilience policy planning is a priority.

This paper concerns a problem, the global pandemic COVID-19, which has influenced religious practices with respect to health protection across the Muslim world. Rapid transmission of the virus between people has become a serious challenge and a threat to the health protection of many countries. The increase in the incidence of COVID-19 in the Muslim community took place during and after the pilgrimages to Iran's Qom and as a result of the Jamaat Tabligh movement meetings. However, restrictions on religious practices have become a platform for political discussions, especially among Muslim clergy. This paper is an analysis of the religious and political situation in Muslim countries, showing the use of Islam to achieve specific goals by the authorities, even at the price of the health and life of citizens.

The COVID-19 pandemic has affected all countries irrespective of their state of development. In countries with traditional societies, religious leaders have been acknowledged as key stakeholders in community engagement activities, including disease prevention. A community-level prevention model was established in 2020 by the Health Promotion Bureau (HPB), Sri Lanka, which incorporated mobilisation of the clergy to support the prevention and response schemes to COVID-19 with non-governmental stakeholders. This model was part of a more extensive community engagement network established by the HPB in cooperation with the country offices for WHO and UNICEF. Building trust, empowering behavioural traits applicable to minimise risks from COVID-19, leadership and coordination, message dissemination, addressing stigma and discrimination, supporting testing procedures, contact tracing activities and vaccination, building community resilience, spiritual and psychosocial support, and welfare provision are some of the useful factors that were identified in the model. Furthermore, a much broader and holistic approach is needed to focus on health behaviours and social and cultural aspects in a multi-faceted nature. This paper highlights a novel COVID-19 prevention model with active involvement of religious leaders that can be implemented in low resource settings. Our experience from Sri Lanka demonstrates the feasibility of implementing this model to mitigate the disastrous situation following the COVID-19 outbreak.

The outbreak of coronavirus infectious disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has rapidly spread throughout the world. Several studies have shown that detecting SARS-CoV-2 in untreated wastewater can be a useful tool to identify new outbreaks, establish outbreak trends, and assess the prevalence of infections. On 06 May 2021, over a year into the pandemic, we conducted a scoping review aiming to summarize research data on SARS-CoV-2 in sewage. Papers dealing with raw sewage collected at wastewater treatment plants, sewer networks, septic tanks, and sludge treatment facilities were included in this review. We also reviewed studies on sewage collected in community settings such as private or municipal hospitals, healthcare facilities, nursing homes, dormitories, campuses, airports, aircraft, and cruise ships. The literature search was conducted using the electronic databases PubMed, EMBASE, and Web Science Core Collection. This comprehensive research yielded 1090 results, 66 of which met the inclusion criteria and are discussed in this review. Studies from 26 countries worldwide have investigated the occurrence of SARS-CoV-2 in sewage of different origin. The percentage of positive samples in sewage ranged from 11.6 to 100%, with viral concentrations ranging from ˂LOD to 4.6 × 108 genome copies/L. This review outlines the evidence currently available on wastewater surveillance: (i) as an early warning system capable of predicting COVID-19 outbreaks days or weeks before clinical cases; (ii) as a tool capable of establishing trends in current outbreaks; (iii) estimating the prevalence of infections; and (iv) studying SARS-CoV-2 genetic diversity. In conclusion, as a cost-effective, rapid, and reliable source of information on the spread of SARS-CoV-2 and its variants in the population, wastewater surveillance can enhance genomic and epidemiological surveillance with independent and complementary data to inform public health decision-making during the ongoing pandemic. Graphic Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s12560-021-09498-6.

Background Clinical guidelines on infection control strategies in healthcare workers (HCWs) play an important role in protecting them during the severe acute respiratory syndrome coronavirus 2 pandemic. Poorly constructed guidelines that are incomprehensive and/or ambiguous may compromise HCWs’ safety. Objective The objective of this study was to develop and validate a tool to appraise guidelines on infection control strategies in HCWs based on the guidelines published early in the coronavirus disease 2019 pandemic. Design, setting, and outcomes A three-stage, web-based, Delphi consensus-building process among a panel of diverse HCWs and healthcare managers was performed. The tool was validated by appraising 40 international, specialty-specific, and procedure-specific guidelines along with national guidelines from countries with a wide range of gross national income. Results Overall consensus (≥75%) was reached at the end of three rounds for all six domains included in the tool. The Delphi panel recommended an ideal infection control guideline should encompass six domains: general characteristics (domain 1), engineering recommendations (domain 2), personal protective equipment (PPE) use (domain 3), and administrative aspects (domain 4-6) of infection control. The appraisal tool performed well across the six domains, and the inter-rater agreement was excellent for the 40 guidelines. All included guidelines performed relatively better in domains 1–3 than in domains 4–6, and this was more evident in guidelines originating from lower income countries. Conclusion The guideline appraisal tool was robust and easy to use. Engineering recommendations aspects of infection control, administrative measures that promote optimal PPE use, and HCW wellbeing were generally lacking in assessed guidelines. This tool may enable health systems to adopt high-quality HCW infection control guidelines during the severe acute respiratory syndrome coronavirus 2 pandemic and may also provide a framework for future guideline development.

Aim This study aimed to assess the nurses' knowledge, concerns, perceived impact and preparedness toward the COVID‐19 pandemic. Background As COVID‐19 is a new disease, its spread and emergence cause fear, anxiety and confusion among the general population. Nurses are in close contact with infected persons, and their knowledge plays an important role in preventing the transmission chain. Methods In this cross‐sectional study, 207 nurses were selected using convenience sampling from 29 March to 19 April 2020. The study used a questionnaire assessing the nurses' baseline characteristics, their source of information, knowledge, concerns, the perceived impact and their preparedness for the COVID‐19 pandemic. Results Around half of the surveyed nurses (51.2%) reported that the Ministry of Health's and World Health Organization's websites and official pages were their main sources of information. The majority of nurses (81.6%) knew the nature of the virus, 83.6% agreed that their job puts them at risk of infection with COVID‐19 and 72% felt personally prepared for the pandemic. Conclusion The majority of nurses had an acceptable level of knowledge regarding COVID‐19. However, psychological interventions are needed to be addressed in the planning stage before any pandemic., Summary statement What is already known about this topic? It is well established that COVID‐19 is a highly infectious disease with a fatality rate of about 6.48% in Egypt.Studies about nursing and COVID‐19 are relatively few.There is a lack of data regarding the nurses' knowledge, concerns, perceived impact and preparedness toward COVID‐19. What does this paper add? Nurses prefer gaining their knowledge regarding COVID‐19 from the Ministry of Health's and the World Health Organization's websites and official pages rather than the social media websites.Nurses have an acceptable level of knowledge regarding COVID‐19. The majority of surveyed nurses knew the nature of the virus along with its signs and symptoms.The majority of surveyed nurses feel that their job puts them at the risk of infection with COVID‐19, and they are quite afraid of being infected. The implications of this paper: Psychological interventions are needed in the planning stage before any pandemic to enhance the protection of nurses and health care workers and to reduce the psychological impact.Sustainable awareness programmes are required for health care workers, keeping them up to date with the most recent information regarding prevention and management methods from the World Health Organization's guidelines and other instructional materials.Hospitals can hold meetings and organize regular psychological support groups to allow nurses to manage their fears and acquire stress reduction strategies.

Food insecurity contributes to negative outcomes for health and wellbeing, and its impact may be exacerbated during periods of vulnerability. While food insecurity is both a driver and a consequence of migration, anecdotal evidence indicates that it is also common during migration when people are ‘on the move’, although its prevalence and severity during these periods are largely undocumented. Food security monitoring is critical to ensuring the universal right to food for migrants, and instruments must be designed which capture the unique challenges faced during these ‘extra-ordinary’ periods of mobility, including in the context of emergencies such as the COVID-19 pandemic. This paper reviews knowledge on food security in migrants on the move and examines how active mobility intersects with food security and its measurement. Considering the potential consequences on health and wellbeing, we call for interdisciplinary research using standard instruments to document food insecurity in migrants on the move. Supplementary Information The online version contains supplementary material available at 10.1007/s10903-021-01276-7.

Objectives Widespread acceptance of the COVID‐19 vaccine will be the next important step in fighting the novel coronavirus disease. Though the Pakistani government has successfully implemented robust policies to overcome the COVID‐19 pandemic; however, studies assessing public intention to get COVID‐19 vaccination (IGCV) are limited. The aim of this study is to deal with this literature gap and has also expanded the conceptual framework of planned behaviour theory. We have introduced three new considerations (risk perceptions of the pandemic, perceived benefits of the vaccine, and unavailability of vaccine) to have a better understanding of the influencing factors that encourage or discourage public IGCV. Methods Results are based on a sample collected from 754 households using an inclusive questionnaire survey. Hypotheses are tested by utilizing the structural equation modelling approach. Results The results disclose that the intention factors, that is, attitude, risk perceptions of the pandemic, and perceived benefits of the vaccine, impart positive effects on public IGCV. In contrast, the cost of the vaccine and the unavailability of the vaccine have negative effects. Notably, environmental concern has an insignificant effect. Conclusions Research findings emphasize the importance of publicizing the devastating impacts of COVID‐19 on society and the environment, ensuring vaccination availability at an accessible price while simultaneously improving public healthcare practices.

Background There is an increase in the incidence of scabies in Turkey, which started before the Covid-19 pandemic, and this situation is considered as an epidemic. With this study, we aimed to reveal the prevalence of scabies during the pandemic period and the risk factors that are effective in the transmission of scabies. Methods Our study was performed as a cross-sectional study in 376 patients who applied to our dermatology outpatient clinic between 1st and 30th April 2021. Sociodemographic and socioeconomic characteristics, living space, health behavior, and health care utilization of the patients were questioned. Results The prevalence of scabies was determined as 10.9%. Features such as sex, area of residence, age, formal education status, employment status, total income, number of shower, number of people per room, water source, and heating method, which were found to be significant as a result of the double test, were included in the logistic regression analysis. Scabies was found 2.728 times (CI 1.325–5.557) more in those who live in rural areas than those who live in urban areas, 2.714 times (CI 1.365–5.451) more in men than women, 2.707 times (CI 1.256–5.833) more in nonworking than working, 2.354 times (CI 1.057–5.243) more in those with less than 9 showers per month than those with 9 or more showers per month. Conclusion During the Covid-19 pandemic period, the prevalence of scabies in Turkey is increasing and it is becoming a serious health problem. Our study emphasizes this increase and determines the risk factors for transmission.

Background Large-scale quarantine facilities staffed with non-healthcare workers (NHCW) were instrumental in preventing community spread of COVID-19 (coronavirus disease of 2019). The objective of this study was to determine the effectiveness of a newly developed procedural skills training framework in ensuring personal protective equipment (PPE) compliance of PPE-naïve NHCWs. Materials and methods We developed a PPE procedural skills training framework for NHCWs using the Learn, See, Practice, Prove, Do, and Maintain (LSPPDM) framework and international guidelines on PPE for healthcare workers. The NHCWs underwent PPE training using this framework, conducted by a team of Infection Prevention nurses, prior to being stationed within the CCF. Effectiveness of the LSPPDM PPE training framework was assessed using: 1) competency assessment scores for NHCWs, 2) PPE compliance rates from daily audit findings, and, 3) healthcare-associated COVID-19 infection rates of NHCWs. Results A total of 883 NHCWs had completed the PPE training and demonstrated competency in PPE compliance, fulfilling 100% of the checklist requirements. Mean PPE compliance of all NHCWs during the 11-week study period was noted to be >96%. The post-implementation improvement was statistically significant when the compliance was expressed in 3-days blocks) and in bed management staff (P = < 0.05). None of the 883 NHCWs who underwent PPE training via the LSPPDM framework were diagnosed with healthcare-associated COVID-19 infection. Conclusions An evidence-based skills training framework is effective in PPE training of large numbers of NHCWs, resulting in high compliance of appropriate PPE use and prevention of healthcare-associated COVID-19 infection.

The COVID-19 pandemic highlights the need for effective infectious disease outbreak prevention. This could entail installing an integrated, international early warning system, aiming to contain and mitigate infectious diseases outbreaks. The amount of resources governments should spend on such preventive measures can be informed by the value citizens attach to such a system. This was already recognized in 2018, when a contingent valuation willingness to pay (WTP) experiment was fielded, eliciting the WTP for such a system in six European countries. We replicated that experiment in the spring of 2020 to test whether and how WTP had changed during an actual pandemic (COVID-19), taking into account differences in infection rates and stringency of measures by government between countries. Overall, we found significant increases in WTP between the two time points, with mean WTP for an early warning system increasing by about 50% (median 30%), from around €20 to €30 per month. However, there were marked differences between countries and subpopulations, and changes were only partially explained by COVID-19 burden. We discuss possible explanations for and implication of our findings. Supplementary Information The online version contains supplementary material available at 10.1007/s10198-021-01353-6.

Background COVID-19 is a global health crisis. Close contact with the mucous membranes and respiratory secretions of patients and aerosol-generating procedures renders dentists and other oral health professionals at high risk of exposure to SARS-CoV-2. We examined dentists’ knowledge, preparedness, and experiences of managing COVID-19 in Australia. Methods A cross-sectional online survey of dentists with a current membership with The Australian Dental Association (ADA) was conducted between March and April 2021. Results Of the 368 survey responses, most dentists (72.3%) reported having a good level of knowledge about COVID-19, with most visiting the ADA Federal COVID-19 (74.7%) and state/territory department of health websites (62.8%), respectively to source up-to-date information. Most dentists (87.6%) felt prepared to manage COVID-19 into the future, although 66% reported not receiving training or certification in the use of PPE. Over half (58.7%) reported not being concerned about contracting SARS-CoV-2 at work, with some (28.9%, n=98/339) feeling more stressed than usual and having heavier workloads. Conclusions COVID-19 had significant impact in oral healthcare in Australia. Dentistry has adapted to the varied challenges raised by the pandemic. Comprehensive training and detailed guidelines were fundamental for successful patient management during the COVID-19 outbreak.

With the recent impact by the COVID‐19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID‐19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID‐19 impact on the research process, (b) researchers/leaders' presentations on the COVID‐19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) “a heavy emphasis on teaching and fluctuating productivity,” (b) “increased funding opportunities and governmental support,” (c) “gendered experience complicated by professional differences,” (d) “delays and changes/modifications in research process,” (e) “limited research settings and difficulties in getting access,” and (f) “increased online dissemination activities with positive changes in the image of nursing.” With all collective wisdom that nurse researchers have obtained during the COVID‐19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

The COVID-19 has been a worldwide pandemic and it needs for studies related to effect on people's demand for insurance during the pandemic which is an important way to transfer risk. However, there is a lack of research linking COVID-19 and people's demand for insurance. The objective of this paper is to investigate the impact of COVID-19 pandemic on issuance demand, using data covering 241 cities on confirmed COVID-19 cases and insurance company revenue in China. The empirical results show that more confirmed COVID-19 cases are associated with greater per capita insurance revenue and the results are robust when considering endogeneity concern. Economically, the per capita insurance revenue increases by 0.896 Yuan for each more confirmed case. In terms of insurance type, the greatest increased insurance revenue is for life insurance, followed by health insurance. We further consider the heterogeneity of regions and find that the impact of COVID-19 on insurance revenue only exists in regions with worse medical treatment conditions or higher medical burden.

Aims In the UK, deaths associated with COVID-19 have occurred in two waves. Evidence has shown an increase in 30-day mortality for hip fracture patients co-infected with COVID-19. However, there are no studies analysing mortality trends between the first two waves of the UK pandemic. Additionally, hospital versus community acquired COVID-19 infection between the two waves has not been analysed. Furthermore, predictive factors of 30-day mortality have not been fully evaluated. Methods Data from two audits conducted by the CHIP collaborative group were used: a published regional audit in England of nine hospitals providing the COVID-19 negative cases and an unpublished UK national audit of 43 hospitals, which provided the COVID-19 positive cases. Data collection for the COVID-19 positive cases was from 23 March to 31 December 2020. September 1, 2020 was used to define the transition between the two waves. Results There were 517 COVID-19 positive hip fracture patients and 1445 COVID-19 negative hip fracture patients. Overall, 30-day mortality rates were 5.7% in the COVID-19 negative group and 22.4% in the COVID-19 positive patients (p

Background Personal-protective equipment (PPE)-preparedness, defined as adherence to guidelines, healthcare worker (HCW) training, procuring PPE stocks and responding appropriately to suspected cases, is crucial to prevent HCW-infections. Objective To perform a follow-up survey to assess changes in PPE-preparedness across six Asia-Pacific countries during the COVID-19 pandemic. Design Prospective follow-up cross-sectional, web-based survey between 10/08/2020 to 01/09/2020, five months after the initial Phase 1 survey. Setting The same six Asia-Pacific countries (Australia, Hong Kong, India, New Zealand, Philippines, and Singapore) that participated in Phase 1. Participants Intensivists from 231 ICUs across these six countries. Main outcome measures Changes in PPE-preparedness between Phases 1 and 2. Results Phase 2 had responses from 132 ICUs (57%). Compared to Phase 1 respondents reported increased use of PPE-based practices such as powered air-purifying respirator (40.2% vs. 6.1%), N95-masks at all times (86.4% vs. 53.7%) and double-gloving (87.9% vs. 42.9%). The reported awareness of PPE stocks (85.6% vs. 51.9%), mandatory showering policies following PPE-breach (31.1% vs. 6.9%) and safety perception amongst HCWs (60.6% vs. 28.4%) improved significantly during Phase 2. Despite reported statistically similar adoption rate of the buddy system in both phases (42.4% vs. 37.2%), there was a reported reduction in donning/doffing training in Phase 2 (44.3% vs. 60.2%). There were no reported differences HCW training in other areas, such as tracheal intubation, intra-hospital transport and safe waste disposal, between the 2 phases. Conclusions Overall reported PPE-preparedness improved between the two survey periods, particularly in PPE use, PPE inventory and HCW perceptions of safety. However, the uptake of HCW training and implementation of low-cost safety measures continued to be low and the awareness of PPE breach management policies were suboptimal. Therefore, the key areas for improvement should focus on regular HCW training, implementing low-cost buddy-system and increasing awareness of PPE-breach management protocols.

Objective: In this study, we aimed to assess anxiety and sleep quality in cancer patients treated or followed up at our clinic at the time of the outbreak of the COVID-19 pandemic. Methods: Seven hundred and sixty-one patients who were either treated or followed up at our oncology clinic between April 2020 and May 2020 were included. Patients were assessed with the State-Trait Anxiety Inventory (STAI) and the Pittsburgh Sleep Quality Index (PSQI). Results: Mean scores of the 761 participants were STAI, 43.45 ± 9.34 (range, 23–75), and PSQI, 5.67 ± 4.24 (range, 0–19). Quality of sleep was found bad in 447 (58.7%) (global score ≥5). Univariate analyses demonstrated statistical differences by stage of cancer, status of treatment, subgroup of treatment, monthly income, and levels of education in anxiety and sleep quality levels. Multivariate analyses showed active treatment (OR: 21.4; 95% CI: 9.08–50.4; p < 0.001) as the major independent variable that affected sleep quality; the major independent variable associated with anxiety was low income (OR: 4.43; 95% CI: 1.69–11.5; p = 0.002). Conclusion: Anxiety and sleep quality levels were found comparable to pre-pandemic reports, and the pandemic was not observed to have additional negative impact on cancer patients. Also, universal basal anxiety and sleep disorder that accompany cancer or active treatment were observed in our study. The accurate effects of the pandemic can be analyzed in further studies using repeated data obtained from the same patient group.

A number of the people who have recovered from the acute effects of COVID-19 are facing long term sequelae from the infection. As the COVID-19 pandemic is still evolving, so is knowledge of the long-term effects of the virus on patients who still experience symptoms. Clearly, news media play a crucial role in distributing information and this distribution of information can, in turn, influence the actions of the public. The purpose of this study was to describe the content of news coverage of COVID-19 long haul symptoms currently posted on the internet. This study utilized Google News, a news aggregator service, and included the first 100 English language pieces of news. Video content and news article content were coded in depth for information on COVID-19 long haul symptoms. A total of 41% of news reports mentioned the length of time that the COVID-19 related symptoms persist. The length of time was reported to range from 1 month to more than 1 year. The symptom most commonly mentioned was tiredness or fatigue (74%), followed by difficulty breathing or shortness of breath (62 cases; 62%), and difficulty thinking or concentrating (50 cases; 50%). Other symptoms were mentioned less frequently. There were no statistically significant differences in any of the content including having video, written news reports, or both video and written news reports by source of the news reports based on consumer, professional, or television or internet-based news (p = .14). More complete coverage by online news media of the long-term effects of COVID-19 enhances public awareness of the post-acute syndromes, augments health providers' awareness of the range of chronic COVID-19 effects and the possibility of a second infection, increases the probability of patients' seeking and obtaining the proper care for their symptoms, and contributes to preventive actions for enhancing public health.

The second wave of COVID-19 pandemic has spread rampantly throughout India between April and May 2021, leading to high mortality rates. Identifying any change in the rate of vaccine hesitancy or refusal due to such mass casualty events will provide further insights on developing appropriate risk communication strategy. Hence, this study was undertaken to identify the vaccine hesitancy and refusal before and during the second wave of COVID-19 pandemic. We conducted a longitudinal study among 900 adults to know about their vaccine hesitancy and refusal pattern before (March 2021 - round-1) and during the second wave of COVID-19 pandemic (May 2021 - round-2). Telephonic interview was conducted using the pre-tested semi-structured questionnaire. There was an increase in the vaccine hesitancy (27.8% in round-1 to 32.7% in round-2) and refusal (25.6% in round-1 to 35.6% in round-2) during the second wave of pandemic in Puducherry. In adjusted analysis, vaccine hesitancy was found to increase by 1.19 times during the round-2 survey compared to round-1 survey (aIRR = 1.19; 95%CI: 1.03-1.37). We also found that the vaccine refusal increased by 1.40 times during the round-2 survey compared to round-1 survey (aIRR = 1.40; 95%CI: 1.22-1.62) after adjusting for age, place of residence, and occupation. We found that the confidence in COVID-19 vaccine efficacy and safety has declined over time leading to increase in the vaccine hesitancy and refusal in our study cohort, with more than one-third refusing to get themselves vaccinated during the second wave of pandemic.

As members of the Clinical Practice Committee (CPC) of the Society for General Internal Medicine (SGIM), we support practice innovation and transformation to achieve a more just system by which all people can achieve and maintain optimal health. The COVID-19 pandemic has tested the US healthcare delivery system and sharpened our national awareness of long-standing and ingrained system shortcomings. In the face of crisis, SGIM members innovated and energetically mobilized to focus on the immediate needs of our patients and communities. Reflecting on these experiences, we are called to consider what was learned from the pandemic that applies to the future of healthcare delivery. CPC members include leaders in primary care delivery, practice finance, quality of care, patient safety, hospital practice, and health policy. CPC members provide expertise in clinical practice, serving as primary care doctors, hospitalists, and patient advocates who understand the intensity of care needed for those with severe COVID-19 infections, the disproportionate impact of the pandemic on Black and Brown communities, the struggles created for those with poor access to care, and the physical and emotional impact it has placed on patients, families, and clinicians. In this consensus statement, we summarize lessons learned from the 2020-2021 pandemic and their broader implications for reform in healthcare delivery. We provide a platform for future work by identifying many interactive elements of healthcare delivery that must be simultaneously addressed in order to ensure that care is accessible, equitably provided, patient-centered, and cost-effective.

In the USA, the COVID-19 pandemic has created challenges beyond the direct consequences of the infection. Because of shifting resources in response to need, many domains within the healthcare sector unrelated to COVID-19 have had interrupted abilities to provide care. In the current study, we focus on preventative sexual health care during the pandemic. In a sample of 511 (mean age = 27.7) people, we examined quantitative data regarding continuation and discontinuation of birth control and PrEP during the pandemic, along with qualitative data illustrating the underlying reasons for participants' (dis)continuation. Results showed that most (92.5%) of birth control users reported continuation of their birth control, with the predominant reasons reported being use for health reasons, long-acting reversible contraceptive use, access to remote healthcare services, and increased vigilance over pregnancy prevention. Conversely, around half (52.6%) of PrEP-using participants reported already discontinuing or planning to discontinue their PrEP regimen. Temporary abstinence and concerns about accessing in-person health care were the predominant reasons for PrEP discontinuation. These results have implications for both researchers and sexual healthcare providers. Disruptions to preventative sexual health care should be considered in ongoing research about patient needs, and healthcare providers may wish to consider particular challenges faced by PrEP users concerning re-start and continuation.

BACKGROUND: Despite health anxiety (HA) is associated with higher incidence of anxiety disorders, no studies have examined the association between this variable and the increased levels of Post-Traumatic Stress Symptoms (PTSS) reported during COVID pandemic. METHODS: This study was conducted online between April and May 2020. Data were collected from 468 men and women from the Spanish general population. Sociodemographic and COVID-19-related data, health anxiety, PTSS, fear of becoming infected, social support, sleep problems and past/current psychological/psychiatric history were assessed. The mediating effect of HA when predicting PTSS was explored with mediational analyses. Moderated mediational analyses were also performed to test if receiving psychological treatment during pandemic changes the mediating effect of HA. RESULTS: Prevalence of PTSS was higher in high-scorers in HA (p

Studies from several countries have shown that the COVID-19 pandemic has disproportionally affected migrants. Many have numerous risk factors making them vulnerable to infection and poor clinical outcome. Policies to mitigate this effect need to take into account public health principles of inclusion, universal health coverage and the right to health. In addition, the migrant health agenda has been compromised by the suspension of asylum processes and resettlement, border closures, increased deportations and lockdown of camps and excessively restrictive public health measures. International organizations including the World Health Organization and the World Bank have recommended measures to actively counter racism, xenophobia and discrimination by systemically including migrants in the COVID-19 pandemic response. Such recommendations include issuing additional support, targeted communication and reducing barriers to accessing health services and information. Some countries have had specific policies and outreach to migrant groups, including facilitating vaccination. Measures and policies targeting migrants should be evaluated, and good models disseminated widely.

Background The European Union has been criticized for responding to the COVID-19 pandemic in a reactive, rather than prosilient manner. For the EU bloc to be prosilient, it needs to have the right early warning indicators to allow short-term healthcare system preparedness and agile planning of the public health response. Method The association of COVID-19 disease burden, as measured by mortality (COVID-19 and all-cause), hospital and ICU occupancy, with incidence rate (IR), total positivity rate (TPR) and adjusted TPR as proposed by Vong and Kakkar, was investigated using Poisson regression analysis. This was carried out using both real-time data and time lags of up to 8 weeks to identify potential for early warning of spikes in disease burden. ECDC weekly figures for these indicators were used, and the analysis was repeated for the subset of data after Week 42 of 2020, when the EU Council introduced minimum COVID-19 testing rates. Results TPR and IR were noted to be the most predictive of COVID-19 disease burden whilst adjusted TPR applied on weekly data was not associated. TPR behaved better at predicting all-cause mortality in both analyses. The TPR and IR were both best associated with hospital and ICU occupancy and COVID-19 mortality with a short time lag (2–3 weeks in the case of TPR with hospital occupancy and COVID-19 mortality). Conclusions Monitoring TPR can provide a 2–3-week warning of a spike in hospital occupancy and COVID-19 mortality. This time, if well utilized, could help health systems save countless lives by mobilising resources.

There has been an unprecedented global effort by researchers from many disciplines to obtain and synthesize knowledge to inform policy responses to SARS-CoV-2. While many major advances have been made in generating and applying knowledge on a pandemic caused by a novel pathogen, some things could have been done better, as revealed by the devastating loss of life and economic impact on livelihoods and communities. We reflect on the context in which the pandemic emerged, characterized by underinvestment in public health and growing distrust in institutions, followed by an overview of three broad areas: generation of new knowledge, synthesis of existing knowledge, both what was known prior to the pandemic and what emerged during it, and the challenges of translating knowledge into policy. We also consider areas that were largely overlooked in the research effort. Across all areas, we aim to draw out relevant lessons for future research and public health practice.

BACKGROUND: COVID-19 pandemic continues to pose a huge threat to public health. Mass vaccination is needed to achieve herd immunity against SARS-CoV-2. Currently, several vaccines are being inoculated on a large-scale. The willingness of COVID-19 vaccination had been well investigated in the pre-vaccination era, but no reported data in the post-vaccination era yet. METHODS: We conducted a large-scale survey among industrial workers during the vaccination campaign in China. Chi-square test and rank sum test were used to identify differences for various intentions regarding COVID-19 vaccination. Univariate analysis and multivariate regression models were utilized to analyze the relationship among demographic factors, related influencing factors and acceptance of COVID-19 vaccination. RESULTS: A total of 23,940 industrial workers were included, 66.0% were willing to take COVID-19 vaccine, 16.6% were unwilling, and 17.4% were unsure. Participants were more likely to get vaccinated if they were male, aged 45–65, being good educated, married, or being recommended by doctors or nurses. Participants with strong risk perception of COVID-19 infection, strong confidence in COVID-19 vaccine, high attention to COVID-19 vaccine, good health status, bad health habit, and a history of vaccination within three months were also more likely to be vaccinated. CONCLUSIONS: This study calls for more attention and health-related education among industrial workers to improve their acceptance of COVID-19 vaccination.

In Italy, the COVID-19 pandemic and the death of many elderly people have put in evidence the uneven territorial distribution of nursing homes, which have amplified the spread and severity of the pandemic. By applying a pooled OLS model to the Italian regions, over the 2010-18 period, we investigate the demand factors, market forces and institutional drivers of the spatial distribution of residential healthcare for the elderly. Using a fine-grained approach that considers specific regional and age-related elements and the market environment, which can reduce or increase the pressure on regional governments to provide formal assistance, we find that the financial resources and the availability of unemployed women as potential caregivers explain the distribution of expenditure better than the health needs of the elderly. As a result, the expenditure is concentrated in richer and more financially autonomous regions and it is not congruent with the distribution of chronicity, health and frailty factors or income among the elderly. These critical issues of the care services for frail elderly people, related to a highly decentralized governance and resulting in fragmented, market-driven provision, could be attacked only by a national reform.

Vaccination is a critical means for mitigating the worst effects of the COVID-19 pandemic in the United States (US). However, the initial high demand for COVID-19 vaccines has not persisted, and the rate of vaccination slowed significantly in the summer of 2021. This study seeks to understand the motivations to receive the COVID-19 vaccine among hesitant adopters. Hesitant adopters are individuals who express some level of hesitancy about the vaccine but have also received at least one dose of the vaccine. Using a qualitative descriptive design, three loci for motivation emerged during analysis: extrinsic motivators, intrinsic motivators, and structural motivators. Extrinsic motivations, such as protecting one’s community, family, and friends, were reported as driving vaccination behavior. Among intrinsic motivators, the desire to protect themselves from COVID-19 was the most frequently reported. Structural motivators were also identified, indicating that vaccine mandates also serve to motivate hesitant adopters of the COVID-19 vaccine. These findings have important implications in ongoing efforts to increase COVID-19 vaccine uptake in the US and highlight the multi-dimensional motivations for vaccination among hesitant adopters. Additionally, we provide recommendations for practice based on our findings.

Infection 50(3), 607-616 (2022). doi:10.1007/s15010-021-01716-4, Published by Springer, Berlin ; Heidelberg

Vaccination behavior is an informative metric for assessing flu seasons and is especially important to understand for the 2020–2021 flu season, which coincided with the COVID-19 pandemic. This study aimed to estimate flu vaccine behavior and assess vaccine perceptions during the pandemic season. Using a cross-sectional descriptive study design, we conducted an online survey to assess vaccination behavior and perceptions of both COVID-19 and the flu. Patients were identified as recently seen by providers in an academic internal medicine practice (n = 827) and surveys were distributed as messages in the Epic electronic medical record system. We found that 88.3% of respondents (188/206) had received their flu vaccination for the season at the time of their survey response in December 2020–February 2021. Of those that had not yet received the flu vaccine, only 13.6% indicated they planned on getting one. 12.5% of respondents said they had changed their flu vaccine plans due to the COVID-19 pandemic. Looking at differences from past season’s behavior, more individuals switched to getting the flu vaccine than those that switched to not getting the vaccine this season. The most frequently cited reasons for not receiving the flu vaccination were concerns about side effects and not being in a priority group. Changes in flu vaccination behavior from previous seasons represent a net positive in the direction of vaccine acceptance. Barriers to vaccination were identified and results from this study provide more information on vaccine perceptions, beliefs, and behavior, which can benefit future vaccination programs.

Given the urgent global need for vaccinating individuals of all ages against the COVID-19 pandemic, understanding the extent and reasons for parents’ willingness to get their children vaccinated is important. This study used an internet-based questionnaire survey to determine parents’ willingness to get their children (0 to 15 years) vaccinated in Japan and was conducted in April 2021 before COVID-19 vaccination for children began. Socio-demographic information, information about parents’ willingness to get children vaccinated, reasons for their responses, and parents’ willingness to get themselves vaccinated were obtained. Descriptive statistics were used to evaluate parents’ willingness to get children vaccinated based on the other variables. Logistic regression analyses were conducted to identify the characteristics of parents who indicated willingness to get their children vaccinated and to identify the reasons for vaccine willingness. Of the 1100 respondents, 472 were willing to get children vaccinated, 470 were not sure, and 158 did not want to get children vaccinated. Considerable differences were found in the willingness to get children vaccinated across gender, age groups, occupation, annual income, respondent’s academic background, and respondent’s willingness to get COVID-19 vaccination for themselves. Reasons for being unsure about the vaccination included the vaccine’s potential side effects (84.9%), uncertainty about vaccine safety (54.7%), and not trusting vaccine efficiency (25.7%). Parents’ willingness to get the COVID-19 vaccine for themselves was a significant factor for their willingness to get children vaccinated after adjusting all other factors. The study recommends disseminating more and correct information to the public to increase vaccine willingness.

For medical students first entering the clinical space in July 2020, the unique challenges related to the coronavirus pandemic threatened to amplify the psychological distress associated with clerkship rotations. This study aimed to characterize the mental health of third-year medical students starting clinical clerkships in the midst of a pandemic by assessing symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) as well as risk, coping, and protective factors associated with psychological outcomes. Of 147 third-year medical students at the Icahn School of Medicine at Mount Sinai in New York City, 110 (75%) participated in this prospective survey-based study with 108 included in the final analysis. 43 (39.8%) respondents screened positive for symptoms of either MDD, GAD, or PTSD. Multiple regression analyses revealed that greater overall symptom severity was associated with more avoidant coping, more traumatic events witnessed, poorer student and leisure functioning, lower trait emotional stability, and lower social support. Worries related to COVID-19 did not significantly influence outcome variables. To better understand the role of the pandemic on psychological outcomes in third-year medical students, additional research should focus on the trajectory of these outcomes over the year during the coronavirus pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11126-021-09955-2.

The purpose of this study was to identify the main barriers to vaccine acceptance among medical students in Kazakhstan and to develop the COVID-19 Vaccine Hesitancy Scale (COV-VHS). A cross-sectional study was carried out among students at Astana Medical University (N = 888, Kazakhstan) in March 2021. Only 2% of the participants were currently vaccinated, and 22.4% showed the potential for COVID-19 vaccine acceptance. The following barriers were the most important in COVID-19 vaccine acceptance: concern about possible side effects of vaccination (73%), absence of sufficient evidence on the effectiveness and safety (57%) and quality (42%), the belief that the immune system will cope with COVID-19 even without vaccination (38%), and lack of trust in the effectiveness of vaccination against COVID-19 (33%). Moreover, this study identified the following factors associated with COVID-19 vaccine acceptance: contextual influences (e.g., communication and media environment, socio-demographic factors, vaccination policies, and perception of the pharmaceutical industry), individual and group influences (e.g., personal experience with vaccination, attitudes about health and prevention, trust in the health system and providers, perceived risk), and specific issues on COVID-19 vaccine/vaccination (e.g., choice of vaccine can reduce vaccine hesitancy by 30%). A developed 12-item 6-factor model of COV-VHS showed good validity and reliability. In conclusion, there was a low-level potential for COVID-19 vaccine acceptance among medical students in Kazakhstan. Thus, an effective vaccination education and policy are needed to combat the COVID-19 pandemic.

The ongoing humanitarian crisis in Venezuela has made it difficult to satisfactorily manage the COVID-19 pandemic in that nation. A vaccination program has begun, but its pace has been slow, as compared to vaccination in other countries. One considerable obstacle faced by vaccination efforts in Venezuela is vaccine hesitancy. Differences across religious groups regarding vaccine hesitancy in Venezuela have not been sufficiently explored. The present study consists of a sample of 230 university students in Venezuela, assessing their intention to get the COVID-19 vaccine. Their responses are compared across religious affiliations, and correlated with three variables: belief in vaccine conspiracy theories, religiosity, and acceptance of the theory of evolution. Results come out showing that Protestants are the religious group most hesitant to get the COVID-19 vaccine, followed by Catholics and the non-religious. Results also show that vaccine hesitancy is correlated with vaccine conspiracy theories and acceptance of the theory of evolution, but not with religiosity itself.