Monitoramento das Produções

by H. M. R. K. G. Nandasena, M. L. Pathirathna, A. M. M. P. Atapattu, P. T. S. Prasanga
Background Understanding the impact of COVID 19 on patients’ quality of life (QOL) following discharge or recovery is essential for planning necessary interventions in advance. As such, this systematic review aimed to provide an overview of the QOL, and the factors associated with it in COVID-19 patients following discharge or recovery. Methods The Databases of PubMed, Cochrane Library, and Science Direct were searched. The review included studies that (1) assessed the QOL of COVID 19 patients following discharge or recovery, (2) were written in English, (3) used a validated instrument to assess the quality of life and (4) used an observational or cohort study design. The PRISMA guidelines were followed. Following the initial search, 2866 articles were identified as being related. A total of 1089 articles were identified as duplicates. 1694 studies were excluded during the title and abstract screening stage, and 83 studies were screened at the full-text screening stage. Finally, 21 studies were included in this systematic review. Results This systematic review included 4408 patients who tested positive for COVID 19. Of them 50.2% (n = 2212) were males. Regardless of the time since discharge or recovery, COVID 19 patients’ QOL has been significantly impacted. Female sex, older age, co-morbidities, Intensive Care Unit (ICU) admission, prolonged ICU stay, and being mechanically ventilated were the most frequently reported factors associated with the low level of QOL. Conclusion The QOL of the post COVID19 patients was significantly impacted, regardless of the time elapses since discharge or recovery. Thus, when implementing programs to improve the QOL of post COVID19 patients, the most affected domains of QOL and associated factors should be considered.

Title: Carta aberta: recomendações para vigilância oportuna dos casos de COVID-19 no Brasil: 10 de setembro de 2020
Authors: ​Covid19Analytics; ​MAVE (PROCC/Fiocruz e EMAp/FGV); ​MonitoraCovid-19 (ICICT/Fiocruz); ​Observatório COVID-19 BR; ​COVID19: Observatório Fluminense
Abstract: Os grupos de pesquisa que assinam esta carta, bem como outros grupos dedicados à vigilância
epidemiológica, utilizam tais métodos e disponibilizam os dados gerados em suas plataformas
(websites ou repositórios de dados) para auxiliar todo e qualquer indivíduo interessado em fazer uso
destes dados seja para comunicação, para tomada de decisão quanto a comportamento individual, ou
para implementação de políticas públicas de enfrentamento da epidemia.
Description: Assinam esta carta: ​Covid19Analytics​, ​MAVE (PROCC/Fiocruz e EMAp/FGV)​, ​MonitoraCovid-19
(ICICT/Fiocruz)​, ​Observatório COVID-19 BR​, ​COVID19: Observatório Fluminense​, como desfecho do
webinar ​"O Panorama da Covid-19 no Rio de Janeiro e no Brasil: onde estamos e para onde vamos"​.

Title: Nota Técnica 23 de 20 de dezembro de 2021. Desigualdades na vacinação contra Covid-19
Abstract: Esta nota técnica apresenta alguns aspectos da desigualdade no processo de vacinação contra Covid-19 no Brasil.
Description: MonitoraCovid-19: https://bigdata-covid19.icict.fiocruz.br/

by Hannah A. Roberts, D. Angus Clark, Claire Kalina, Carter Sherman, Sarah Brislin, Mary M. Heitzeg, Brian M. Hicks

The novel coronavirus (COVID-19) is a highly contagious disease responsible for millions of deaths worldwide. Effective vaccines against COVID-19 are now available, however, an extreme form of vaccine hesitancy known as anti-vax attitudes challenge vaccine acceptance and distribution efforts. To understand these anti-vax attitudes and their associated psychological characteristics, we examined several predictors of vaccine hesitancy for COVID-19 and anti-vax attitudes generally. We surveyed 1004 adults (M = 47.0 years, SD = 17.1 years, range 18–98 years) in September-October 2020 across the United States (51% female, 49% male; 76.5% White, 23.5% non-White), prior to widespread availability of the COVID-19 vaccines. Attitudes toward vaccinations were influenced by a variety of factors, especially political attitudes. We should therefore anticipate and attempt to mitigate these challenges to achieving widespread vaccination to reduce the spread of COVID-19 and other communicable diseases.

by Christopher J. Gonzalez, Cameron J. Hogan, Mangala Rajan, Martin T. Wells, Monika M. Safford, Laura C. Pinheiro, Arnab K. Ghosh, Justin J. Choi, Clare A. Burchenal, Pooja D. Shah, Martin F. Shapiro

Older individuals with chronic health conditions are at highest risk of adverse clinical outcomes from COVID-19, but there is widespread belief that risk to younger, relatively lower-risk individuals is negligible. We assessed the rate and predictors of life-threatening complications among relatively lower-risk adults hospitalized with COVID-19. Of 3766 adults hospitalized with COVID-19 to three hospitals in New York City from March to May 2020, 963 were relatively lower-risk based on absence of preexisting health conditions. Multivariable logistic regression models examined in-hospital development of life-threatening complications (major medical events, intubation, or death). Covariates included age, sex, race/ethnicity, hypertension, weight, insurance type, and area-level sociodemographic factors (poverty, crowdedness, and limited English proficiency). In individuals ≥55 years old (n = 522), 33.3% experienced a life-threatening complication, 17.4% were intubated, and 22.6% died. Among those

by Ninh T. Nguyen, Justine Chinn, Katherine Kirby, Samuel F. Hohmann, Alpesh Amin
Introduction The coronavirus disease 2019 (COVID-19) pandemic continues to spread globally and as of February 4, 2021, there are more than 26 million confirmed cases and more than 440,000 deaths in the United States (US). A top priority of the Centers for Disease Control and Prevention (CDC) is to identify risk factors for severe COVID-19 illness. The objective of this study was to analyze the characteristics and outcomes of COVID-19 adults who were managed in an outpatient setting compared to patients who required hospitalization at US academic centers. Methods Using the Vizient clinical database, Discharge records of adults with a diagnosis of COVID-19 between March 1, 2020 and January 31, 2021 were reviewed. Outcome measures included demographics, characteristics, rate of hospitalization, and mortality, and data were analyzed based on inpatient versus outpatient management. Results Among COVID-19 adults, 1,360,078 patients were managed in an outpatient setting while 545,635 patients required hospitalization. Compared to hospitalized COVID-19 adults, COVID-19 adults who were managed in an outpatient setting were more likely to be female (56.1% vs 47.5%, p

by Anders Carlander, Mats Lekander, Gordon J. G. Asmundson, Steven Taylor, Roger Olofsson Bagge, Ann-Sophie Lindqvist Bagge
Background The COVID Stress Scales (CSS) assess health- and contamination-related distress in the face of a medical outbreak like the ongoing COVID-19 pandemic. Though the CSS is translated into 21 languages, it has not been validated in a Swedish national sample. Aim Our general objective is to provide a translation, replication, and validation of the CSS and test its convergent- and discriminant validity in relation to anxiety, health anxiety, depression, and stress in the general Swedish population. We also present latent psychometric properties by modelling based on item response theory. Methods Participants consisted of 3044 Swedish adults (> 18 years) from a pre-stratified (gender, age, and education) sample from The Swedish Citizen Panel. Mental health status was assessed by validated instruments, including the CSS, PHQ-4, SHAI-14, and PSS-10. Results Results indicate that our Swedish translation of CSS has good psychometric properties and consists of 5 correlated factors. Discussion The CSS is useful either as a unidimensional or multidimensional construct using the CSS scales to measure key facets of pandemic-related stress. Conclusions The findings support the cross-cultural validity of the CSS and its potential utility in understanding many of the emotional challenges posed by the current and future pandemics.

by Julian Oliver Dörr, Jan Kinne, David Lenz, Georg Licht, Peter Winker

Usually, official and survey-based statistics guide policymakers in their choice of response instruments to economic crises. However, in an early phase, after a sudden and unforeseen shock has caused unexpected and fast-changing dynamics, data from traditional statistics are only available with non-negligible time delays. This leaves policymakers uncertain about how to most effectively manage their economic countermeasures to support businesses, especially when they need to respond quickly, as in the COVID-19 pandemic. Given this information deficit, we propose a framework that guided policymakers throughout all stages of this unforeseen economic shock by providing timely and reliable sources of firm-level data as a basis to make informed policy decisions. We do so by combining early stage ‘ad hoc’ web analyses, ‘follow-up’ business surveys, and ‘retrospective’ analyses of firm outcomes. A particular focus of our framework is on assessing the early effects of the pandemic, using highly dynamic and large-scale data from corporate websites. Most notably, we show that textual references to the coronavirus pandemic published on a large sample of company websites and state-of-the-art text analysis methods allowed to capture the heterogeneity of the pandemic’s effects at a very early stage and entailed a leading indication on later movements in firm credit ratings. While the proposed framework is specific to the COVID-19 pandemic, the integration of results obtained from real-time online sources in the design of subsequent surveys and their value in forecasting firm-level outcomes typically targeted by policy measures, is a first step towards a more timely and holistic approach for policy guidance in times of economic shocks.

Title: Simultaneous circulation of Zika, Dengue, and Chikungunya viruses and their vertical co-transmission among Aedes aegypti
Authors: Teixeira, Adriano Fernandes; Brito, Breno Bittencourt de; Correia, Thiago Macêdo Lopes; Viana, Airton Idalécio Sousa; Carvalho, Juliana Cabral; Silva, Filipe Antônio França da; Santos, Maria Luísa Cordeiro; Silveira, Eliezer Almeida da; Granger Neto, Henry Paul; Silva, Natalia Maria Pereira da; Rocha, Cínthya Viana Souza; Pinheiro, Fillipe Dantas; Chaves, Bárbara Aparecida; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícius Guimarães de; Secundino, Nágila Francinete Costa; Pimenta, Paulo Filemon Paolucci; Melo, Fabrício Freire de

by Peter Ashcroft, Sonja Lehtinen, Sebastian Bonhoeffer

The test-trace-isolate-quarantine (TTIQ) strategy, where confirmed-positive pathogen carriers are isolated from the community and their recent close contacts are identified and pre-emptively quarantined, is used to break chains of transmission during a disease outbreak. The protocol is frequently followed after an individual presents with disease symptoms, at which point they will be tested for the pathogen. This TTIQ strategy, along with hygiene and social distancing measures, make up the non-pharmaceutical interventions that are utilised to suppress the ongoing COVID-19 pandemic. Here we develop a tractable mathematical model of disease transmission and the TTIQ intervention to quantify how the probability of detecting and isolating a case following symptom onset, the fraction of contacts that are identified and quarantined, and the delays inherent to these processes impact epidemic growth. In the model, the timing of disease transmission and symptom onset, as well as the frequency of asymptomatic cases, is based on empirical distributions of SARS-CoV-2 infection dynamics, while the isolation of confirmed cases and quarantine of their contacts is implemented by truncating their respective infectious periods. We find that a successful TTIQ strategy requires intensive testing: the majority of transmission is prevented by isolating symptomatic individuals and doing so in a short amount of time. Despite the lesser impact, additional contact tracing and quarantine increases the parameter space in which an epidemic is controllable and is necessary to control epidemics with a high reproductive number. TTIQ could remain an important intervention for the foreseeable future of the COVID-19 pandemic due to slow vaccine rollout and highly-transmissible variants with the potential for vaccine escape. Our results can be used to assess how TTIQ can be improved and optimised, and the methodology represents an improvement over previous quantification methods that is applicable to future epidemic scenarios.

by Diego Vinicius Santinelli Pestana, Dante Raglione, Luiz Dalfior Junior, Caroline de Souza Pereira Liberatti, Elisangela Camargo Braga, Vitor Augusto de Lima Ezequiel, Adriana da Silva Alves, Juliana Gil Mauro, José Omar de Araújo Dias, Paulo Thadeu Fantinato Moreira, Bruno Del Bianco Madureira, Lilian Petroni Paiva, Bruno Melo Nóbrega de Lucena, João Manoel Silva Junior, Luiz Marcelo Sá Malbouisson
Objective Professionals working in intensive care units (ICUs) during the COVID-19 pandemic have been exposed to stressful situations and increased workload. The association between symptoms of traumatic stress disorders, substance abuse and personal/occupational characteristics of Brazilian COVID-19-ICU workers is still to be addressed. Our aim was to evaluate the prevalence of those conditions and to find if those associations exist. Methods In this observational, single-center, cross-sectional study, all professionals working in a COVID-19 ICU were invited to fill an anonymous form containing screening tools for traumatic stress disorders and substance abuse, and a section with questions regarding personal and occupational information. Results Three hundred seventy-six ICU professionals participated. Direct exposure to patients infected by COVID-19, history of relatives infected by COVID-19, and sex (female) were significantly associated with signs and symptoms of traumatic stress disorders. 76.5% of the participants had scores compatible with a diagnosis of traumatic stress disorders. Moreover, the prevalence of scores suggestive of Tobacco and Alcohol abuse were 11.7% and 24.7%, respectively. Conclusion ICU workers had significantly elevated scores on both screening forms. Providing psycho-social support to ICU professionals may prevent future problems with traumatic stress disorders or substance abuse.

by Yao-Jen Chang, Li-Ju Chen, Yun-Jau Chang
Background This study aimed to assess the severity of appendicitis during the coronavirus disease 2019 (COVID-19) pandemic, as patients with appendicitis may procrastinate seeking medical attention during the pandemic. Methods Information on patients with appendicitis who were treated at the Taipei City Hospital during the COVID-19 pandemic (January 1, 2020 to June 30, 2020) was retrieved. Patients who were diagnosed with appendicitis and treated at the same hospital from January 1, 2019 to July 1, 2019 were designated as the control group. Multivariate logistic regression analysis was conducted to assess changes in the severity of appendicitis (at a 2-week interval) between the two groups. Results We identified 307 (study group: 149; control group: 158) consecutive patients with appendicitis. The mean age was 46.2 +– 19.8 years. Between the two groups, there were no significant differences in age, sex, comorbidity, surgery type (laparoscopic or open appendectomy) or surgery time. The number of patients in the study group decreased between January 29, 2020 and April 21, 2020, which paralleled the period of spikes in the confirmed COVID-19 cases and restricted daily activities. The percentage of uncomplicated and complicated appendicitis (excluding mild appendicitis or normal appendix) in the study group increased between February 26 and March 10, as well as between April 8 and April 21. In the multivariate regression analysis, the odds of uncomplicated and complicated appendicitis increased in three bi-weeks for the study group but not in the control group. Conclusion The severity of acute appendicitis might increase during the COVID-19 pandemic, because patients with mild appendicitis (or abdominal pain) may hesitate to seek help.

Title: Activation of an Effective Immune Response after Yellow Fever Vaccination Is Associated with the Genetic Background and Early Response of IFN- and CLEC5A
Authors: Azamor, Tamiris; Silva, Andréa Marques Vieira da; Melgaço, Juliana Gil; Santos, Ana Paula dos; Carvalho, Caroline Xavier; Alvarado-Arnez, Lucia Elena; Silva, Leonardo Ribeiro Batista; Matos, Denise Cristina de Souza; Bayma, Camilla; Missailidis, Sotiris; Ano Bom, Ana Paula Dinis; Moraes, Milton Ozorio; Neves, Patrícia Cristina da Costa

by Geoff Kaine, Suzie Greenhalgh, Vic Wright

Governments around the world are seeking to slow the spread of Covid-19 by implementing measures that encourage, or mandate, changes in people’s behaviour. These changes include the wearing of face masks, social distancing, and testing and self-isolating when unwell. The success of these measures depends on the commitment of individuals to change their behaviour accordingly. Understanding and predicting the motivation of individuals to change their behaviour is therefore critical in assessing the likely effectiveness of these measures in slowing the spread of the virus. In this paper we draw on a novel framework, the I3 Compliance Response Framework, to understand and predict the motivation of residents in Auckland, New Zealand, to comply with measures to prevent the spread of Covid-19. The Framework is based on two concepts. The first uses the involvement construct to predict the motivation of individuals to comply. The second separates the influence of the policy measure from the influence of the policy outcome on the motivation of individuals to comply. In short, the Framework differentiates between the strength of individuals’ motivation and their beliefs about the advantages and disadvantages of policy outcomes and policy measures. We found this differentiation was useful in predicting an individual’s possible behavioural responses to a measure and discuss how it could assist government agencies to develop strategies to enhance compliance.

by Karandeep Singh, Gabriel Lima, Meeyoung Cha, Chiyoung Cha, Juhi Kulshrestha, Yong-Yeol Ahn, Onur Varol

The COVID-19 pandemic has been damaging to the lives of people all around the world. Accompanied by the pandemic is an infodemic, an abundant and uncontrolled spread of potentially harmful misinformation. The infodemic may severely change the pandemic’s course by interfering with public health interventions such as wearing masks, social distancing, and vaccination. In particular, the impact of the infodemic on vaccination is critical because it holds the key to reverting to pre-pandemic normalcy. This paper presents findings from a global survey on the extent of worldwide exposure to the COVID-19 infodemic, assesses different populations’ susceptibility to false claims, and analyzes its association with vaccine acceptance. Based on responses gathered from over 18,400 individuals from 40 countries, we find a strong association between perceived believability of COVID-19 misinformation and vaccination hesitancy. Our study shows that only half of the online users exposed to rumors might have seen corresponding fact-checked information. Moreover, depending on the country, between 6% and 37% of individuals considered these rumors believable. A key finding of this research is that poorer regions were more susceptible to encountering and believing COVID-19 misinformation; countries with lower gross domestic product (GDP) per capita showed a substantially higher prevalence of misinformation. We discuss implications of our findings to public campaigns that proactively spread accurate information to countries that are more susceptible to the infodemic. We also defend that fact-checking platforms should prioritize claims that not only have wide exposure but are also perceived to be believable. Our findings give insights into how to successfully handle risk communication during the initial phase of a future pandemic.

by Ashwinee Devi Soobhug, Homeswaree Jowaheer, Naushad Mamode Khan, Neeshti Reetoo, Kursheed Meethoo-Badulla, Laurent Musango, Célestin C. Kokonendji, Azmi Chutoo, Nawel Aries

This paper proposes some high-ordered integer-valued auto-regressive time series process of order p (INAR(p)) with Zero-Inflated and Poisson-mixtures innovation distributions, wherein the predictor functions in these mentioned distributions allow for covariate specification, in particular, time-dependent covariates. The proposed time series structures are tested suitable to model the SARs-CoV-2 series in Mauritius which demonstrates excess zeros and hence significant over-dispersion with non-stationary trend. In addition, the INAR models allow the assessment of possible causes of COVID-19 in Mauritius. The results illustrate that the event of Vaccination and COVID-19 Stringency index are the most influential factors that can reduce the locally acquired COVID-19 cases and ultimately, the associated death cases. Moreover, the INAR(7) with Zero-inflated Negative Binomial innovations provides the best fitting and reliable Root Mean Square Errors, based on some short term forecasts. Undeniably, these information will hugely be useful to Mauritian authorities for implementation of comprehensive policies.

by Jack P. Hughes, Alexandros Efstratiou, Sara R. Komer, Lilli A. Baxter, Milica Vasiljevic, Ana C. Leite

Throughout the COVID-19 pandemic, conspiracy theories about the virus spread rapidly, and whilst governments across the globe put in place different restrictions and guidelines to contain the pandemic, these were not universally adhered to. This research examined the association between pandemic related risk perceptions, belief in conspiracy theories, and compliance with COVID-19 public guidelines amongst a UK sample (n = 368). Participants rated their level of concern for a series of potential risks during the pandemic (to the economy, personal health, freedom, media integrity and health risk to others). Participants also rated their level of belief in different conspiracy theories and self-reported their behaviour during the first UK lockdown. Mediational analyses showed that stronger belief in conspiracy theories was associated with perceptions of lower risk to health and higher risk to the economy and freedom, which in turn were associated with lower compliance with COVID-19 related governmental guidelines. Perception of information transparency risks did not mediate the association between belief in conspiracy theories and compliant behaviours. These results highlight the key role that risk perception may play in translating belief in conspiracy theories into low compliance with governmental COVID-19 related guidelines. Our findings suggest new patterns with respect to the relationship between conspiracy theory adherence and salience of different risk perceptions amidst the pandemic, which could have implications for the development of public health messaging and communication interventions.

by Harmanmeet Kaur, Labanya Mukhopadhyay, Nivedita Gupta, Neeraj Aggarwal, Lucky Sangal, Varsha Potdar, Francis Yesuraj Inbanathan, Jitendra Narayan, Swati Gupta, Salaj Rana, Neetu Vijay, Harpreet Singh, Jasmine Kaur, Vinit Kumar, Nirmal Kaundal, Priya Abraham, Vasanthapuram Ravi

Sudden emergence and rapid spread of COVID-19 created an inevitable need for expansion of the COVID-19 laboratory testing network across the world. The strategy to test-track-treat was advocated for quick detection and containment of the disease. Being the second most populous country in the world, India was challenged to make COVID-19 testing available and accessible in all parts of the country. The molecular laboratory testing network was augmented expeditiously, and number of laboratories was increased from one in January 2020 to 2951 till mid-September, 2021. This rapid expansion warranted the need to have inbuilt systems of quality control/ quality assurance. In addition to the ongoing inter-laboratory quality control (ILQC), India implemented an External Quality Assurance Program (EQAP) with assistance from World Health Organization (WHO) and Royal College of Pathologists, Australasia. Out of the 953 open system rRTPCR laboratories in both public and private sector who participated in the first round of EQAP, 891(93.4%) laboratories obtained a passing score of > = 80%. The satisfactory performance of Indian COVID-19 testing laboratories has boosted the confidence of the public and policy makers in the quality of testing. ILQC and EQAP need to continue to ensure adherence of the testing laboratories to the desired quality standards.

by Charles Egloff, Camille Couffignal, Anne Gael Cordier, Philippe Deruelle, Jeanne Sibiude, Olivia Anselem, Alexandra Benachi, Dominique Luton, Laurent Mandelbrot, Christelle Vauloup-Fellous, Alexandre J. Vivanti, Olivier Picone
Introduction Pregnant women are at increased risk for COVID-19, and COVID-19 vaccine is the most promising solution to overcome the current pandemic. This study was conducted to evaluate pregnant women’s perceptions and acceptance of COVID-19 vaccination. Materials & methods A cross-sectional study was conducted from February 18 to April 5 2021. An anonymous survey was distributed in 7 French obstetrics departments to all pregnant women before a prenatal visit. All pregnant women attending a follow-up consultation were asked to participate in the study. An anonymous web survey was available through a QR code and participants were asked whether or not they would agree to be vaccinated against SARS-CoV-2, and why. The questionnaire included questions on the patients’ demographics and their knowledge of COVID-19 vaccines. Results Of the 664 pregnant women who completed the questionnaire, 29.5% (95% CI 27.7; 31.3) indicated they would agree to be vaccinated against COVID-19. The main reason for not agreeing was being more afraid of potential side effects of the SARS-CoV-2 vaccine on the fetus than of COVID-19. Factors influencing acceptance of vaccination were: being slightly older, multiparity, having discussed it with a caregiver and acceptance of the influenza vaccine. Discussion Nearly one-third of pregnant women in this population would be willing to be vaccinated. In addition to studies establishing fetal safety, public health agencies and healthcare professionals should provide accurate information about the safety of COVID-19 vaccines.

by Lebapotswe B. Tlale, Lesego Gabaitiri, Lorato K. Totolo, Gomolemo Smith, Orapeleng Puswane-Katse, Eunice Ramonna, Basego Mothowaeng, John Tlhakanelo, Tiny Masupe, Goabaone Rankgoane-Pono, John Irige, Faith Mafa, Samuel Kolane
Background The COVID-19 disease burden continues to be high worldwide and vaccines continue to be developed to help combat the pandemic. Acceptance and risk perception for COVID-19 vaccines is unknown in Botswana despite the government’s decision to roll out the vaccine nationally. Objectives This study aims to assess the acceptance rate and risk perception of COVID-19 vaccines amongst the general population in Botswana. Methods We interviewed 5300 adults in Botswana from 1–28 February 2021 using self-administered questionnaires. The main outcomes of the study were vaccine acceptance and hesitancy rates. Demographic, experiential and socio-cultural factors were explored for their association with outcome variables. Results Two-thirds of the participants were females (3199), with those aged 24–54 making the highest proportion (61%). The acceptance rate of COVID-19 vaccine was 73.4% (95% CI: 72.2%-74.6%) with vaccine hesitancy at 31.3% (95% CI: 30.0%-32.6%). When the dependent variable was vaccine acceptance, males had higher odds of accepting the vaccine compared to females (OR = 1.2, 95% CI: 1.0, 1.4). Individuals aged 55–64 had high odds of accepting the vaccine compared to those aged 65 and above (OR = 1.2, 95% CI: 0.6, 2.5). The odds of accepting the vaccine for someone with primary school education were about 2.5 times that of an individual with post graduate level of education. Finally, individuals with comorbidities had higher odds (OR = 1.2, 95% CI: 1.0, 1.5) of accepting the vaccine compared to those without any underlying conditions. Conclusion This study demonstrated a high acceptance rate for the COVID-19 vaccine and a low risk perception in Botswana. In order to achieve a high vaccine coverage and ensure a successful vaccination process, there is need to target populations with high vaccine hesitancy rates. A qualitative study to assess the factors associated with vaccine acceptance and hesitancy is recommended to provide an in-depth analysis of the findings.

by Sana Sheikh, Wil Van Cleve, Vinod Kumar, Ghazal Peerwani, Saba Aijaz, Asad Pathan
Background A reduction in overall acute coronary syndrome (ACS) cases, increases in the severity of ACS presentation, and increased rates of out-of-hospital cardiac arrest (OHCA) have been reported from multiple countries during the COVID-19 pandemic. The attributed factors include COVID-19 infection, fear of COVID-19 and resultant avoidance of health care facilities, and restrictions on mobility. Pakistan, a country with a high burden of cardiovascular disease (CVD) and challenges related to health care access, will be expected to demonstrate these same findings. Therefore, we compared ACS hospitalization, ACS severity, and patients who have already died (dead on arrival, or DOA) due to presumed OHCA at a tertiary cardiac hospital during pre-pandemic and intra-pandemic periods in Pakistan. Methods Standardized data elements were extracted from the charts of patients with ACS, and telephonic verbal autopsies (VA) using a validated tool were conducted for patients who were arrived DOA. As a comparison, cases during the same months prior to the COVID-19 were analyzed for respective waves. Events were counted, and proportions and frequencies are reported for each time period. Results A total of 4,480 ACS cases were reviewed; 1,216 cases during March-July 2019, 804 cases in the same months of 2020 (33.8% decrease); 1,304 cases in August 2019-January 2020 and 1,157 in the corresponding months of 2020 and 2021 (11.2% decrease). There was no observed change in the baseline characteristics of patients with ACS or their symptom-to-door time, and in-hospital mortality was unchanged across all time periods. There were 218 DOA cases in pre-pandemic months and 360 cases during the pandemic. The pre-pandemic rate of DOA was 12/1000 emergency patients (95% CI 10–13) compared to 22/1000 (95% CI 22–27) during the pandemic (30/1000in the 1st wave and 17/1000 during 2nd wave). On VA, CVD was found to be the major cause of death during both time periods. Conclusion At a cardiac hospital in Pakistan, the COVID-19 pandemic was associated with a reduction in ACS hospitalization and an increased DOA rate.

by Narendran Gopalan, Sumathi Senthil, Narmadha Lakshmi Prabakar, Thirumaran Senguttuvan, Adhin Bhaskar, Muthukumaran Jagannathan, Ravi Sivaraman, Jayalakshmi Ramasamy, Ponnuraja Chinnaiyan, Vijayalakshmi Arumugam, Banumathy Getrude, Gautham Sakthivel, Vignes Anand Srinivasalu, Dhanalakshmi Rajendran, Arunjith Nadukkandiyil, Vaishnavi Ravi, Sadiqa Nasreen Hifzour Rahamane, Nirmal Athur Paramasivam, Tamizhselvan Manoharan, Maheshwari Theyagarajan, Vineet Kumar Chadha, Mohan Natrajan, Baskaran Dhanaraj, Manoj Vasant Murhekar, Shanthi Malar Ramalingam, Padmapriyadarsini Chandrasekaran
Background We retrospectively data-mined the case records of Reverse Transcription Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients hospitalized to a tertiary care centre to derive mortality predictors and formulate a risk score, for prioritizing admission. Methods and findings Data on clinical manifestations, comorbidities, vital signs, and basic lab investigations collected as part of routine medical management at admission to a COVID-19 tertiary care centre in Chengalpattu, South India between May and November 2020 were retrospectively analysed to ascertain predictors of mortality in the univariate analysis using their relative difference in distribution among ‘survivors’ and ‘non-survivors’. The regression coefficients of those factors remaining significant in the multivariable logistic regression were utilised for risk score formulation and validated in 1000 bootstrap datasets.Among 746 COVID-19 patients hospitalised [487 “survivors” and 259 “non-survivors” (deaths)], there was a slight male predilection [62.5%, (466/746)], with a higher mortality rate observed among 40–70 years age group [59.1%, (441/746)] and highest among diabetic patients with elevated urea levels [65.4% (68/104)]. The adjusted odds ratios of factors [OR (95% CI)] significant in the multivariable logistic regression were SaO23; 3.01 (1.61–5.83), Age ≥50 years;2.52 (1.45–4.43), Pulse Rate ≥100/min: 2.02 (1.19–3.47) and coexisting Diabetes Mellitus; 1.73 (1.02–2.95) with hypertension and gender not retaining their significance. The individual risk scores for SaO23–11, Age ≥50 years-9, Pulse Rate ≥100/min-7 and coexisting diabetes mellitus-6, acronymed collectively as ‘OUR-ARDs score’ showed that the sum of scores ≥ 25 predicted mortality with a sensitivity-90%, specificity-64% and AUC of 0.85. Conclusions The ‘OUR ARDs’ risk score, derived from easily assessable factors predicting mortality, offered a tangible solution for prioritizing admission to COVID-19 tertiary care centre, that enhanced patient care but without unduly straining the health system.

by Vladimir Petrović, Vladimir Vuković, Aleksandra Patić, Miloš Marković, Mioljub Ristić
Background Mass vaccination is the key element in controlling current COVID-19 pandemic. Studies comparing immunogenicity of different COVID-19 vaccines are largely lacking. We aimed at measuring anti-S antibody (Ab) levels in individuals fully vaccinated with BNT162b2, BBIBP-CorV and Gam-COVID-Vac, as well as in COVID-19 convalescents. Methods In this cross-sectional study, serum was collected from 400 age- and sex-matched participants, 100 fully vaccinated with BNT162b2, 100 with BBIBP-CorV and 100 with Gam-COVID-Vac on the 28th day after the second vaccine dose, and 100 recovered from COVID-19 at least 28 days after symptom(s) resolution. Sera were analyzed using the LIAISON SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Saluggia, Italy). Wilcoxon rank-sum or Kruskal–Wallis tests was used for comparison of Ab levels. Results Highest mean value (210.11, SD = 100.42) was measured in the BNT162b2 group, followed by Gam-COVID-Vac (171.11, SD = 120.69) and BBIBP-CorV (68.50, SD = 72.78) AU/mL (p

by Nikolina Bogdanić, Loris Močibob, Toni Vidović, Ana Soldo, Josip Begovać
Background During the initial phase of the COVID-19 pandemic, there was great enthusiasm for the use of azithromycin with or without hydroxychloroquine. Objectives We analyzed azithromycin consumption in Croatia in 2020 and compared this to the period 2017–2019. Methods Azithromycin consumption was evaluated using the IQVIA Adriatic d.o.o. database which collects data on azithromycin distribution from wholesale pharmacies to hospital and non-hospital pharmacies in Croatia. We analyzed data for the period from January 2017 to December 2020. Azithromycin distribution was measured as days of therapy (DOT) and reported as per 1000 inhabitants or per 1000 inhabitant-days. Results In the period 2017–2020, total azithromycin DOT in Croatia increased in 2017, 2018, 2019, and 2020 (1.76, 1.91, 1.91 and 2.01/1000 inhabitant-days, respectively). Non-hospital pharmacies received 2.18 times and hospital pharmacies 4.39 times more DOT units/1000 inhabitants of azithromycin in March 2020 compared to the average distribution rate in March 2017–2019. During the peak of the COVID-19 epidemic (November and December 2020) azithromycin distribution increased considerably in hospital (3.62 and 3.19 times, respectively) and non-hospital pharmacies (1.93 and 1.84 times, respectively) compared to the average consumption in the same months in 2017–2019. Conclusions Our data showed increased azithromycin distribution in the period 2017–2020 which indicates azithromycin overuse. Preliminary information on COVID-19 treatments with a desire to offer and try what is available even in the absence of strong scientific evidence may have influenced practices of antimicrobial prescriptions.

by Ilari Kuitunen, Jarkko Jokihaara, Ville Ponkilainen, Aleksi Reito, Juha Paloneva, Ville M. Mattila, Antti P. Launonen
Introductions The rate of acute hand trauma visits to emergency departments (ED) and surgeries decreased during the COVID-19 lockdown. Our aim was to analyze the influence of national lockdown during the first wave and the regional restrictions during the second wave on the rate of visits to the ED and urgent hand surgeries in Finland. Methods Material for this retrospective study was gathered from three Finnish hospitals All ED visits and urgent or emergency surgeries from January 2017 to December 2020 were included. Incidences per 100 000 persons with 95% confidence intervals (CI) were calculated and compared by incidence rate ratios (IRR). Results The incidence of hand injury was lower after the beginning of the lockdown in March 2020 (IRR 0.70 CI 0.63–0.78). After lockdown ended in May, the monthly incidences of ED visits returned to the reference level. During the lockdown, the incidence of fractures and dislocations was 42% lower in March (IRR 0.58 CI 0.50–0.68) and 33% lower in April 2020 (IRR 0.67 CI 0.57–0.80). The incidence of fracture repair surgeries was 43% lower in March 2020 (IRR 0.57 CI 0.35–0.93) and 41% lower in July 2020 (IRR 0.59 CI 0.36–0.98). Incidence of replantation was 49% higher in March 2020 (IRR 1.49 CI 0.53–4.20) and 200% higher in July 2020 (IRR 3.00 CI 0.68–13.2) but these increases had high uncertainty. Conclusions The rate of ED visits due to hand injuries decreased while the rate of emergency hand operations remained unchanged during the national COVID-19 lockdown in spring. After the lockdown, the incidences returned to reference level and were unaffected by regional restrictions during the second wave of pandemic.

by André Voigt, Stig Omholt, Eivind Almaas

With limited availability of vaccines, an efficient use of the limited supply of vaccines in order to achieve herd immunity will be an important tool to combat the wide-spread prevalence of COVID-19. Here, we compare a selection of strategies for vaccine distribution, including a novel targeted vaccination approach (EHR) that provides a noticeable increase in vaccine impact on disease spread compared to age-prioritized and random selection vaccination schemes. Using high-fidelity individual-based computer simulations with Oslo, Norway as an example, we find that for a community reproductive number in a setting where the base pre-vaccination reproduction number R = 2.1 without population immunity, the EHR method reaches herd immunity at 48% of the population vaccinated with 90% efficiency, whereas the common age-prioritized approach needs 89%, and a population-wide random selection approach requires 61%. We find that age-based strategies have a substantially weaker impact on epidemic spread and struggle to achieve herd immunity under the majority of conditions. Furthermore, the vaccination of minors is essential to achieving herd immunity, even for ideal vaccines providing 100% protection.

by Savannah Kiah Hui Siew, Jonathan Louis Chia, Rathi Mahendran, Junhong Yu
Background Distrust, and more broadly, public perception of government’s handling of a crisis, has been a widely studied topic within health crisis research and suggests that these perceptions are significantly associated with the behavior of its citizens. Purpose To understand which aspects of the public’s perception of government handling of the COVID-19 pandemic predicted engagement of protective behaviors among older adults, who are the most vulnerable to COVID-19. Methods Participants were recruited from an ongoing biopsychosocial study on aging amongst community-dwelling older adults. There were two rounds of data collection, during the national lockdown and post-lockdown. The average length of follow-up was 5.88 months. N = 421 completed the first round of data collection and N = 318 subsequently completed the second round of questionnaires. Results During the lockdown, perceptions that pandemic-related measures in place were sufficient, effective, timely, provided a sense of safety, important information was easily accessible, and government handling of the pandemic could be trusted, were found to significantly predict engagement in protective behaviors. During post-lockdown, only perceptions that measures in place were sufficient, provided a sense of safety, and important information was easily accessible, remained significant predictors. The perception that COVID-19 measures were clear and easy to understand now became a significant predictor. Conclusions Public perceptions of government handling of the pandemic predicted engagement in protective behaviors but were less important during post-lockdown. To effectively engage older adults in protective behavior, our findings suggest for pandemic-related information to be accessible, introducing timely safety measures, and having easy-to-understand instructions for nuanced measures.

by Naiire Salmani, Imane Bagheri, Atena Dadgari
Introduction With the emergence of the COVID-19 pandemic, universities immediately responded to protect students’ lives by implementing e-learning in order to stop the spread of the communicable disease within the academic population. This study aimed to describe iranian nursing students’ experiences of e-learning during the COVID-19 pandemic. Materials and methods The current study used a qualitative descriptive study. Ten nursing undergraduate students from a single Iranian university identified using purposive sampling methods. Face-to-face semi-structured interview conducted from May to July 2021 and analyzed through thematic analysis. Lincoln and Goba criteria were used to obtain data validity and reliability. Results Four themes emerged including"novelty of e-learning","advantages of e-learning", "disadvantages of e-learning"and"passage of time and the desire to return to face education". Participants evaluated e-learning as a novel method without proper infrastructure, it was initially confusing but became the new normal as their knowledge of the way to use it improved. Advantages included self-centered flexible learning and reduction in their concerns experienced with face-to-face learning. Disadvantages including changing the way they interact with teachers, decreasing interactions with classmates, problems with education files, superficial learning, hardware problems, family members’ perceptions of the student role, interference of home affairs with e-learning, cheating on exams and assignments and being far away from the clinical context. Conclusion The findings revealed that e-learning has been introduced as a new method for the current research participants and despite the perceived benefits, these students believed that e-learning could supplement face education but not replace it.

by Ararso Baru, Menbeu Sultan, Lemlem Beza
Background COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors. Methods A total of 233 patients consecutively transported to Saint Paul’s Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals. Results The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11–9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02–0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0–55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2–13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9–56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients. Conclusions There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care.

by Kosuke Mori, Shohei Imaki, Yutaro Ohyama, Kosuke Satoh, Takeru Abe, Ichiro Takeuchi

Rapid screening and diagnosis of coronavirus disease 2019 in the emergency department is important for controlling infections. When polymerase chain reaction tests cannot be rapidly performed, rapid antigen testing is often used, albeit with insufficient sensitivity. Therefore, we evaluated the diagnostic accuracy of combining rapid antigen and antibody test results. This was a retrospective review of patients who visited our emergency department between February and May 2021 and underwent rapid antigen, immunoglobulin G antibody, and reverse transcription–polymerase chain reaction tests. The study included 1,070 patients, of whom 56 (5.2%) tested positive on reverse transcription–polymerase chain reaction. The sensitivity, specificity, and area under the curve of rapid antigen testing were 73.7%, 100.0%, and 0.87, respectively. The combined rapid antigen and antibody test result had improved diagnostic accuracy, with 91.2% sensitivity, 97.9% specificity, and an area under the curve of 0.95. The results of the rapid antigen and antibody tests could be combined as a reliable alternative to reverse transcription–polymerase chain reaction.