COVID-19: A Risk Assessment Perspective

Knowledge, Attitudes, Practices and Information Needs During the COVID-19 Pandemic in Indonesia

INTRODUCTION

In the absence of vaccines and specific drugs, prevention effort has been attributed as the primary control mechanism of COVID-19. Knowledge, attitude, and practice are used to determine the current situation and formulate appropriate control interventions as well as risk communication. This study, therefore, aims to assess knowledge, attitude, practice and information needs about COVID-19 in Indonesian society.

METHODS

A cross-sectional study was conducted through an online survey in the third week of August 2020. Purposive and random sampling was used to select the respondents. People with a minimum age of 18 years and residing in Indonesia were allowed to participate in this study. The survey was conducted with an online questionnaire that spread on several platforms such as WhatsApp, Instagram and Facebook by distributing the link and continuous chain messages on that platform. Data were analysed using descriptive, chi-square and logistic regression test.

RESULTS

A total of 816 respondents were included in this study. In general, public knowledge about COVID-19 was sufficient, but some topic areas were still low. Most people had a positive attitude about the COVID-19, but they provided a negative response to government policies. Most of the community has taken preventive measures for COVID-19. However, some behaviours received a low percentage. Information about how to prevent COVID-19 was the most wanted information during this pandemic. Social media was a favourite source of information, with the most popular type of visualisation was a table containing numbers. Age and education were significantly associated with knowledge. Some attitudes were affected by age and occupation scope. Gender and health insurance ownership significantly associated with preventive measures.

CONCLUSION

This research highlights the importance of providing valid, effective, efficient, and continuous information to the public through appropriate channels to increase understanding about COVID-19 precautions.

Modeling Framework to Evaluate Vaccine Strategies against the COVID-19 Pandemic

SARS-CoV-2, with an infection fatality rate between 0.5 and 1%, has spread to all corners of the globe and infected millions of people. While vaccination is essential to protect against the virus and halt community transmission, rapidly making and delivering safe and efficacious vaccines presents unique development, manufacturing, supply chain, delivery, and post-market surveillance challenges. Despite the large number of vaccines in or entering the clinic, it is unclear how many candidates will meet regulatory requirements and which vaccine strategy will most effectively lead to sustained, population-wide immunity. Interviews with experts from biopharmaceutical companies, regulatory and multilateral organizations, non-profit foundations, and academic research groups, complemented with extensive literature review, informed the development of a framework for understanding the factors leading to population-wide immunity against SARS-CoV-2, in particular considering the role of vaccines. This paper presents a systems-level modeling framework to guide the development of analytical tools aimed at informing time-critical decisions to make vaccines globally and equitably accessible. Such a framework can be used for scenario planning and evaluating tradeoffs across access strategies. It highlights the diverse and powerful ways in which data can be used to evaluate future risks and strategically allocate limited resources.

Fight against COVID-19 pandemic with the help of carbon-based nanomaterials

We have considered the newest momentous outcomes in carbon-based nanomaterials for utility in controlling and fighting the SARS-CoV-2 virus.

Laboratory biosafety measures involving SARS-CoV-2 and the classification as a Risk Group 3 biological agent

The current public health emergency surrounding the COVID-19 pandemic, that is the illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in thousands of cases in Australia since 25 January 2020 when the first case was diagnosed. This emerging virus presents particular hazards to researchers and laboratory staff in a clinical setting, highlighted by rapid and widespread global transmission. Based on the epidemiological and clinical data that have become available in mid-2020, we propose the interim classification of SARS-CoV-2 as a Risk Group 3 organism is reasonable, and discuss establishing Biosafety Level 3 (BSL-3) regulations accordingly. Despite its global spread, the reported mortality rate of SARS-CoV-2 ranging from 0.13% to 6.22% is considerably less than that of other Risk Group 4 agents including Ebola and Marburg viruses with fatality rates as high as 90%. In addition, studies have demonstrated that approximately 86% of patients presenting with severe courses of the disease are aged 70 years or above, with the presence of comorbid conditions such as cardiovascular and respiratory system diseases in the majority of all fatal cases. In contrary to recent discussions surrounding the protective and administrative measures needed in a laboratory, the emerging evidence surrounding mortality rate, distinct demographics of severe infections, and the presence of underlying diseases does not justify the categorisation of SARS-CoV-2 as a Risk Group 4 organism. This article summarises biosafety precautions, control measures and appropriate physical containment facilities required to minimise the risk of laboratory-acquired infections with SARS-CoV-2.

Effects of mask-wearing on the inhalability and deposition of airborne SARS-CoV-2 aerosols in human upper airway

Even though face masks are well accepted as tools useful in reducing COVID-19 transmissions, their effectiveness in reducing viral loads in the respiratory tract is unclear. Wearing a mask will significantly alter the airflow and particle dynamics near the face, which can change the inhalability of ambient particles. The objective of this study is to investigate the effects of wearing a surgical mask on inspiratory airflow and dosimetry of airborne, virus-laden aerosols on the face and in the respiratory tract. A computational model was developed that comprised a pleated surgical mask, a face model, and an image-based upper airway geometry. The viral load in the nose was particularly examined with and without a mask. Results show that when breathing without a mask, air enters the mouth and nose through specific paths. When wearing a mask, however, air enters the mouth and nose through the entire surface of the mask at lower speeds, which favors the inhalation of ambient aerosols into the nose. With a 65% filtration efficiency (FE) typical for a three-layer surgical mask, wearing a mask reduces dosimetry for all micrometer particles except those of size 1 µm-3 µm, for which equivalent dosimetry with and without a mask in the upper airway was predicted. Wearing a mask reduces particle penetration into the lungs, regardless of the FE of the mask. The results also show that mask-wearing protects the upper airway (particularly the nose and larynx) best from particles larger than 10 µm while protecting the lungs best from particles smaller than 10 µm.

Omega 3 Fatty Acids and COVID-19: A Comprehensive Review

The rapid international spread of severe acute respiratory syndrome coronavirus 2 responsible for coronavirus disease 2019 (COVID-19) has posed a global health emergency in 2020. It has affected over 52 million people and led to over 1.29 million deaths worldwide, as of November 13th, 2020. Patients diagnosed with COVID-19 present with symptoms ranging from none to severe and include fever, shortness of breath, dry cough, anosmia, and gastrointestinal abnormalities. Severe complications are largely due to overdrive of the host immune system leading to "cytokine storm". This results in disseminated intravascular coagulation, acute respiratory distress syndrome, multiple organ dysfunction syndrome, and death. Due to its highly infectious nature and concerning mortality rate, every effort has been focused on prevention and creating new medications or repurposing old treatment options to ameliorate the suffering of COVID-19 patients including the immune dysregulation. Omega-3 fatty acids are known to be incorporated throughout the body into the bi-phospholipid layer of the cell membrane leading to the production of less pro-inflammatory mediators compared to other fatty acids that are more prevalent in the Western diet. In this article, the benefits of omega-3 fatty acids, especially eicosapentaenoic acid and docosahexaenoic acid, including their anti-inflammatory, immunomodulating, and possible antiviral effects have been discussed.

Antimicrobial Copper Cold Spray Coatings and SARS-CoV-2 Surface Inactivation

This article contextualizes how the antimicrobial properties and antipathogenic contact killing/inactivating performance of copper cold spray surfaces and coatings and can be extended to the COVID-19 pandemic as a preventative measure. Specifically, literature is reviewed in terms of how copper cold spray coatings can be applied to high-touch surfaces in biomedical as well as healthcare settings to prevent fomite transmission of SARS-CoV-2 through rapidly inactivating SARS-CoV-2 virions after contaminating a surface. The relevant literature on copper-based antipathogenic coatings and surfaces are then detailed. Particular attention is then given to the unique microstructurally-mediated pathway of copper ion diffusion associated with copper cold spray coatings that enable fomite inactivation.

Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments

The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.

Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments

The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.

Targeting the SARS-CoV-2 RNA Genome with Small Molecule Binders and Ribonuclease Targeting Chimera (RIBOTAC) Degraders

COVID-19 is a global pandemic, thus requiring multiple strategies to develop modalities against it. Herein, we designed multiple bioactive small molecules that target a functional structure within the SARS-CoV-2's RNA genome, the causative agent of COVID-19. An analysis to characterize the structure of the RNA genome provided a revised model of the SARS-CoV-2 frameshifting element, in particular its attenuator hairpin. By studying an RNA-focused small molecule collection, we identified a drug-like small molecule (C5) that avidly binds to the revised attenuator hairpin structure with a K d of 11 nM. The compound stabilizes the hairpin's folded state and impairs frameshifting in cells. The ligand was further elaborated into a ribonuclease targeting chimera (RIBOTAC) to recruit a cellular ribonuclease to destroy the viral genome (C5-RIBOTAC) and into a covalent molecule (C5-Chem-CLIP) that validated direct target engagement and demonstrated its specificity for the viral RNA, as compared to highly expressed host mRNAs. The RIBOTAC lead optimization strategy improved the bioactivity of the compound at least 10-fold. Collectively, these studies demonstrate that the SARS-CoV-2 RNA genome should be considered druggable.

Healthcare-Associated SARS-CoV-2 Transmission-Experiences from a German University Hospital

During the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare systems worldwide have to prevent nosocomial SARS-CoV-2 transmission while maintaining duty of care. In our study, we characterize the transmission dynamic of SARS-CoV-2 in inpatients and healthcare workers (HCWs) at the University Hospital Münster (UHM) in northwest Germany. We identified 27 cases of healthcare-associated SARS-CoV-2 infections (4 inpatients and 23 HCWs) who had contact with patients and/or HCWs without the use of adequate PPE. The contacts of these index cases were followed up for SARS-CoV-2 infection after unprotected exposure and a quantitative measure of probability of becoming infected, the attack rate, was calculated. In addition, transmission was evaluated in the context of infection control measures established during the pandemic and we compared the epidemiological data of all index cases, including symptoms and Ct values of virology test results. The overall attack rate in the hospital setting was 1.3% (inpatients 0.9%, HCWs 1.6%). However, during an outbreak, the attack rate was 25.5% (inpatients 20.0%, HCWs 29.6%). For both scenarios, HCWs had a higher attack rate illustrating their role in healthcare-associated SARS-CoV-2 transmission. Taken together, our experiences demonstrate how infection control measures can minimize the transmission of SARS-CoV-2 in the healthcare setting.

Resilient and agile engineering solutions to address societal challenges such as coronavirus pandemic

The world is witnessing tumultuous times as major economic powers including the US, UK, Russia, India, and most of Europe continue to be in a state of lockdown. The worst-hit sectors due to this lockdown are sales, production (manufacturing), transport (aerospace and automotive) and tourism. Lockdowns became necessary as a preventive measure to avoid the spread of the contagious and infectious "Coronavirus Disease 2019" (COVID-19). This newly identified disease is caused by a new strain of the virus being referred to as Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS CoV-2; formerly called 2019-nCoV). We review the current medical and manufacturing response to COVID-19, including advances in instrumentation, sensing, use of lasers, fumigation chambers and development of novel tools such as lab-on-the-chip using combinatorial additive and subtractive manufacturing techniques and use of molecular modelling and molecular docking in drug and vaccine discovery. We also offer perspectives on future considerations on climate change, outsourced versus indigenous manufacturing, automation, and antimicrobial resistance. Overall, this paper attempts to identify key areas where manufacturing can be employed to address societal challenges such as COVID-19.