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Esmonde K, Jones J, Johns M, Hutler B, Faden R, Barnhill A. "Lives versus livelihoods": Conflict and coherence between policy objectives in the COVID-19 pandemic. Soc Sci Med 2024; 357:117188. [PMID: 39146902 DOI: 10.1016/j.socscimed.2024.117188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 07/17/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
Many policies were put in place during the COVID-19 pandemic in the United States to manage the negative impact of the coronavirus. Limiting severe illness and death was one important objective of these policies, but it is widely acknowledged by public health ethicists that pandemic policies needed to consider other factors. Drawing on semi-structured interviews with 38 people across 17 states who participated in the state-level COVID-19 pandemic policy process, we examine how those actors recounted their engagement with four different objectives over the course of the pandemic: protecting public health with respect to COVID-19 (which we refer to as pathogen-focused disease prevention), protecting the economy, promoting the public's broader health and wellbeing, and preserving and restoring individual freedoms. We describe the different ways that pathogen-focused disease prevention was thought to have conflicted with, or to have been coherent with, the other three policy objectives over the course of the pandemic. In tracing the shifting relationships between objectives, we highlight four reasons put forward by the participants for why policy changes occurred throughout the pandemic: a change on the part of decisionmaker(s) regarding the perceived acceptability of the negative effects of a policy on one or more policy objectives; a change in the epistemic context; a change in the 'tools in the toolbox'; and a change in the public's attitudes that affected the feasibility of a policy. We conclude by considering the ethical implications of the shifting relationships that were described between objectives over the course of the pandemic.
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Affiliation(s)
- Katelyn Esmonde
- Johns Hopkins University, Berman Institute of Bioethics, 1809 Ashland Ave., Baltimore, MD, USA, 21205.
| | - Jeff Jones
- Johns Hopkins University, Berman Institute of Bioethics, 1809 Ashland Ave., Baltimore, MD, USA, 21205
| | - Michaela Johns
- McGill University, Faculty of Law, 3644 Peel St., Montreal, Quebec, Canada, H3A 1W9
| | - Brian Hutler
- Temple University, College of Liberal Arts, 1114 Polett Walk, Philadelphia, PA, USA, 19122
| | - Ruth Faden
- Johns Hopkins University, Berman Institute of Bioethics, 1809 Ashland Ave., Baltimore, MD, USA, 21205; Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA, 21205
| | - Anne Barnhill
- Johns Hopkins University, Berman Institute of Bioethics, 1809 Ashland Ave., Baltimore, MD, USA, 21205; Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD, USA, 21205
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Esmonde K, Jones J, Johns M, Hutler B, Faden R, Barnhill A. 'Staying in the lane' of public health? Boundary-work in the roles of state health officials and experts in COVID-19 policymaking. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:1004-1022. [PMID: 38234072 DOI: 10.1111/1467-9566.13751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
The state-level COVID-19 response in the United States necessitated collaboration between governor' offices, health departments and numerous other departments and outside experts. To gain insight into how health officials and experts contributed to advising on COVID-19 policies, we conducted semi-structured interviews with 25 individuals with a health specialisation who were involved in COVID-19 policymaking, taking place between February and December 2022. We found two diverging understandings of the role of health officials and experts in COVID-19 policymaking: the role of 'staying in the lane' of public health in terms of the information that they collected, their advocacy for policies and their area of expertise and the role of engaging in the balancing of multiple considerations, such as public health, feasibility and competing objectives (such as the economy) in the crafting of pandemic policy. We draw on the concept of boundary-work to examine how these roles were constructed. We conclude by considering the appropriateness as well as the ethical implications of these two approaches to public health policymaking.
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Affiliation(s)
- Katelyn Esmonde
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeff Jones
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michaela Johns
- Faculty of Law, McGill University, Montreal, Quebec, Canada
| | - Brian Hutler
- Department of Philosophy, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania, USA
| | - Ruth Faden
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne Barnhill
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Harjani T, He H, Chao MM. The Moral Foundations of Vaccine Passports. JOURNAL OF BUSINESS ETHICS : JBE 2023:1-29. [PMID: 37359793 PMCID: PMC10200013 DOI: 10.1007/s10551-023-05427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
The debate around vaccine passports has been polarising and controversial. Although the measure allows businesses to resume in-person operations and enables transitioning out of lockdown due to the COVID-19 pandemic, some have expressed concerns about liberty violations and discrimination. Understanding the splintered viewpoints can aid businesses in communicating such measures to employees and consumers. We conceptualise the business implementation of vaccine passports as a moral decision rooted in individual values that influence reasoning and emotional reaction. We surveyed support for vaccine passports on a nationally representative sample in the United Kingdom in 2021: April (n = 349), May (n = 328), and July (n = 311). Drawing on the Moral Foundations Theory-binding (loyalty, authority, and sanctity), individualising (fairness and harm), and liberty values-we find that individualising values are a positive predictor and liberty values a negative predictor of support for passports, suggesting adoption hinges on addressing liberty concerns. Longitudinal analysis examining the trajectory of change in support over time finds that individualising foundations positively predict changes in utilitarian and deontological reasoning over time. In contrast, a fall in anger over time predicts increased support towards vaccine passports. Our study can inform business and policy communication strategies of existing vaccine passports, general vaccine mandates, and similar measures in future pandemics.
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Affiliation(s)
- Trisha Harjani
- Department of Psychology, University of Cambridge, Cambridge, CB2 3EB UK
| | - Hongwei He
- Alliance Manchester Business School, The University of Manchester, Manchester, M13 9SS UK
| | - Melody Manchi Chao
- Department of Management, School of Business and Management, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong S.A.R
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Sayuti RH, Taqiuddin M, Evendi A, Hidayati SA, Muttaqin MZ. Impact of COVID-19 pandemic on the existence of social solidarity: evidence from rural-urban communities in Lombok Island, Indonesia. FRONTIERS IN SOCIOLOGY 2023; 8:1164837. [PMID: 37214597 PMCID: PMC10196632 DOI: 10.3389/fsoc.2023.1164837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023]
Abstract
The COVID-19 pandemic that has hit the entire world since the beginning of 2020 is an unimaginable phenomenon. The pandemic is disastrous because it has caused loss of life and livelihood for a large part of the population. People lose their jobs, spaces for social interaction are closed, and social relationships are disrupted. Several studies show that social solidarity should be a major concern for people to sustain the future quality of their lives. Social solidarity dimensions in this study include gotong royong (local culture of mutual help), marriage banjars (local association), cooperation, and sharing of information. This study aims to examine the existence of social solidarity during the pandemic in rural and urban areas and to know the level of community exposure to COVID-19 in Lombok Island, Indonesia. This research adopted a quantitative approach to identify and analyse the existence of social solidarity in rural and urban communities during the COVID-19 pandemic. A set of questionnaires was distributed and shared by enumerators with 1,100 targeted-respondents from Lombok Island. The survey was carried out from 14th October to 28th October 2021, that is, during a recovery period from the pandemic while restrictions implemented by the government were still in full force. Chi square statistical analysis was used to test whether there were differences in social solidarity between those who lived in rural areas and those who lived in urban areas. This research found the existence of social solidarity in both rural and urban communities during the pandemic. The level of social solidarity in rural areas is higher than in urban areas. While related to the number of those who were exposed and died, conditions were higher in rural areas than in urban areas. However, in terms of the death rate, the level of death rate in urban areas is higher than in rural areas. This condition indicates differences in the characteristics of rural and urban communities, which can be considered in implementing policies during a future pandemic. This research provides evidence for local governments in formulating policies with a social solidarity perspective by taking into account the different characteristics of rural and urban communities.
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Affiliation(s)
- Rosiady H. Sayuti
- Sociology Study Program, University of Mataram, Mataram City, Indonesia
| | - Moh Taqiuddin
- Faculty of Animal Husbandry, University of Mataram, Mataram City, Indonesia
| | - Azhari Evendi
- Sociology Laboratory, University of Mataram, Mataram City, Indonesia
| | - Siti Aisyah Hidayati
- Faculty of Economics and Business, University of Mataram, Mataram City, Indonesia
| | - M. Zaenul Muttaqin
- Department of Public Administration, University of Cenderawasih, Jayapura City, Indonesia
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Kontodimopoulos N, Poulaki E, Fanourgiakis J, Talias MA. The Association between Fear of COVID-19 and Health-Related Quality of Life: A Cross-Sectional Study in the Greek General Population. J Pers Med 2022; 12:jpm12111891. [PMID: 36422068 PMCID: PMC9699023 DOI: 10.3390/jpm12111891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this cross-sectional study was to assess the level of fear related to the SARS-CoV-2 virus and the association of fear, and of sociodemographic and clinical characteristics, with health-related quality of life (HRQoL). A large sample of the Greek general population (N = 583) completed the validated versions of the Fear of COVID-19 scale (FCV-19s) and the 12-item Short Form (SF-12), and provided data on socio-demographic status, health history and COVID-19 protective behaviors. Variables were compared with Mann-Whitney and Kruskal-Wallis tests and associations with Spearman’s correlations. Gamma regression models investigated the influence of sociodemographic and COVID-related variables on HRQoL. The mean FCV-19s score for the sample was 18.3 ± 5.6, and physical and mental component summary scores were 50.2 ± 7.9 and 46.7 ± 10.1, respectively. More fear of COVID-19 was expressed by females (p < 0.001), individuals with comorbidities (p < 0.01), those with contacts with comorbidities (p < 0.001), and individuals not having caught COVID-19 (p < 0.05). Contrastingly, less fear was expressed by unvaccinated individuals and those with less frequent intake of information about the pandemic. Item level and overall FCV-19s scores were negatively associated with SF-12 summary scores, and fear of COVID-19 was the most important predictor of both physical and mental HRQoL. The findings from this and other similar studies could help to identify specific population groups in need of interventions to improve their physical and mental health, which had deteriorated due to the pandemic.
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Affiliation(s)
- Nikolaos Kontodimopoulos
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
- Healthcare Management Program, School of Economics & Management, Open University of Cyprus, 2220 Nicosia, Cyprus
- Correspondence:
| | - Effimia Poulaki
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - John Fanourgiakis
- Faculty of Social Sciences, Hellenic Open University, 26335 Patras, Greece
- Department of Management Science and Technology, Hellenic Mediterranean University, 72100 Agios Nikolaos, Greece
| | - Michael A. Talias
- Healthcare Management Program, School of Economics & Management, Open University of Cyprus, 2220 Nicosia, Cyprus
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Kwon HY, Kim Y, Lee SY, Kim CB. Quarantining: a mentally distressful but physically comfortable experience in South Korea. Health Qual Life Outcomes 2022; 20:144. [PMID: 36253782 PMCID: PMC9574814 DOI: 10.1186/s12955-022-02051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/25/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Quarantine is the first response to the COVID-19 pandemic. Restricting daily life can cause several problems. This study aimed to measure the impact of the COVID-19 quarantine on health-related quality of life (HRQoL) by comparing to the pre-pandemic. Methods HRQoL during COVID-19 quarantine was surveyed online using EQ-5D index and matched to that of the pre-pandemic-extracted from nationwide representative data of the Korea Community Health Survey- with propensity scores. A beta regression for the EQ-5D scores and a logistic analysis for individual dimensions of the EQ-5D index were performed to measure the impact of the COVID-19 quarantine on health utility. Results The overall scores of the EQ-5D index were significantly higher in the group under quarantine during the COVID-19 pandemic (0.971 SD 0.064) than those before the pandemic (0.964 SD 0.079, Diff. 0.007 SD 0.101, p = 0.043). The beta regression for the overall scores of EQ-5D revealed that quarantining during the COVID-19 pandemic increased by 52.7% compared to normal life before the outbreak(p = 0.045). Specifically, “Depression/Anxiety” deteriorated significantly during quarantining (OR = 0.62, 95% CI:0.48–0.80). However, “Pain/Discomfort” and “Mobility” significantly improved (OR = 5.37, 95% CI:3.71–7.78 and OR = 2.05, 95% CI:1.11–3.80, respectively). Conclusion Although the world is facing a challenging moment that it has never been through before, mandatory quarantine has served as an experience that provided mental distress but physical comfort in the Korean context.
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Affiliation(s)
- Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, South Korea
| | - Yongjoo Kim
- College of Korean Medicine, Sangji University, Wonju, South Korea.
| | - Seung-Young Lee
- Department of Nursing Science, Kyungbuk College, Seoul, South Korea
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Schippers MC, Ioannidis JPA, Joffe AR. Aggressive measures, rising inequalities, and mass formation during the COVID-19 crisis: An overview and proposed way forward. Front Public Health 2022; 10:950965. [PMID: 36159300 PMCID: PMC9491114 DOI: 10.3389/fpubh.2022.950965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
A series of aggressive restrictive measures were adopted around the world in 2020-2022 to attempt to prevent SARS-CoV-2 from spreading. However, it has become increasingly clear the most aggressive (lockdown) response strategies may involve negative side-effects such as a steep increase in poverty, hunger, and inequalities. Several economic, educational, and health repercussions have fallen disproportionately on children, students, young workers, and especially on groups with pre-existing inequalities such as low-income families, ethnic minorities, and women. This has led to a vicious cycle of rising inequalities and health issues. For example, educational and financial security decreased along with rising unemployment and loss of life purpose. Domestic violence surged due to dysfunctional families being forced to spend more time with each other. In the current narrative and scoping review, we describe macro-dynamics that are taking place because of aggressive public health policies and psychological tactics to influence public behavior, such as mass formation and crowd behavior. Coupled with the effect of inequalities, we describe how these factors can interact toward aggravating ripple effects. In light of evidence regarding the health, economic and social costs, that likely far outweigh potential benefits, the authors suggest that, first, where applicable, aggressive lockdown policies should be reversed and their re-adoption in the future should be avoided. If measures are needed, these should be non-disruptive. Second, it is important to assess dispassionately the damage done by aggressive measures and offer ways to alleviate the burden and long-term effects. Third, the structures in place that have led to counterproductive policies should be assessed and ways should be sought to optimize decision-making, such as counteracting groupthink and increasing the level of reflexivity. Finally, a package of scalable positive psychology interventions is suggested to counteract the damage done and improve humanity's prospects.
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Affiliation(s)
- Michaéla C. Schippers
- Department of Technology and Operations Management, Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, Netherlands,*Correspondence: Michaéla C. Schippers
| | - John P. A. Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, United States,Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States,Department of Biomedical Data Science, Stanford University, Stanford, CA, United States,Department of Statistics, Stanford University, Stanford, CA, United States,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, United States
| | - Ari R. Joffe
- Division of Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada,John Dossetor Health Ethics Center, University of Alberta, Edmonton, AB, Canada
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Cheng S, Zhao Y, Kaminga AC, Zhang X, Xu H. China's Fight Against COVID-19: What We Have Done and What We Should Do Next? Front Public Health 2022; 10:548056. [PMID: 35844877 PMCID: PMC9282890 DOI: 10.3389/fpubh.2022.548056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chinese government conducted unprecedented massive public health prevention interventions at the national level, which have effectively contained the spread of Coronavirus Disease 2019 (COVID-19) infections. Specifically, the outbreak in Wuhan has been effectively controlled. Meanwhile, the Chinese efforts to contain the virus have been widely recognized. Even the World Health Organization has praised the efforts of the Chinese government and advised other countries to learn from China's experience in the fight against COVID-19. However, the measures that have been conducted by China to effectively prevent the spread of COVID 19 in the country have not been rigorously analyzed. Therefore, this study aimed to explore the characteristics of China's control and prevention strategies, and identify the elements that changed the epidemiological curve of rapidly rising new confirmed cases of COVID-19. Methods Public health intervention measures and their effects on the spread of COVID-19 in terms of daily newly confirmed and cumulative cases were collected between January 20, 2020, and March 5. Notices of the Joint Prevention and Control Mechanism for COVID-19 of the State Council on Implementing Measures in Hubei were collected. Information obtained by relevant important documents and announcements was collected from the official website of the Chinese government. Additionally, from other media platforms, news, articles, and reviews were used to explain the intervention measure. Thus, using these data, we performed a retrospective description of the intervention strategies at three stages. Results The Chinese government adopted non-pharmacological interventions measures (NPIs) timely and efficiently. On February 20, the declining epidemic trend in China indicated that the three strictest disease prevention and control strategies issued by the Hubei Government had contributed to a smooth decline in the spread of the epidemic. Conclusions The NPIs taken by China play a decisive role to control the spread of novel coronavirus outbreaks. Further research and action are needed to ensure a sufficiently sensitive surveillance system and strong response mechanism, including the establishment of a highly accessible laboratory network, maintenance of awareness of both primary healthcare providers and the public, and regular training and exercise of local Centers for Disease Control and Prevention and general practitioners in the community-level.
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Affiliation(s)
- Sixiang Cheng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
- College of Data Science and Information Engineering, Guizhou Minzu University, Guiyang, China
| | - Yuxin Zhao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa Chiwanda Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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9
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Bokemper SE, Huber GA, James EK, Gerber AS, Omer SB. Testing persuasive messaging to encourage COVID-19 risk reduction. PLoS One 2022; 17:e0264782. [PMID: 35320285 PMCID: PMC8942219 DOI: 10.1371/journal.pone.0264782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 11/18/2022] Open
Abstract
What types of public health messages are effective at changing people's beliefs and intentions to practice social distancing to slow the spread of COVID-19? We conducted two randomized experiments in summer 2020 that assigned respondents to read a public health message and then measured their beliefs and behavioral intentions across a wide variety of outcomes. Using both a convenience sample and a pre-registered replication with a nationally representative sample of Americans, we find that a message that reframes not social distancing as recklessness rather than bravery and a message that highlights the need for everyone to take action to protect one another are the most effective at increasing beliefs and intentions related to social distancing. These results provide an evidentiary basis for building effective public health campaigns to increase social distancing during flu pandemics.
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Affiliation(s)
- Scott E. Bokemper
- Institution for Social and Policy Studies, Yale University, New Haven, Connecticut, United States of America
- Center for the Study of American Politics, Yale University, New Haven, Connecticut, United States of America
| | - Gregory A. Huber
- Institution for Social and Policy Studies, Yale University, New Haven, Connecticut, United States of America
- Center for the Study of American Politics, Yale University, New Haven, Connecticut, United States of America
- Department of Political Science, Yale University, New Haven, Connecticut, United States of America
| | - Erin K. James
- Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Alan S. Gerber
- Institution for Social and Policy Studies, Yale University, New Haven, Connecticut, United States of America
- Center for the Study of American Politics, Yale University, New Haven, Connecticut, United States of America
- Department of Political Science, Yale University, New Haven, Connecticut, United States of America
| | - Saad B. Omer
- Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
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D'Errico S, Padovano M, Scopetti M, Manetti F, Zanon M, Santurro A, Frati P, Fineschi V. Supporting Decision Making in Intensive Care: Ethical Principles for Managing Access to Care During the COVID-19 Pandemic. Front Med (Lausanne) 2021; 8:787805. [PMID: 34926530 PMCID: PMC8678038 DOI: 10.3389/fmed.2021.787805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
The pandemic from COVID-19 causes a health threat for many countries and requires an internationally coordinated response due to the high spread of the infection. The current local and international situation gives rise to logistical and ethical considerations regarding the imbalance between needs for assistance and availability of health resources in the continuation of the emergency. A shortage condition will require healthcare professionals to choose between patients who will have access to respiratory support and those who will have to continue without. The sharing of criteria for the introduction of patients to the different therapeutic paths is fundamental to prevent the onset of ethical issues. The present paper analyzes the critical issues related to the scarcity of healthcare resources and the limitation of access to intensive care with the aim of proposing ethically sustainable principles for the management of the current pandemic situation.
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Affiliation(s)
- Stefano D'Errico
- Department of Medicine, Surgery, and Health, University of Trieste, Trieste, Italy
| | - Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Martina Zanon
- Department of Medicine, Surgery, and Health, University of Trieste, Trieste, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Neuromed, Pozzilli, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Neuromed, Pozzilli, Italy
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11
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Harris CE. The Conflict of Public Health Law and Civil Liberties: The Role of Research Data and First Amendment Law. Am J Med 2021; 134:1312-1313. [PMID: 34097887 PMCID: PMC8178057 DOI: 10.1016/j.amjmed.2021.04.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Curtis E Harris
- Department of Endocrinology, The Clinic, Ada, Okla; Oklahoma City University School of Law, Okla; Department of Medicine, Oklahoma State School of Medicine, Tulsa.
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12
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Riza E, Kakalou E, Nitsa E, Hodges-Mameletzis I, Goggolidou P, Terzidis A, Cardoso E, Puchner KP, Solomos Z, Pikouli A, Stoupa EP, Kakalou C, Karamagioli E, Pikoulis E. Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9257. [PMID: 34501844 PMCID: PMC8431650 DOI: 10.3390/ijerph18179257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contact tracing as an epidemiological strategy has repeatedly contributed to the containment of various past epidemics and succeeded in controlling the spread of disease in the community. Systematic training of contact tracers is crucial in ensuring the effectiveness of epidemic containment. METHODS An intensive training course was offered to 216 health and other professionals who work with vulnerable population groups, such as Roma, refugees, and migrants in Greece, by the scientific team of the postgraduate programme "Global Health-Disaster Medicine" of the Medical School, National and Kapodistrian University of Athens, with the support of the Swiss embassy in Greece. The course was delivered online due to the pandemic restriction measures and was comprised of 16 h over 2 days. The course curriculum was adapted in Greek using, upon agreement, a similar training course to what was developed by the Johns Hopkins University Bloomberg School of Public Health. Evaluation of the course was conducted in order to determine the short term satisfaction from participating in this training course. RESULTS A total of 70% of the course participants completed the evaluation questionnaires and all trainers gave feedback on the course. The training modules were ranked as extremely useful by the majority of the participants and over 50% of the participants specifically stated that the course content was directly related to their work with vulnerable groups. Content about the ethics of contact tracing and the effective communication skills presented were deemed most useful. CONCLUSION The course was well organised and provided the required skills for effective contact tracing. Many course participants intend to use some components in their work with vulnerable populations groups. Contact tracing efforts work best in a systematic and coordinated way and the provision of systematic and organised training can greatly increase its effectiveness.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Eleni Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evangelia Nitsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Ioannis Hodges-Mameletzis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Paraskevi Goggolidou
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Agis Terzidis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni Cardoso
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Karl Philipp Puchner
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | | | - Anastasia Pikouli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni-Panagiota Stoupa
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Christina Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evika Karamagioli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Emmanouil Pikoulis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
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13
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Reeves JJ, Pageler NM, Wick EC, Melton GB, Tan YHG, Clay BJ, Longhurst CA. The Clinical Information Systems Response to the COVID-19 Pandemic. Yearb Med Inform 2021; 30:105-125. [PMID: 34479384 PMCID: PMC8416224 DOI: 10.1055/s-0041-1726513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. METHODS PubMed/MEDLINE, Google Scholar, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies pertaining to CIS, pandemics, and COVID-19 through October 2020. The most informative and detailed studies were highlighted, while many others were referenced. RESULTS CIS were heavily relied upon by health systems and governmental agencies worldwide in response to COVID-19. Technology-based screening tools were developed to assist rapid case identification and appropriate triaging. Clinical care was supported by utilizing the electronic health record (EHR) to onboard frontline providers to new protocols, offer clinical decision support, and improve systems for diagnostic testing. Telehealth became the most rapidly adopted medical trend in recent history and an essential strategy for allowing safe and effective access to medical care. Artificial intelligence and machine learning algorithms were developed to enhance screening, diagnostic imaging, and predictive analytics - though evidence of improved outcomes remains limited. Geographic information systems and big data enabled real-time dashboards vital for epidemic monitoring, hospital preparedness strategies, and health policy decision making. Digital contact tracing systems were implemented to assist a labor-intensive task with the aim of curbing transmission. Large scale data sharing, effective health information exchange, and interoperability of EHRs remain challenges for the informatics community with immense clinical and academic potential. CIS must be used in combination with engaged stakeholders and operational change management in order to meaningfully improve patient outcomes. CONCLUSION Managing a pandemic requires widespread, timely, and effective distribution of reliable information. In the past year, CIS and informaticists made prominent and influential contributions in the global response to the COVID-19 pandemic.
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Affiliation(s)
- J. Jeffery Reeves
- Department of Surgery, University of California, San Diego, La Jolla, California, USA
| | - Natalie M. Pageler
- Department of Pediatrics, Division of Critical Care Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth C. Wick
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Genevieve B. Melton
- Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Yu-Heng Gamaliel Tan
- Department of Orthopedics, Chief Medical Information Officer, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Brian J. Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
| | - Christopher A. Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA
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14
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Morris AH, Stagg B, Lanspa M, Orme J, Clemmer TP, Weaver LK, Thomas F, Grissom CK, Hirshberg E, East TD, Wallace CJ, Young MP, Sittig DF, Pesenti A, Bombino M, Beck E, Sward KA, Weir C, Phansalkar SS, Bernard GR, Taylor Thompson B, Brower R, Truwit JD, Steingrub J, Duncan Hite R, Willson DF, Zimmerman JJ, Nadkarni VM, Randolph A, Curley MAQ, Newth CJL, Lacroix J, Agus MSD, Lee KH, deBoisblanc BP, Scott Evans R, Sorenson DK, Wong A, Boland MV, Grainger DW, Dere WH, Crandall AS, Facelli JC, Huff SM, Haug PJ, Pielmeier U, Rees SE, Karbing DS, Andreassen S, Fan E, Goldring RM, Berger KI, Oppenheimer BW, Wesley Ely E, Gajic O, Pickering B, Schoenfeld DA, Tocino I, Gonnering RS, Pronovost PJ, Savitz LA, Dreyfuss D, Slutsky AS, Crapo JD, Angus D, Pinsky MR, James B, Berwick D. Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions. J Am Med Inform Assoc 2021; 28:1330-1344. [PMID: 33594410 PMCID: PMC8661391 DOI: 10.1093/jamia/ocaa294] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 02/05/2023] Open
Abstract
Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention-the starting point for delivery of "All the right care, but only the right care," an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are based only on their training, expertise, and experience. Electronic health records (EHRs) could improve healthcare with robust decision-support tools that reduce unwarranted variation of clinician decisions and actions. Current EHRs, focused on results review, documentation, and accounting, are awkward, time-consuming, and contribute to clinician stress and burnout. Decision-support tools could reduce clinician burden and enable replicable clinician decisions and actions that personalize patient care. Most current clinical decision-support tools or aids lack detail and neither reduce burden nor enable replicable actions. Clinicians must provide subjective interpretation and missing logic, thus introducing personal biases and mindless, unwarranted, variation from evidence-based practice. Replicability occurs when different clinicians, with the same patient information and context, come to the same decision and action. We propose a feasible subset of therapeutic decision-support tools based on credible clinical outcome evidence: computer protocols leading to replicable clinician actions (eActions). eActions enable different clinicians to make consistent decisions and actions when faced with the same patient input data. eActions embrace good everyday decision-making informed by evidence, experience, EHR data, and individual patient status. eActions can reduce unwarranted variation, increase quality of clinical care and research, reduce EHR noise, and could enable a learning healthcare system.
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Affiliation(s)
- Alan H Morris
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
| | - Brian Stagg
- Department of Ophthalmology and Visual Sciences and John Moran Eye Center
| | - Michael Lanspa
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - James Orme
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Terry P Clemmer
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
- Emeritus
| | - Lindell K Weaver
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Frank Thomas
- Department of Value Engineering, University of Utah Hospitals and Clinics, Salt Lake City, Utah, USA
- Emeritus
| | - Colin K Grissom
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine
- Department of Biomedical Informatics
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Ellie Hirshberg
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Thomas D East
- SYNCRONYS, and University of New Mexico Health Sciences Library & Informatics, Albuquerque, New Mexico, USA
| | - Carrie Jane Wallace
- Department of Ophthalmology and Visual Sciences and John Moran Eye Center
- Emeritus
| | - Michael P Young
- Critical Care Division, Renown Medical Center, School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Dean F Sittig
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Michela Bombino
- Department of Emergency and Intensive Care Medicine, ASST-Monza San Gerardo Hospital, Milan, Italy
| | - Eduardo Beck
- Ospedale di Desio—ASST Monza, UOC Anestesia e Rianimazione, Milan, Italy
| | | | - Charlene Weir
- Department of Biomedical Informatics
- School of Nursing
| | | | - Gordon R Bernard
- Pulmonary, Critical Care, and Allergy Division, Department of Internal Medicine
| | - B Taylor Thompson
- Pulmonary, Critical Care, and Sleep Division , Department of Internal Medicine
| | - Roy Brower
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathon D Truwit
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Steingrub
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - R Duncan Hite
- Pulmonary, Critical Care, and Sleep Division, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Douglas F Willson
- Division of Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jerry J Zimmerman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vinay M Nadkarni
- Department of Anesthesia and Critical Care Medicine
- Department of Pediatrics, Perelman School of Medicine
| | | | - Martha A. Q Curley
- Department of Pediatrics, Perelman School of Medicine
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher J. L Newth
- Department of Pediatrics, University of Southern California, Los Angeles, California, USA
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montréal, Canada
| | | | - Kang H Lee
- Asian American Liver Centre, Gleneagles Hospital, Singapore, Singapore
| | - Bennett P deBoisblanc
- Section of Pulmonary/Critical Care & Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | | | - Anthony Wong
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | - David W Grainger
- Department of Biomedical Engineering and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah
| | - Willard H Dere
- Department of Biomedical Engineering and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah
| | - Alan S Crandall
- Department of Ophthalmology and Visual Sciences and John Moran Eye Center
| | - Julio C Facelli
- Department of Biomedical Informatics
- Center for Clinical and Translational Science, School of Medicine
| | | | | | - Ulrike Pielmeier
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stephen E Rees
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dan S Karbing
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Steen Andreassen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Eddy Fan
- Institute of Health Policy, Management and Evaluation
| | - Roberta M Goldring
- Pulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA
| | - Kenneth I Berger
- Pulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA
| | - Beno W Oppenheimer
- Pulmonary, Critical Care, and Sleep Division, NYU School of Medicine, New York, New York, USA
| | - E Wesley Ely
- Pulmonary, Critical Care, and Allergy Division, Department of Internal Medicine
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center
- Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center (GRECC), Nashville, Tennessee, USA
| | - Ognjen Gajic
- Pulmonary , Critical Care, and Sleep Division, Department of Internal Medicine
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - David A Schoenfeld
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Irena Tocino
- Department of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Russell S Gonnering
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Peter J Pronovost
- Critical Care, Department of Anesthesia, Chief Clinical Transformation Officer, University Hospitals, Highland Hills, Case Western Reserve University, Cleveland, OH, USA
| | - Lucy A Savitz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Didier Dreyfuss
- Assistance Publique – Hôpitaux de Paris, Université de Paris, INSERM unit UMR S_1155 (Common and Rare Kidney Diseases), Sorbonne Université, Paris, France
| | - Arthur S Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute / ST. Michaels' Hospital and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - James D Crapo
- Department of Internal Medicine, National Jewish Health, Denver, Colorado, USA
| | - Derek Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael R Pinsky
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brent James
- Clinical Excellence Research Center (CERC), Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donald Berwick
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
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15
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Lan KP, Hsu YS, Chang CI, Wei PC, Guo TG, Yen DHT, Hsu TF, Tzeng YM, Ming JL. Experience of resources management on coronavirus disease 2019 epidemic at a tertiary medical center in Northern Taiwan. J Chin Med Assoc 2021; 84:545-549. [PMID: 33871390 DOI: 10.1097/jcma.0000000000000527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes infectious symptoms including fever, cough, respiratory and gastrointestinal symptoms, and even loss of smell/taste and to date had caused 489 000 people to be infected with 32 000 deaths. This article aims to develop some strategies in dealing with the COVID-19 epidemic to prevent nosocomial infection and ensure the safety of healthcare workforce and employees. METHODS This is a prospectively registered and retrospective descriptive study investigating the clinical characteristics, results of diagnostic tests, and patients' disposition from February 1, 2020, to April 30, 2020, at a tertiary medical center in Northern Taiwan. RESULTS There is no nosocomial spreading of SARS-CoV-2 in our facility. The following strategies were followed: information transparency; epidemic prevention resources planning by authorities; multidisciplinary cooperation; informative technologies; immigration quarantine policies; travel restrictions; management of diversion/subdivision; self-health monitoring; social distancing; screening of travel, occupation, contact, and cluster (TOCC) history; traffic control bundling (TCB); training of using personal protective equipment; real-name visiting management; and employee care. The patients' basic characteristics and diagnostic results were gathered. Of the 3832 cases, about 25.9% had travel history. Most of them were traveling to Asia (419 people/time, 10.9%) and from China (256 people/time, 6.7%). Meanwhile, healthcare personnel accounted for 316 people/time (8.3%) and cleaning personnel, 6 people/time (0.16%). The 36 cases who care or have contact with confirmed cases have negative results from the COVID-19 test. The most frequent symptoms were fever and upper respiratory infection followed by gastrointestinal symptoms. CONCLUSION The above strategies were followed. Patients were stratified based on the risk of TOCC history assessment to ensure the safety of healthcare personnel and patients' appropriate and timely medical services.
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Affiliation(s)
- Kai-Ping Lan
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yueh-Shuang Hsu
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-I Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pi-Ching Wei
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ti-Gen Guo
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - David Hung-Tsang Yen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Emergency Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Teh-Fu Hsu
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Emergency Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
| | - Yuann-Meei Tzeng
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jin-Lain Ming
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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16
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Barbieri PN, Bonini B. Political orientation and adherence to social distancing during the COVID-19 pandemic in Italy. ECONOMIA POLITICA (BOLOGNA, ITALY) 2021; 38:483-504. [PMID: 35422606 PMCID: PMC7980748 DOI: 10.1007/s40888-021-00224-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/10/2021] [Indexed: 05/14/2023]
Abstract
Many governments have implemented social distancing and lockdown measures to curb the spread of the novel coronavirus (COVID-19). Using province-level geolocation data from Italy, we document that political disbelief can limit government policy effectiveness. Residents in provinces leaning towards extreme right-wing parties show lower rates of compliance with social distancing order. We also find that, during the Italian lockdown, provinces with high protest votes virtually disregarded all social distancing orders. On the contrary, in provinces with higher political support for the current political legislation, we found a higher degree of social distancing compliance. These results are robust to controlling for other factors, including time, geography, local COVID-19 cases and deaths, healthcare hospital beds, and other sociodemographic and economic characteristics. Our research shows that bipartisan support and national responsibility are essential to implement and manage social distancing efficiently. From a broader perspective, our findings suggest that partisan politics and discontent with the political class (i.e., protest voting) might significantly affect human health and the economy.
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Affiliation(s)
- Paolo Nicola Barbieri
- Prometeia & Centre for Health Economics, University of Gothenburg, Gothenburg, Sweden
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17
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Xu Y, Lin G, Spada C, Zhao H, Wang S, Chen X, Chen Y, Zhang Y, Marraro GA, Zeng X, Ye X, Zhang L, Zeng Y. Public Knowledge, Attitudes, and Practices Behaviors Towards Coronavirus Disease 2019 (COVID-19) During a National Epidemic-China. Front Public Health 2021; 9:638430. [PMID: 33816423 PMCID: PMC8017307 DOI: 10.3389/fpubh.2021.638430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The rapid outbreak of coronavirus disease 2019 (COVID-19) posed a serious threat to China, followed by compulsive measures taken against the national emergency to control its further spread. This study was designed to describe residents' knowledge, attitudes, and practice behaviors (KAP) during the outbreak of COVID-19. Methods: An anonymous online questionnaire was randomly administrated to residents in mainland China between Mar 7 and Mar 16, 2020. Residents' responses to KAP were quantified by descriptive and stratified analyses. A Multiple Logistic Regression model was employed to identify risk factors associated with KAP scores. Results: A total of 10,195 participants were enrolled from 32 provinces of China. Participants of the ≥61 years group had higher KAP scores [adjusted Odds Ratio (ORadj) = 4.8, 95% Confidence Interval (CI): 3.0-7.7, P < 0.0001], and the married participants and those in low-income families had higher scores of KAP (ORadj = 1.2, 95% CI: 1.1-1.3; ORadj = 1.8, 95% CI: 1.6-2.2, respectively, both P < 0.0001). The participants living with more than two family members had higher scores in an increasing ORs when the family members increased (ORadj = 1.3, 95% CI: 1.1-1.6, P = 0.013; ORadj = 1.3, 95% CI: 1.1-1.6, P = 0.003; ORadj = 1.3, 95% CI: 1.0-1.6, P = 0.02; for groups of 2, 3-4 and ≥5, respectively). Conclusions: Out of the enrolled participants who completed the survey, 85.5% responded positively toward the mandatory public health interventions implemented nationwide by the Chinese authorities. These effective practices seem to be related to a proper attitude generated by the increased knowledge and better awareness of the risks related to the COVID-19 pandemic and the consequent need for safe and responsible behavior.
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Affiliation(s)
- Yuan Xu
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Guofu Lin
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China.,The Second Clinical College, Fujian Medical University, Quanzhou, China
| | - Claudio Spada
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Healthcare Accountability Lab, University of Milan, Milan, Italy
| | - Huifen Zhao
- Department of Nursing Teaching and Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Shuo Wang
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiaoyang Chen
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Yunfeng Chen
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Yixiang Zhang
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Giuseppe A Marraro
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,The Second Clinical College, Fujian Medical University, Quanzhou, China
| | - Xiaohong Zeng
- Department of Preventive Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xiangjia Ye
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Li Zhang
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
| | - Yiming Zeng
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.,Respiratory Medicine Center of Fujian Province, Quanzhou, China
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18
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has challenged the traditional public health balance between benefiting the good of the community through contact tracing and restricting individual liberty. This article first analyzes important technical and ethical issues regarding new smartphone apps that facilitate contact tracing and exposure notification. It then presents a framework for assessing contact tracing, whether manual or digital: the effectiveness at mitigating the pandemic; acceptability of risks, particularly privacy; and equitable distribution of benefits and risks. Both manual and digital contact tracing require public trust, engagement of minority communities, prompt COVID-19 testing and return of results, and high adherence with physical distancing and use of masks.
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Affiliation(s)
- Bernard Lo
- University of California, San Francisco, and The Greenwall Foundation, New York, New York (B.L.)
| | - Ida Sim
- University of California, San Francisco, San Francisco, California (I.S.)
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19
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Ganczak M, Pasek O, Duda-Duma Ł, Świstara D, Korzeń M. Use of masks in public places in Poland during SARS-Cov-2 epidemic: a covert observational study. BMC Public Health 2021; 21:393. [PMID: 33622279 PMCID: PMC7901005 DOI: 10.1186/s12889-021-10418-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022] Open
Abstract
Background Face masks have been employed in the COVID-19 pandemic plans as a public and personal health control measure against the spread of SARS-CoV-2. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020; a relaxation of previous universal measures was announced on May 29th, 2020, limiting use to indoor public places. Objective To assess use of masks or other protective devices in public spaces in Poland during the SARS-Cov-2 epidemic. Methods A non-participatory covert observational study was conducted on three dates, (10.05/18.05/25.05.2020) at public spaces in 13 regions with different risks. Ten consecutive individuals were observed by each of 82 medical students (n = 2460 observations), using a structured checklist. Results Among 2353 observed persons, the female/male ratios were 1.0, 1.1, and 1.0 on the three dates. Almost three quarters - 73.6% (n = 552/750) were using masks on date 1, 66.5% (544/818) on date 2; and 65.7% (516/785) on date 3. Cloth masks predominated on all dates (64.7–62.3%-62.6%), followed by medical (23.4–28.5%-26.9%). Being female (OR = 1.77–1.47-1.53 respectively) and location in a closed space (OR = 2.60–2.59-2.32) were each associated with higher usage. Participants in sports were about two times less likely to use masks (OR = 0.64–0.53-0.53) as compared to other activities. The proportion using masks correctly decreased gradually over time (364/552; 65.9%; 339/544; 62.3% and 304/516; 58.9%). More females wore masks correctly (date 1: 205/294; 69.7% vs 159/258; 61.6%, and date 3: 186/284; 65.5% vs 118/232; 50.9%; p = 0.045; p = 0.0008 respectively). Uncovered noses (47.3–52.7%) and masks around the neck (39.2–42.6%) were the most frequent incorrect practices. Conclusions Practices were not in line with official recommendations, especially among males, and deteriorated over time. Cloth masks were predominantly used in public spaces. Health promotion, through utilizing all available communication channels, would be helpful to increase compliance.
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Affiliation(s)
- Maria Ganczak
- Department of Infectious Diseases, Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland.
| | - Oskar Pasek
- Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Łukasz Duda-Duma
- Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Dawid Świstara
- Collegium Medicum, Uniwersytet Zielonogórski, Zielona Góra, Poland
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence & Applied Mathematics, Westpomeranian University of Technology, Szczecin, Poland
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20
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Abounoori M, Maddah MM, Sharif Nia H, Rahmatpour P, Khosravifar S, SamadiKouchaksaraei M, Khosravifar S. Development and Validation of the Knowledge and Attitude Scale Toward COVID-19 Pandemic Breaking Transmission Chain (KA-C) Among Iranian Population. Front Public Health 2021; 9:627013. [PMID: 33681135 PMCID: PMC7925831 DOI: 10.3389/fpubh.2021.627013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/18/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives: We aimed to develop a scale and evaluate this scale's validity and reliability to measure factors affecting people's knowledge and attitudes toward the pandemic breaking transmission chain. Methods: This exploratory mixed-method study was carried out in two phases: (1) item generation using literature reviews and interviews and, (2) item reduction by psychometric assessments of the developed scale. The face, content, construct (exploratory and confirmatory factor analysis), convergent, and discriminant validity of the scale were assessed in the Iranian population (n = 500) from March to June 2020. The Composite Reliability (CR) and the internal consistency correlation coefficient were estimated. Results: The Knowledge and Attitude Scale Toward COVID-19 Pandemic Breaking Transmission Chain (KA-C) among the Iranian population included 18 items. Two factors with a whole variance of 66.05% were identified by exploratory factor analysis. Factors were labeled as "health literacy" and "home health empowerment." The confirmatory factor analysis showed the goodness of fit. The CR of the scale for first and second factors were 0.965 and 0.833 receptively. The scale's internal consistency correlation coefficient was acceptable (Cronbach's alpha = 0.960 and 0.823, average interitem correlation = 0.643 and 0.635, McDonald's omega = 0.963 and 0.829, for the first and second factor, receptively). Conclusion: The KA-C scale can be exerted to screen the people's knowledge and attitude about the COVID-19 pandemic breaking the transmission chain as a valid and reliable scale for further policymaking, health care providers, and for a multi-dimensional psychosocial assessment of the pandemic period.
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Affiliation(s)
- Mahdi Abounoori
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Moein Maddah
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Pardis Rahmatpour
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Khosravifar
- Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shahrzad Khosravifar
- Department of Medicine, Aliasghar Children Hospital, Iran University of Medical Science, Tehran, Iran
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21
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Abstract
Abstract
The events surrounding COVID-19, combined with the mandatory quarantines widely imposed in Asia and Europe since the virus outbreak, have reignited discussion of the balance between individual rights and liberties and public health during epidemics and pandemics. This article analyses this issue from the perspectives of precaution and necessity. There is a difficult relationship between these two seemingly opposite principles, both of which are frequently invoked in this domain. Although the precautionary principle (PP) encourages the use of quarantines, including mandatory quarantines, and associated restrictive measures, the principle of necessity (PN) puts a break on such measures. The COVID-19 pandemic reveals once again the different interrelations between these two principles. However, the alleged conflict between the PN and the PP is based on a superficial analysis. The relation between these two principles is far more complex, as this article will demonstrate.
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22
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Dos Santos JLG, Stein Messetti PA, Adami F, Bezerra IMP, Maia PCGGS, Tristan-Cheever E, de Abreu LC. Collision of Fundamental Human Rights and the Right to Health Access During the Novel Coronavirus Pandemic. Front Public Health 2021; 8:570243. [PMID: 33490011 PMCID: PMC7820746 DOI: 10.3389/fpubh.2020.570243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction: COVID-19 requires governmental measures to protect healthcare system access for people. In this process, the collision of fundamental rights emerges as a crucial challenge for decision-making. Policy Options and Implications: This policy review analyzes selected articles by the PubMed searcher about extreme measures taken in several countries during precedent pandemics and the current pandemic, and selects hard decisions relating to the exceptional measures taken by judicial departments in Brazil, connecting them to the “collision of fundamental rights and law principles.” The collision of rights and principles imposed on decision makers a duty to provide balanced rights, and to adopt the enforcement of some rights prioritization. Ethical concerns were also verified in this field involving rights limitations. During a pandemic, the importance of extreme measures to protect health rights and healthcare systems is instrumental for focused, fast, and correct decision making to avoid loss of life and the collapse of healthcare systems. The main goals of this research are to discuss the implications and guidelines for public health decision making, the indispensable ethical and legal aspects for safeguarding health systems and the lives of people, and the respect of the Justice principle and of fundamental health and dignity rights. We conclude that COVID-19 justifies the prioritization of collective and individual health access rights. Acceptable standards of fundamental rights restrictions are established at the constitutional and international levels and must be enforced by rules and governmental action, to ensure fast and accurate decision making during a pandemic. Freedom rights exercises must be linked to solidarity for the realization of social welfare, for the health rights of all individuals and for health systems to function well during a pandemic. Actionable Recommendations: All individuals are free and equal, therefore social exclusion is prohibited. Institutions must consider social inequalities when discussing public health measures and be guided by ethical standards, by law principles, and rules recognized by constitutional and international law for the benefit of all during a health pandemic. Conclusions: Collective and individual health rights prevail over the collision of rights when facing pandemic occurrences, case by case, in health systems protection, based on the literature, on precedent pandemics and on legitimate Public Health efforts.
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Affiliation(s)
- José Luiz Gondim Dos Santos
- Laboratório de Delineamento de Estudos e de Escrita Científica, Centro Universitário Saúde ABC Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
| | - Paulo André Stein Messetti
- Laboratório de Delineamento de Estudos e de Escrita Científica, Centro Universitário Saúde ABC Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
| | - Fernando Adami
- Laboratório de Delineamento de Estudos e de Escrita Científica, Centro Universitário Saúde ABC Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
| | - Italla Maria Pinheiro Bezerra
- Laboratório de Delineamento de Estudos e de Escrita Científica, Centro Universitário Saúde ABC Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
| | - Paula Christianne G G Souto Maia
- Laboratório de Delineamento de Estudos e de Escrita Científica, Centro Universitário Saúde ABC Faculdade de Medicina do ABC (FMABC), Santo André, Brazil
| | - Elisa Tristan-Cheever
- Cambridge Health Alliance, Cambridge, MA, United States.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Delineamento de Estudos e de Escrita Científica, Centro Universitário Saúde ABC Faculdade de Medicina do ABC (FMABC), Santo André, Brazil.,Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,School of Medicine, University of Limerick, Limerick, Ireland.,Federal University of Espírito Santo, Vitória, Brazil
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23
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Chan JJ, Chen KK, Choi P, Rojas EO, Schipper ON, Aiyer A, de Cesar Netto C, Haleem AM, Kadakia AR, Vulcano E. Impact of COVID-19 Pandemic on Patients’ Perceptions of Safety and Need for Elective Foot and Ankle Surgery in the United States. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211013788. [PMID: 35097451 PMCID: PMC8702750 DOI: 10.1177/24730114211013788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: With the development of the COVID-19 pandemic, elective foot and ankle surgeries were delayed throughout the United States to divert health care resources and limit exposure. Little is known about the impact of COVID-19 on patient’s willingness to proceed with elective procedures once restrictions are lifted and factors contributing to such decision. Methods: Patients across 6 US orthopedic institutions who had their elective foot and ankle surgeries cancelled secondary to the pandemic were given a questionnaire. Specifically, patients were asked about their willingness to move forward with surgery once restrictions were lifted and if not why. Pain-level and pain medication use were also assessed. Univariate analysis was used to identify factors that contribute to patient’s decisions. Results: A total of 150 patients participated in this study. Twenty-one (14%) opted not to proceed with surgery once restrictions were lifted. Forty-three percent (n = 9) listed concern for COVID infection as the reason; however, 14% of them would proceed if procedures were performed in surgery center. Twenty-nine (19% of the total cohort) patients had increased pain and 11% of patients were taking more pain meds because of the delay to their procedure. Patients who decided not to proceed with surgery reported pain reduction (3% vs 14%) and lower increase in pain medication used (5% vs 12%). Conclusion: COVID-19 has made a significant impact on the health care system. Delay of elective foot and ankle procedures impact patient quality of life and outcomes. Access to surgery centers may provide a partial solution during the pandemic Level of Evidence: Level III.
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Affiliation(s)
| | | | - Peter Choi
- University of Massachusetts, Worcester, MA, USA
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24
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The Legal Response to COVID-19: Legal Pathways to a More Effective and Equitable Response. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 27 Suppl 1, COVID-19 and Public Health: Looking Back, Moving Forward:S72-S79. [PMID: 33239567 DOI: 10.1097/phh.0000000000001277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Mobasseri K, Azami-Aghdash S, Khanijahani A, Khodayari-Zarnaq R. The Main Issues and Challenges Older Adults Face in the SARS-CoV-2 Pandemic: A Scoping Review of Literature. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:2295-2307. [PMID: 34178736 PMCID: PMC8215059 DOI: 10.18502/ijph.v49i12.4810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background The Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (SARS-CoV-2) severely affects those above the age of 60 yr and those with other conditions. This study aimed to review the available evidence on older adult's issues in facing the COVID-19 pandemic. Methods The framework is based on scoping review of literature published from Jan 10 to Jul 31, 2020. Medline, Scopus, Web of Science, and Google Scholar databases and other sources of information, to identify grey literature, were selected for data collection. Two researchers independently screened all studies and extracted data. All types of studies published about SARS-CoV-2 and related to older adults' issues were eligible. Results Overall, 210 documents were included in the final analysis. Letter to the editor was the most frequent article format (20.95%). Most of the papers were from the United States (38.09%) and published in Jun 2020 (29.52%). After content analysis, six following themes were extracted: Supporting and information sources, e-health services, access to essential supplies, Long Term Care Facilities (LTCFs), physical and mental consequences of self-isolation, neglect of older adults, ageism and age discrimination. Conclusion In the pandemic, there is an urgent need for interventional research and innovational implementations to address issues related to providing services for older adults. This can help older adults to maintain their physical and mental health, and reduce the spread of infection in nursing homes. Further studies focusing on the rights of the older adults are needed on all issues associated with COVID-19.
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Affiliation(s)
- Khorshid Mobasseri
- Department of Health Education and Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Rahim Khodayari-Zarnaq
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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26
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Kavanagh MM, Singh R. Democracy, Capacity, and Coercion in Pandemic Response: COVID-19 in Comparative Political Perspective. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2020; 45:997-1012. [PMID: 32464665 DOI: 10.1215/03616878-8641530] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The COVID-19 pandemic has challenged governments around the world. It also has challenged conventional wisdom and empirical understandings in the comparative politics and policy of health. Three major questions present themselves: First, some of the countries considered to be most prepared-having the greatest capacity for outbreak response-have failed to respond effectively to the pandemic. How should our understanding of capacity shift in light of COVID-19, and how can we incorporate political capacity into thinking about pandemic preparedness? Second, several of the mechanisms through which democracy has been shown to be beneficial for health have not traveled well to explain the performance of governments in this pandemic. Is there an authoritarian advantage in disease response? Third, after decades in which coercive public health measures have increasingly been considered counterproductive, COVID-19 has inspired widespread embrace of rigid lockdowns, isolation, and quarantine enforced by police. Will these measures prove effective in the long run and reshape public health thinking? This article explores some of these questions with emerging examples, even amid the pandemic, when it is too soon to draw conclusions.
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27
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Verma BK, Verma M, Verma VK, Abdullah RB, Nath DC, Khan HTA, Verma A, Vishwakarma RK, Verma V. Global lockdown: An effective safeguard in responding to the threat of COVID-19. J Eval Clin Pract 2020; 26:1592-1598. [PMID: 32970386 PMCID: PMC7719340 DOI: 10.1111/jep.13483] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 12/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The recent outbreak of coronavirus (COVID-19) has infected around 1 560 000 individuals till 10 April 2020, which has resulted in 95 000 deaths globally. While no vaccine or anti-viral drugs for COVID-19 are available, lockdown acts as a protective public health measures to reduce human interaction and lower transmission. The study aims to explore the impact of delayed planning or lack of planning for the lockdown and inadequate implementation of the lockdown, on the transmission rate of COVID-19. METHOD Epidemiological data on the incidence and mortality of COVID-19 cases as reported by public health authorities were accessed from six countries based on total number of infected cases, namely, United States and Italy (more than 100 000 cases); United Kingdom, and France (50 000-100 000 cases), and India and Russia (6000-10 000 cases). The Bayesian inferential technique was used to observe the changes (three points) in pattern of number of cases on different duration of exposure (in days) in these selected countries 1 month after World Health Organization (WHO) declaration about COVID-19 as a global pandemic. RESULTS On comparing the pattern of transmission rates observed in these six countries at posterior estimated change points, it is found that partial implementation of lockdown (in the United States), delayed planning in lockdown (Russia, United Kingdom, and France), and inadequate implementation of the lockdown (in India and Italy) were responsible to the spread of infections. CONCLUSIONS In order to control the spreading of COVID-19, like other national and international laws, lockdown must be implemented and enforced. It is suggested that on-time or adequate implementation of lockdown is a step towards social distancing and to control the spread of this pandemic.
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Affiliation(s)
| | - Mamta Verma
- Department of LawKazi Nazrul UniversityWest BengalIndia
| | | | | | | | - Hafiz T. A. Khan
- College of Nursing, Midwifery and HealthcareUniversity of West LondonBrentfordUK
| | - Anita Verma
- Departments of NeurologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Ramesh K. Vishwakarma
- Department of BiostatisticsKing Abdullah International Medical Research CenterRiyadhSaudi Arabia
- King Saud bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
- Ministry of the National Guard ‐ Health AffairsRiyadhSaudi Arabia
| | - Vivek Verma
- Departments of NeurologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
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28
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Al-Rohaimi AH, Al Otaibi F. Novel SARS-CoV-2 outbreak and COVID19 disease; a systemic review on the global pandemic. Genes Dis 2020; 7:491-501. [PMID: 33335956 PMCID: PMC7729096 DOI: 10.1016/j.gendis.2020.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022] Open
Abstract
Since the beginning of the 21st century, several viral outbreaks have threatened humankind and posed a new challenge to the modern healthcare system. The recent outbreak in Wuhan (December 2019), China, represents a beta coronavirus classified as novel Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) which belongs to the Coronaviridae family. Novel SARS-CoV-2 represents a significant similarity with previous coronaviruses such as SARS-CoV in 2002, China and MERS-CoV in 2015, Middle East. However, preliminary research investigations have shown the novel SARS-CoV-2 evolved with several mutations and developed the capacity to cross the species, i.e., animal to human. The initial findings have shown that spike proteins are vital molecules target hACE2 receptor for its attachment and entry into cells. After successful entry virus primarily focuses on respiratory airway cell lines and triggers a massive immune response leading to mucus generation. In severe conditions, the virus is capable of forcing viral pneumonia leading to the collapse of the respiratory system, i.e., COVID19. So far, there is a lack of immunity against the virus in humans. At the same in the absence of therapeutic interventions, many countries experienced high mortality, such as the United States, European countries, i.e., Italy, Spain, France, and the United Kingdom. The vaccine development is underway and experiencing challenges, as many reports demonstrated genetic variations in viral genome and proteins as well. The present study provides a complete comprehensive overview of the novel SARS-CoV-2 outbreak, human transmission, and global spread.
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Affiliation(s)
| | - Faisal Al Otaibi
- Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M6BQ, UK
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29
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Farooq S, Ngaini Z. Natural and Synthetic Drugs as Potential Treatment for Coronavirus Disease 2019 (COVID-2019). CHEMISTRY AFRICA 2020. [PMCID: PMC7682129 DOI: 10.1007/s42250-020-00203-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has become a global pandemic in a short period, where a tragically large number of human lives being lost. It is an infectious pandemic that recently infected more than two hundred countries in the world. Many potential treatments have been introduced, which are considered potent antiviral drugs and commonly reported as herbal or traditional and medicinal treatments. A variety of bioactive metabolites extracts from natural herbal have been reported for coronaviruses with some effective results. Food and Drug Administration (FDA) has approved numerous drugs to be introduced against COVID-19, which commercially available as antiviral drugs and vaccines. In this study, a comprehensive review is discussed on the potential antiviral remedies based on natural and synthetic drugs. This review highlighted the potential remedies of COVID-19 which successfully applied to patients with high cytopathic inhibition potency for cell-to-cell spread and replication of coronavirus.
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30
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Kim K, Choi JW, Moon J, Akilov H, Tuychiev L, Rakhimov B, Min KS. Clinical Features of COVID-19 in Uzbekistan. J Korean Med Sci 2020; 35:e404. [PMID: 33230989 PMCID: PMC7683242 DOI: 10.3346/jkms.2020.35.e404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND As of April 30, 2020, a total of 2,039 cases of the novel coronavirus disease 2019 (COVID-19) were confirmed in the Republic of Uzbekistan after the first detection on March 15. Reports on symptoms of COVID-19 are non-specific and known to vary from asymptomatic, mild to severe, or fatal. This study aimed to analyze the symptomatic and clinical characteristics of study participants based on the medical records of participants hospitalized with COVID-19 in Uzbekistan. METHODS We collected all data from medical records of COVID-19 confirmed patients in 19 hospitals from 13 regions of Uzbekistan between March 15 and April 30. We selected 1,030 patients discharged from the hospitals after COVID-19 treatment as study participants, excluding those with missing data. Further, we collected demographics, symptoms, clinical outcomes, and treatment data through medical records. RESULTS More than half (57.6%) of confirmed cases of COVID-19 were males, and the median age was 36.0 years. The most frequent symptoms at the first inspection on hospital admission of all patients were fatigue (59.7%), dry cough (54.1%), pharyngalgia (31.6%), headache (20.6%), and anorexia (12.5%). Compared to the oldest group, the youngest group showed a lower frequency of symptoms. About half of the group aged 18-49 years reported that they came from abroad. One-fifth of patients in group 50-84 received oxygen support, while no patients in group aged 0-17 years received oxygen support. About two-thirds of the participants from intensive care unit (ICU) came from abroad, whereas 42.1% of the non-ICU group returned from other countries. Regarding symptoms, 16.9% of the patients in the ICU group were asymptomatic, while 5.8% in the non-ICU group were asymptomatic. CONCLUSION This study suggests that the medical delivery system and resource distribution need to be implemented based on clinical characteristics by age and severity to delay and effectively respond to the spread of infections in the future. This study analyzed symptoms of COVID-19 patients across Uzbekistan, which is useful as primary data for policies on COVID-19 in Uzbekistan.
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Affiliation(s)
- KyungHee Kim
- Institute for Environmental Health, Korea University, Seoul, Korea
| | - Jae Wook Choi
- Institute for Environmental Health, Korea University, Seoul, Korea
- Graduate School of Public Health, Korea University, Seoul, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
| | - Juyoung Moon
- Institute for Environmental Health, Korea University, Seoul, Korea
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - Habibulla Akilov
- The Tashkent Institute of Postgraduate Medical Education, Tashkent, Uzbekistan
| | | | | | - Kwang Sung Min
- Department of International Development Cooperation, Graduate School of Pan-Pacific International Studies, Kyung Hee University, Seoul, Korea
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31
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Do BN, Nguyen PA, Pham KM, Nguyen HC, Nguyen MH, Tran CQ, Nguyen TTP, Tran TV, Pham LV, Tran KV, Duong TT, Duong TH, Nguyen KT, Pham TTM, Hsu MH, Duong TV. Determinants of Health Literacy and Its Associations With Health-Related Behaviors, Depression Among the Older People With and Without Suspected COVID-19 Symptoms: A Multi-Institutional Study. Front Public Health 2020; 8:581746. [PMID: 33313037 PMCID: PMC7703185 DOI: 10.3389/fpubh.2020.581746] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose: We examined factors associated with health literacy among elders with and without suspected COVID-19 symptoms (S-COVID-19-S). Methods: A cross-sectional study was conducted at outpatient departments of nine hospitals and health centers 14 February-2 March 2020. Self-administered questionnaires were used to assess patient characteristics, health literacy, clinical information, health-related behaviors, and depression. A sample of 928 participants aged 60-85 years were analyzed. Results: The proportion of people with S-COVID-19-S and depression were 48.3 and 13.4%, respectively. The determinants of health literacy in groups with and without S-COVID-19-S were age, gender, education, ability to pay for medication, and social status. In people with S-COVID-19-S, one-score increment of health literacy was associated with 8% higher healthy eating likelihood (odds ratio, OR, 1.08; 95% confidence interval, 95%CI, 1.04, 1.13; p < 0.001), 4% higher physical activity likelihood (OR, 1.04; 95%CI, 1.01, 1.08, p = 0.023), and 9% lower depression likelihood (OR, 0.90; 95%CI, 0.87, 0.94; p < 0.001). These associations were not found in people without S-COVID-19-S. Conclusions: The older people with higher health literacy were less likely to have depression and had healthier behaviors in the group with S-COVD-19-S. Potential health literacy interventions are suggested to promote healthy behaviors and improve mental health outcomes to lessen the pandemic's damage in this age group.
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Affiliation(s)
- Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Phung-Anh Nguyen
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.,Department of Healthcare Information and Management, Ming Chuan University, Taoyuan City, Taiwan
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.,President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Hoang C Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City, Vietnam.,President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City, Vietnam
| | - Minh H Nguyen
- International Master/Ph.D. Program in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cuong Q Tran
- Department of Anesthesiology, Thu Duc District Hospital, Ho Chi Minh City, Vietnam.,Director Office, Thu Duc District Health Center, Ho Chi Minh City, Vietnam
| | - Thao T P Nguyen
- Health Management Training Institute, Hue University of Medicine and Pharmacy, Hue, Vietnam.,Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Tien V Tran
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Director Office, Military Hospital 103, Hanoi, Vietnam
| | - Linh V Pham
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam.,Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Khanh V Tran
- Director Office, Hospital District 2, Ho Chi Minh City, Vietnam
| | - Trang T Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City, Vietnam
| | - Thai H Duong
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.,Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City, Vietnam
| | - Kien T Nguyen
- Department of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Thu T M Pham
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan City, Taiwan.,President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City, Vietnam
| | - Min-Huei Hsu
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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Lo A, Huang JJ, Chen CC, Chou FHC, Shieh V. From biological safety to social safety: How Taiwan's community centered prevention program controlled the COVID-19 outbreak. J Glob Health 2020; 10:020303. [PMID: 33110507 PMCID: PMC7533428 DOI: 10.7189/jogh.10.020303] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Angela Lo
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Taiwan
| | - Joh-Jong Huang
- Department of Family Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung Taiwan
| | - Cheng-Chung Chen
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung Taiwan
| | | | - Vincent Shieh
- Graduate Institute of Gender Education, National Kaohsiung Normal University, Kaohsiung Taiwan
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33
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Ludvigsson J, von Herrath MG, Mallone R, Buschard K, Cilio C, Craig M, Ilonen J, Leslie D, McGeoch JEM, Schneider D, Skyler JS, Flodström Tullberg M, Hober D. Corona Pandemic: Assisted Isolation and Care to Protect Vulnerable Populations May Allow Us to Shorten the Universal Lock-Down and Gradually Re-open Society. Front Public Health 2020; 8:562901. [PMID: 33102423 PMCID: PMC7555689 DOI: 10.3389/fpubh.2020.562901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/09/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Johnny Ludvigsson
- Department of Biomedical and Clinical Sciences, Crown Princess Victoria Children's Hospital and Division of Pediatrics, Linköping University, Linköping, Sweden
| | | | - Roberto Mallone
- Université de Paris, Institut Cochin, CNRS, INSERM; Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires de Paris Centre-Université de Paris, Cochin Hospital, Service de Diabétologie et Immunologie Clinique, Paris, France
| | | | - Corrado Cilio
- ImmunoVirology Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Craig
- Children's Hospital at Westmead and University of Sydney, Sydney, NSW, Australia
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - David Leslie
- Blizard Institute, Queen Mary, University of London, Whitechapel, United Kingdom
| | - Julie E M McGeoch
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | - Darius Schneider
- La Jolla Institute for Allergy and Immunology, La Jolla, CA, United States
| | - Jay S Skyler
- Department of Medicine, Diabetes Research Institute, University of Miami, Miami, FL, United States
| | - Malin Flodström Tullberg
- Department of Medicine Huddinge, The Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Didier Hober
- Université de Lille, CHU Lille, Laboratoire de Virologie-ULR3610, Lille, France
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34
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Tanveer F, Khalil AT, Ali M, Shinwari ZK. Ethics, pandemic and environment; looking at the future of low middle income countries. Int J Equity Health 2020; 19:182. [PMID: 33059674 PMCID: PMC7557237 DOI: 10.1186/s12939-020-01296-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 02/17/2023] Open
Abstract
COVID-19 which started in Wuhan, China and swiftly expanded geographically worldwide, including to Low to Middle Income Countries (LMICs). This in turn raised numerous ethical concerns in preparedness, knowledge sharing, intellectual property rights, environmental health together with the serious constraints regarding readiness of health care systems in LMICs to respond to this enormous public health crisis. From the restrictions on public freedom and burgeoning socio-economic impacts to the rationing of scarce medical resources, the spread of COVID-19 is an extraordinary ethical dilemma for resource constrained nations with less developed health and research systems. In the current crisis, scientific knowledge and technology has an important role to play in effective response. Emergency preparedness is a shared responsibility of all countries with a moral obligation to support each other. This review discusses the ethical concerns regarding the national capacities and response strategies in LMICs to deal with the COVID-19 pandemic as well as the deep link between the environment and the increasing risk of pandemics.
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Affiliation(s)
- Faouzia Tanveer
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Ali Talha Khalil
- Department of Pathology, Lady Reading Hospital (MTI), Peshawar, Pakistan
| | - Muhammad Ali
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Zabta Khan Shinwari
- Pakistan Academy of Sciences, Islamabad, Pakistan
- Department of Plant Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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35
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Virtual interviews for surgical critical care fellowships and acute care fellowships amid the COVID-19 pandemic: The show must still go on. J Trauma Acute Care Surg 2020; 89:e92-e94. [PMID: 32618965 PMCID: PMC7586855 DOI: 10.1097/ta.0000000000002831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text.
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36
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Application of state law in the public health emergency response to COVID-19: an example from Delaware in the United States. J Public Health Policy 2020; 42:167-175. [PMID: 32989234 PMCID: PMC7521194 DOI: 10.1057/s41271-020-00257-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 11/21/2022]
Abstract
The unprecedented COVID-19 pandemic of 2019–2020 generated an equally unprecedented response from government institutions to control contagion. These legal responses included shelter in place orders, closure of non-essential businesses, limiting public gatherings, and mandatory mask wearing, among others. The State of Delaware in the United States experienced an outbreak later than most states but a particularly intense one that required a rapid and effective public health response. We describe the ways that Delaware responded through the interplay of public health, law, and government action, contrasting the state to others. We discuss how evolution of this state’s public heath legal response to the pandemic can inform future disease outbreak policies.
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.
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38
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Acuti Martellucci C, Flacco ME, Cappadona R, Bravi F, Mantovani L, Manzoli L. SARS-CoV-2 pandemic: An overview. Adv Biol Regul 2020; 77:100736. [PMID: 32773099 PMCID: PMC7832554 DOI: 10.1016/j.jbior.2020.100736] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 02/07/2023]
Abstract
By the end of May 2020, SARS-CoV-2 pandemic caused more than 350,000 deaths worldwide. In the first months, there have been uncertainties on almost any area: infection transmission route, virus origin and persistence in the environment, diagnostic tests, therapeutic approach, high-risk subjects, lethality, and containment policies. We provide an updated summary of the current knowledge on the pandemic, discussing the available evidence on the effectiveness of the adopted mitigation strategies.
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Affiliation(s)
- Cecilia Acuti Martellucci
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Public Health, University of the Marche Region, Via Conca, 60126, Ancona, Italy
| | - Maria Elena Flacco
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Rosaria Cappadona
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - Francesca Bravi
- "Sant'Anna" University Hospital of Ferrara, Via Aldo Moro 8, 44124, Cona (Fe), Italy
| | - Lorenzo Mantovani
- University Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126, Milan, Italy; IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy.
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39
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Chams N, Chams S, Badran R, Shams A, Araji A, Raad M, Mukhopadhyay S, Stroberg E, Duval EJ, Barton LM, Hajj Hussein I. COVID-19: A Multidisciplinary Review. Front Public Health 2020; 8:383. [PMID: 32850602 PMCID: PMC7403483 DOI: 10.3389/fpubh.2020.00383] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that is responsible for the 2019-2020 pandemic. In this comprehensive review, we discuss the current published literature surrounding the SARS-CoV-2 virus. We examine the fundamental concepts including the origin, virology, pathogenesis, clinical manifestations, diagnosis, laboratory, radiology, and histopathologic findings, complications, and treatment. Given that much of the information has been extrapolated from what we know about other coronaviruses including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), we identify and provide insight into controversies and research gaps for the current pandemic to assist with future research ideas. Finally, we discuss the global response to the coronavirus disease-2019 (COVID-19) pandemic and provide thoughts regarding lessons for future pandemics.
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Affiliation(s)
- Nour Chams
- Geriatric Division, Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, United States
| | - Sana Chams
- Geriatric Division, Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, United States
| | - Reina Badran
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, United States
| | - Ali Shams
- Department of Emergency Medicine, Beaumont Health System, Royal Oak, MI, United States
| | - Abdallah Araji
- Department of Diagnostic Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Mohamad Raad
- Department of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | | | - Edana Stroberg
- Office of the Chief Medical Examiner, Oklahoma City, OK, United States
| | - Eric J. Duval
- Office of the Chief Medical Examiner, Oklahoma City, OK, United States
| | - Lisa M. Barton
- Office of the Chief Medical Examiner, Oklahoma City, OK, United States
| | - Inaya Hajj Hussein
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
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40
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Jazieh AR, Kozlakidis Z. Healthcare Transformation in the Post-Coronavirus Pandemic Era. Front Med (Lausanne) 2020; 7:429. [PMID: 32850915 PMCID: PMC7399067 DOI: 10.3389/fmed.2020.00429] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/03/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Abdul Rahman Jazieh
- Department of Oncology, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Zisis Kozlakidis
- Laboratory Services and Biobanking, International Agency for Research on Cancer, World Health Organization, Lyon, France
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41
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Zhu RF, Gao YL, Robert SH, Gao JP, Yang SG, Zhu CT. Systematic review of the registered clinical trials for coronavirus disease 2019 (COVID-19). J Transl Med 2020; 18:274. [PMID: 32631442 PMCID: PMC7338108 DOI: 10.1186/s12967-020-02442-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Since the outbreak of coronavirus disease 2019 (COVID-19), many researchers in China have performed related clinical research. However, systematic reviews of the registered clinical trials are still lacking. Therefore, we conducted a systematic review of clinical trials for COVID-19 to summarize their characteristics. METHODS This study is based on the PRISMA recommendations in the Cochrane handbook. The Chinese Clinical Registration Center and the ClinicalTrials.gov databases were searched to identify registered clinical trials related to COVID-19. The retrieval inception date was February 9, 2020. Two researchers independently selected the literature based on the inclusion and exclusion criteria, extracted data, and evaluated the risk of bias. RESULTS A total of 75 registered clinical trials (63 interventional studies and 12 observational studies) for COVID-19 were identified. The majority of clinical trials were sponsored by Chinese hospitals. Only 11 trials have begun to recruit patients, and none of the registered clinical trials have been completed; 34 trials were early clinical exploratory trials or in the pre-experiment stage, 13 trials were phase III, and four trials were phase IV. The intervention methods included traditional Chinese medicine in 26 trials, Western medicine in 30 trials, and integrated traditional Chinese medicine and Western medicine in 19 trials. The subjects were primarily non-critical adult patients (≥ 18 years old). The median sample size of the trials was 100 (IQR: 60-200), and the median length of the trial periods was 179 d (IQR: 94-366 d). The main outcomes were clinical observation and examinations. Overall, the methodological quality of both the interventional trials and observational studies was low. CONCLUSIONS Intensive clinical trials on the treatment of COVID-19 using traditional Chinese medicine and Western medicine are ongoing or will be performed in China. However, based on the uncertain methodological quality, small sample size, and long trial duration, we will not be able to obtain reliable, high-quality clinical evidence regarding the treatment of COVID-19 in the near future. Improving the quality of study design, prioritizing promising drugs, and using different designs and statistical methods are worth advocating and recommending for clinical trials of COVID-19 in the future.
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Affiliation(s)
- Rui-Fang Zhu
- Editorial Department, First Hospital of Shanxi Medical University, No 85 Jiefang South Road, Taiyuan, Shanxi, China.
| | - Yu-Lu Gao
- Department of Laboratory Medicine, Kunshan Hospital Affiliated To Nanjing University of Traditional Chinese Medicine, Kunshan, Jiangsu, China
| | - Sue-Ho Robert
- Infection Service, University Hospital of Coventry and Warwickshire (UHCW) NHS Trust, Coventry, UK
| | - Jin-Ping Gao
- Editorial Department, First Hospital of Shanxi Medical University, No 85 Jiefang South Road, Taiyuan, Shanxi, China
| | - Shi-Gui Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chang-Tai Zhu
- Department of Transfusion Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No 600 Yishan Road, Shanghai, 200233, China.
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42
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COVID-19 and involuntary hospitalisation: navigating the challenge. Lancet Psychiatry 2020; 7:572-573. [PMID: 32563300 PMCID: PMC7302774 DOI: 10.1016/s2215-0366(20)30246-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
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43
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Brown TS, Bedard NA, Rojas EO, Anthony CA, Schwarzkopf R, Barnes CL, Stambough JB, Mears SC, Edwards PK, Nandi S, Prieto HA, Parvizi J. The Effect of the COVID-19 Pandemic on Electively Scheduled Hip and Knee Arthroplasty Patients in the United States. J Arthroplasty 2020; 35:S49-S55. [PMID: 32376163 PMCID: PMC7195093 DOI: 10.1016/j.arth.2020.04.052] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, hospitals in the United States were recommended to stop performing elective procedures. This stoppage has led to the cancellation of a large number of hip and knee arthroplasties. The effect of this on patients' physical mental and economic health is unknown. METHODS A survey was developed by the AAHKS Research Committee to assess pain, anxiety, physical function, and economic ability of patients to undergo a delayed operation. Six institutions conducted the survey to 360 patients who had to have elective hip and knee arthroplasty cancelled between March and July of 2020. RESULTS Patients were most anxious about the uncertainty of when their operation could be rescheduled. Although 85% of patients understood and agreed with the public health measures to curb infections, almost 90% of patients plan to reschedule as soon as possible. Age and geographic region of the patients affected their anxiety. Younger patients were more likely to have financial concerns and concerns about job security. Patients in the Northeast were more concerned about catching COVID-19 during a future hospitalization. CONCLUSIONS Patients suffering from the pain of hip and knee arthritis continue to struggle with pain from their end-stage disease. They have anxiety about the COVID-19 pandemic. Few patients feel they will be limited financially and 90% want to have surgery as soon as possible. Age and physical location of the patients affect their causes for anxiety around their future surgery.
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Affiliation(s)
- Timothy S. Brown
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA,Reprint requests: Timothy S. Brown, MD, Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242
| | - Nicholas A. Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Edward O. Rojas
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Ran Schwarzkopf
- Division of Orthopedics, Adult Joint Reconstruction, NYU Langone, New York, NY
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Paul K. Edwards
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sumon Nandi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Hernan A. Prieto
- Department of Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA
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44
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Zheng Y, Lai W. Dermatology staff participate in fight against Covid-19 in China. J Eur Acad Dermatol Venereol 2020; 34:e210-e211. [PMID: 32201983 DOI: 10.1111/jdv.16390] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y Zheng
- Dermatology Department, Third Affiliated Hospital of Sun-Yat sen University, Guangzhou, China
| | - W Lai
- Dermatology Department, Third Affiliated Hospital of Sun-Yat sen University, Guangzhou, China
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45
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Affiliation(s)
- Nicholas G Evans
- Department of Philosophy, University of Massachusetts Lowell, 883 Broadway Street, Dugan 200F, Lowell MA 01852, USA
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46
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Yu Y, Chen P. Coronavirus Disease 2019 (COVID-19) in Neonates and Children From China: A Review. Front Pediatr 2020; 8:287. [PMID: 32574286 PMCID: PMC7243210 DOI: 10.3389/fped.2020.00287] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023] Open
Abstract
At the end of 2019, a novel coronavirus began to spread in Wuhan, Hubei Province, China. The confirmed cases increased nationwide rapidly, in part due to the increased population mobility during the Chinese Lunar New Year festival. The World Health Organization (WHO) subsequently named the novel coronavirus pneumonia Coronavirus Disease 2019 (COVID-19) and named the virus Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Soon, transmission from person to person was confirmed and the virus spread to many other countries. To date, many cases have been reported in the pediatric age group, most of which were from China. The management and treatment strategies have also been improved, which we believe would be helpful to pediatric series in other countries as well. However, the characteristics of neonatal and childhood infection still have not been evaluated in detail. This review summarizes the current understanding of SARS-CoV-2 infection in neonates and children from January 24 to May 1, as an experience from China.
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Affiliation(s)
| | - Pingyang Chen
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
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47
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Khanna RC, Cicinelli MV, Gilbert SS, Honavar SG, Murthy GVS. COVID-19 pandemic: Lessons learned and future directions. Indian J Ophthalmol 2020; 68:703-710. [PMID: 32317432 PMCID: PMC7350475 DOI: 10.4103/ijo.ijo_843_20] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
Emerging pandemics show that humans are not infallible and communities need to be prepared. Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Worldwide countries are responding differently to the virus outbreak. A delay in detection and response has been recorded in China, as well as in other major countries, which led to an overburdening of the local health systems. On the other hand, some other nations have put in place effective strategies to contain the infection and have recorded a very low number of cases since the beginning of the pandemics. Restrictive measures like social distancing, lockdown, case detection, isolation, contact tracing, and quarantine of exposed had revealed the most efficient actions to control the disease spreading. This review will help the readers to understand the difference in response by different countries and their outcomes. Based on the experience of these countries, India responded to the pandemic accordingly. Only time will tell how well India has faced the outbreak. We also suggest the future directions that the global community should take to manage and mitigate the emergency.
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Affiliation(s)
- Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eyecare, LV Prasad Eye Institute, Hyderabad, Telangana, India
- Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, via Olgettina, Milan, Italy
| | - Suzanne S Gilbert
- Senior Director, Research, Seva Foundation, Berkeley, California
- North America Region Chair, International Agency for the Prevention of Blindness, India
- President, International Society of Geographical and Epidemiological Ophthalmology, India
| | - Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Centre for Sight, Hyderabad, Telangana, India
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Indian Institute of Public Health, Hyderabad, Telangana, India
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Paul E, Brown GW, Ridde V. COVID-19: time for paradigm shift in the nexus between local, national and global health. BMJ Glob Health 2020; 5:e002622. [PMID: 32399261 PMCID: PMC7204939 DOI: 10.1136/bmjgh-2020-002622] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Elisabeth Paul
- School of Public Health, Université Libre de Bruxelles, Bruxelles, Belgium.,Tax Institute, Liege University, Liege, Belgium
| | - Garrett W Brown
- Global Health Theme, POLIS, University of Leeds, Leeds, West Yorkshire, UK
| | - Valery Ridde
- CEPED (IRD-Universités de Paris), INSERM, Institut de recherche pour le developpement, Paris, France
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Affiliation(s)
- Wendy E Parmet
- From the Center for Health Policy and Law, Northeastern University School of Law (W.E.P., M.S.S.), the Harvard-MIT Center for Regulatory Science (M.S.S.), and Harvard Medical School (M.S.S.) - all in Boston
| | - Michael S Sinha
- From the Center for Health Policy and Law, Northeastern University School of Law (W.E.P., M.S.S.), the Harvard-MIT Center for Regulatory Science (M.S.S.), and Harvard Medical School (M.S.S.) - all in Boston
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Abstract
There is a new public health crises threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in December 2019. There have been around 96,000 reported cases of coronavirus disease 2019 (COVID-2019) and 3300 reported deaths to date (05/03/2020). The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 d. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. The case fatality rate is estimated to range from 2 to 3%. Diagnosis is by demonstration of the virus in respiratory secretions by special molecular tests. Common laboratory findings include normal/ low white cell counts with elevated C-reactive protein (CRP). The computerized tomographic chest scan is usually abnormal even in those with no symptoms or mild disease. Treatment is essentially supportive; role of antiviral agents is yet to be established. Prevention entails home isolation of suspected cases and those with mild illnesses and strict infection control measures at hospitals that include contact and droplet precautions. The virus spreads faster than its two ancestors the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality. The global impact of this new epidemic is yet uncertain.
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Affiliation(s)
- Tanu Singhal
- Department of Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
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