COVID-19 containment: China provides important lessons for global response

A New Experience in the Turkish Health System in Response to COVID-19

OBJECTIVE

A substantial amount of work addressing strategies on how to respond to the coronavirus disease (COVID-19) crisis already exists. However, there is simply not enough evidence to support a systematic and all-encompassing approach. This study aims to systematically review and present the roadmap of Turkiye's response to COVID-19.

METHODS

This study is based on a thematic content analysis of official policy documents to present the roadmap in Turkiye's fight against COVID-19. The analysis included 46 press releases accessed from the Ministry of Health's website. The coding structure was created by the researchers based on the literature. Documents were analyzed by dividing them into 3 periods: the panic period, the controlled normalization period, and the normalization period. Each document was sub-coded under the main themes of "concerns" and "strategies" and interpreted by comparing them with each other.

RESULTS

The study results show that different categories and coding structures were formed between periods. Some categories that emerged under the theme of concerns were "vaccine concerns" and "social concerns." Similarly, some categories that appeared under the theme of strategies were "vaccine strategies," "monitoring and surveillance strategies," and "intervention strategies."

CONCLUSION

The results provide policy-makers with an appropriate conceptual framework to deal with the pandemic crisis that may be encountered in the future.

Multi-source dynamic ensemble prediction of infectious disease and application in COVID-19 case

BACKGROUND

The development of an epidemic always exhibits multiwave oscillation owing to various anthropogenic sources of transmission. Particularly in populated areas, the large-scaled human mobility led to the transmission of the virus faster and more complex. The accurate prediction of the spread of infectious diseases remains a problem. To solve this problem, we propose a new method called the multi-source dynamic ensemble prediction (MDEP) method that incorporates a modified susceptible-exposed-infected-removed (SEIR) model to improve the accuracy of the prediction result.

METHODS

The modified SEIR model is based on the compartment model, which is suitable for local-scale and confined spaces, where human mobility on a large scale is not considered. Moreover, compartmental models cannot be used to predict multiwave epidemics. The proposed MDEP method can remedy defects in the compartment model. In this study, multi-source prediction was made on the development of coronavirus disease 2019 (COVID-19) and dynamically assembled to obtain the final integrated result. We used the real epidemic data of COVID-19 in three cities in China: Beijing, Lanzhou, and Beihai. Epidemiological data were collected from 17 April, 2022 to 12 August, 2022.

RESULTS

Compared to the one-wave modified SEIR model, the MDEP method can depict the multiwave development of COVID-19. The MDEP method was applied to predict the number of cumulative cases of recent COVID-19 outbreaks in the aforementioned cities in China. The average accuracy rates in Beijing, Lanzhou, and Beihai were 89.15%, 91.74%, and 94.97%, respectively.

CONCLUSIONS

The MDEP method improved the prediction accuracy of COVID-19. With further application to other infectious diseases, the MDEP method will provide accurate predictions of infectious diseases and aid governments make appropriate directives.

Does Physical Activity Affect Clinical Symptoms and the Quality of Life of Mild-Infected Individuals with COVID-19 in China? A Cross-Sectional Study

BACKGROUND

Few studies have identified the links between physical activity (PA), clinical symptoms, and the quality of life (QoL) among mildly infected individuals with COVID-19. This cross-sectional study aims to evaluate how PA levels before infections affect the infectious symptoms and the QoL in mildly infected patients with COVID-19.

METHODS

An online questionnaire link including participants' sociodemographic and anthropometric characteristics, clinical symptoms during the COVID-19 infectious period, the QoL of the worst symptomatic day, and PA in the last seven days before COVID-19 infections was disclosed. Logistic regression and multiple linear regression analyses were applied to assess the relationships between PA levels in the last seven days before infections and COVID-19-related outcomes. The level of statistical significance was set at p < 0.05.

RESULTS

Compared to the low-PA-level group, the moderate-PA-level group presented a higher risk of headaches (OR = 1.34, 95% CI = 1.03 to 1.75, and p = 0.03) and the high-PA-level group presented a higher risk of muscle/body aches (OR = 1.42, 95% CI = 1.04 to 1.93, and p = 0.03). The adjusted linear regression analysis showed that no associations were found between PA levels in the last seven days before infections and the QoL index value on the worst symptomatic day (moderate-PA-level group: β = -0.04, and p = 0.08; high-PA-level group: β = -0.04, and p = 0.17). However, for the mobility and usual activities dimensions of EQ-5D-5L, the lower-PA-level group had a lower burden of QoL than the higher-PA-level group did on the worst-symptomatic day.

CONCLUSIONS

Among mildly infected patients with COVID-19, a higher PA level is associated with a higher risk of experiencing clinical symptoms and a lower QoL.

Association between psychological stress, anxiety and oral health status among college students during the Omicron wave: a cross-sectional study

BACKGROUND

Within 3 years of the COVID-19 pandemic, increasing interest has been given to its potential influence on health status due to lockdowns caused by the pandemic. However, the impact is inadequately understood, especially for college students. This study aimed to investigate the potential association between psychological stress, anxiety and oral health of college students during the Omicron wave of the COVID-19 pandemic.

METHODS

An online survey with measurements of psychological stress, anxiety and oral health was completed by 1770 Chinese college students. The Perceived Stress Scale-14 (PSS-14) and Generalized Anxiety Disorder-7 (GAD-7) were used to measure psychological stress and anxiety, respectively. Oral health status was self-reported including toothache, gingival bleeding, and oral ulcer. Multivariable logistic regressions were performed to determine underlying associations for outcome variables. Structural equation modeling (SEM) was performed to confirm the relationship between mental and oral health status.

RESULTS

Of the 1770 subjects, 39.2% presented high psychological stress and only 41.2% expressed no anxiety. A significant association was found between psychological stress, anxiety and oral health status. Anxiety has significant impacts on toothache (OR = 0.36; 95%CI: 0.23-0.55; p < 0.01), gingival bleeding (OR = 0.43; 95%CI: 0.29-0.65; p < 0.01), and oral ulcer (OR = 0.54; 95%CI: 0.36-0.80; p < 0.01). Anxiety significantly mediated the association between psychological stress and self-reported oral symptoms.

CONCLUSIONS

Anxiety may be a significant risk indicator for mental health among college students and demonstrates a significant relationship with the occurrence of self-reported oral symptoms. Concerns about academic and life changes caused by the pandemic were the two most significant sources of stress.

Gone with the epidemic? The spatial effects of the Covid-19 on global investment network

The outbreak of Covid-19 epidemic has a prolonged impact on global economic activities. In recent years, many scholars have been motivated to estimate the effects of Covid-19 shock on global foreign direct investment (FDI). However, existing studies have not paid enough attention to the spillover effects caused by the epidemic. Although few academic works have explored the geographic-neighboring spillover effects of epidemic shock on global investment, we further extent the understanding of the spillover effects in an economic network. On the basis of country-month greenfield FDI panels, we construct a spatial Durbin model, and figure out that Covid-19 shock may have positive FDI spillover effects in an economic network via global FDI transfers. Furthermore, we find that such spillovers are greatly conditioned by country-level network position and institutional ties among nations. Our research suggests that global FDI transfers may partly offset economic-adverse effects of the Covid-19 shock. While global countries, especially those in the Global South, should be more closely embedded in the global investment network in such an uncertain environment.

Perceived risk of COVID-19 pandemic on crop production: an implication for food security in Ethiopia

BACKGROUND

Risk perception is a subjective psychological construct that is influenced by cognitive, emotional, social, cultural, and individual differences, both within and between individuals and across countries. Although the impact of COVID-19 on short- and long-term food security is difficult to predict, some risk factors and lessons from previous pandemics can be identified. The goal of this study is to assess rural farmers' perceptions of the COVID-19 pandemic's impact on crop production and its implications for food security in West Arsi Zone, Oromia, Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 634 small-holder farmers in the west Arsi zone district. From November 1-30, 2020, data was gathered through interviews with local farmers. Data was gathered using a semi-structured questionnaire. Six trained expert agricultural workers were used as data collectors and supervisors, respectively, and both were trained. The questionnaire had been pre-tested. The Statistical Package for the Social Sciences (SPSS) software version 25 was used to analyze the data. To identify factors associated with risk perception of the COVID-19 pandemic on crop production, binary and multivariable logistic regression were used, with statistical significance determined at a p-value of 0.05.

RESULTS

This study found that among farmers in West Arsi Zone, Oromia, Ethiopia, about 32.5% reported having perceived risk of COVID-19 pandemic on crop production, and that age greater than or equal to 57, female sex (AOR,1.48 95% CI (1.03-2.12)), primary Educational status (AOR,2.85(1.78-4.58)), and permanent employed occupation of the house head (AOR, 2.27(1.24-4.17) were found to be independent predictors of perceived risk of COVID-19 pandemic on crop production among farmers in West Arsi Zone, Oromia, Ethiopia.

CONCLUSION

Perceived risk of COVID-19 on crop production was high and varied across age groups, sexes, educational attainment levels, and the occupation of the head of the household.

Evaluation of the impact of the COVID-19 pandemic on health service utilization in China: A study using auto-regressive integrated moving average model

Background

The outbreak of COVID-19 in early 2020 presented a major challenge to the healthcare system in China. This study aimed to quantitatively evaluate the impact of COVID-19 on health services utilization in China in 2020.

Methods

Health service-related data for this study were extracted from the China Health Statistical Yearbook. The Auto-Regressive Integrated Moving Average model (ARIMA) was used to forecast the data for the year 2020 based on trends observed between 2010 and 2019. The differences between the actual 2020 values reported in the statistical yearbook and the forecast values from the ARIMA model were used to assess the impact of COVID-19 on health services utilization.

Results

In 2020, the number of admissions and outpatient visits in China declined by 17.74 and 14.37%, respectively, compared to the ARIMA model’s forecast values. Notably, public hospitals experienced the largest decrease in outpatient visits and admissions, of 18.55 and 19.64%, respectively. Among all departments, the pediatrics department had the greatest decrease in outpatient visits (35.15%). Regarding geographical distribution, Beijing and Heilongjiang were the regions most affected by the decline in outpatient visits (29.96%) and admissions (43.20%) respectively.

Conclusion

The study’s findings suggest that during the first year of the COVID-19 pandemic, one in seven outpatient services and one in six admissions were affected in China. Therefore, there is an urgent need to establish a green channel for seeking medical treatment without spatial and institutional barriers during epidemic prevention and control periods.

Facilitators and barriers of preventive behaviors against COVID-19 during Ramadan: A phenomenology of Indonesian adults

Introduction

Intercity mobility restriction, physical distancing, and mask-wearing are preventive behaviors to reduce the transmission of COVID-19. However, strong cultural and religious traditions become particular challenges in Indonesia. This study uses the Behavior Change Wheel to explore barriers and facilitators for intercity mobility restriction, physical distancing, and mask-wearing during Ramadan.

Methods

Semi-structured in-depth interviews with 50 Indonesian adults were conducted between 10 April and 4 June 2020. Having mapped codes into the Capacity, Opportunity, Motivation - Behavior (COM-B), and Theoretical Domain Framework (TDF) model, we conducted summative content analysis to analyze the most identified factors to preventive behaviors and proposed interventions to address those factors.

Results

Belief about the consequence of preventive behaviors was the most mentioned facilitator to all preventive behaviors among compliers. However, optimism as a TDF factor was commonly mentioned as a barrier to preventive behaviors among non-compliers, while environmental context and resources were the most commonly mentioned factors for intercity mobility restriction.

Conclusions

Public health intervention should be implemented considering the persuasion and involvement of religious and local leaders. Concerning job and economic context, policy related to the intercity mobility restriction should be reconsidered to prevent a counterproductive effect.

Global Health Security Index not a proven surrogate for health systems capacity to respond to pandemics: The case of COVID-19

INTRODUCTION

Global Health Security borders on prevention, detection and response to public health threats like the novel coronavirus disease 2019 (COVID-19). Global Health Security Index (GHSI) of 2019 and 2021 revealed the world remains ill-prepared to deal with future pandemics, evident in the historic impact of COVID-19 on countries. As at 7th December 2022, COVID-19 has infected over 600 million people and claimed over six million lives, mostly in countries with higher GHSI scores.

OBJECTIVE

Determine whether the GHSI scores of countries have a correlation with COVID-19 cases, deaths and vaccination coverage, while adjusting for country level dynamics.

METHODS

This paper utilizes GHSI database of 195 countries. Data consists of 171 questions grouped into 37 indicators across six overarching categories on health security and COVID-19. Multivariate multiple regression analysis with robust standard errors was conducted to test the hypothesis that high GHSI ratings do not guarantee better COVID-19 outcomes like cases, deaths and vaccination coverage. Also, avplots STATA command was used to check outliers with potential negative effect on outcome and predictor variables.

RESULTS

Global average GHSI score for all 195 countries was 38.9. United States of America recorded the highest GHSI score of 75.9 but also recorded one of the highest COVID-19 cases and deaths; Somalia recorded the worst GHSI score of 16.0 and one of the lowest COVID-19 cases and deaths. High GHSI scores did not associate positively with reduction in COVID-19 cases (Coef=157133.4, p-value=0.009, [95%CI 39728.64 274538.15]) and deaths (Coef=1405.804, p-value=0.047, [95%CI 18.1 2793.508]). However, high GHSI ratings associated with increases in persons fully vaccinated per 100 population (Coef=0.572, p-value=0.000, [95%CI.272.873]).

CONCLUSION

It appears the world might still not be adequately prepared for the next major pandemic, if the narrative remains unchanged. Countries that recorded higher GHSI scores, counter-intuitively, recorded higher COVID-19 cases and deaths. Countries need to invest more in interventions towards attaining Universal Health Coverage (UHC) including integrated health systems and formidable primary health care to enhance preparedness and response to pandemics.

Association between Air Pollution and Physical Activity and Sedentary Behavior among Adults Aged 60 Years or Older in China: A Cross-Sectional Study

BACKGROUND

Exposure to air pollution is associated with an increased risk of all-cause mortality in older adults. Promoting physical activity (PA) and avoiding sedentary behavior (SB) serve as key strategies to maintain and improve human health. However, ambient air pollution can adversely affect PA and SB, increasing the risks of health problems. This study aimed to visualize national spatial patterns of average AQI concentration, PA, and SB distributions and to examine the associations between air pollution and PA and SB in a national sample of Chinese older adults aged 60 years or older.

METHODS

We analyzed the data of the China Longitudinal Aging Social Survey 2020 (CLASS 2020), which sampled 11,399 older men and women from 30 cities in China. Moderate, vigorous, and light PA and SB were measured using the Chinese version of the International Physical Activity Questionnaire-Short Form (IPAQ-C). The environmental measures included the average hourly air quality index (AQI), PM_2.5, PM₁₀, and NO₂ (µg/m³). The data were analyzed using multivariable linear regression.

RESULTS

Increases in the standard deviations (±SD) of AQI, PM_2.5, PM₁₀, and NO₂ concentrations were associated with decreases in MVPA per week of -2.34 (95%CI = -3.36, -1.32), -2.58 (95%CI = -3.61, -1.55), -1.96 (95%CI = -3.05, -0.08), and -1.19 (95%CI = -2.06, -0.31) and decreases in LPA per week of -6.06 (95%CI = -7.15, -4.97), -4.86 (95%CI = -5.88, -3.85), -4.78 (95%CI = -5.89, -3.68), and -4.59 (95%CI = -5.57, -3.61) h/week, respectively. Increases in one SD of AQI, PM_2.5, PM₁₀, and NO₂ were associated with increases in SB per week of 1.32 (95%CI = 0.77, 1.88), 0.62 (95%CI = 0.09, 1.14), 1.03 (95%CI = 0.48, 1.59), and 0.98 (95%CI = 0.46, 1.49) h/week, respectively.

CONCLUSIONS

The spatial distributions of the average AQI concentration, MVPA, LPA, and SB are useful and allow environmental and health policymakers to identify the areas with the highest priority air pollution environmental equality concerns. AQI was positively associated with MVPA and LPA, and it was negatively associated with SB among older adults. AQI, PM_2.5, PM₁₀, and NO₂ were hardly associated with women's average time spent engaged in MVPA. Region-specific and multi-level health policy options are needed to reduce ambient air pollution by taking different types of pollutants into account in order to avoid changes in PA and SB in this population, especially in locations with high air pollution concentrations.

Temporal dynamic characteristics of human monkeypox epidemic in 2022 around the world under the COVID-19 pandemic background

Background

The reemergence of the monkeypox epidemic has aroused great concern internationally. Concurrently, the COVID-19 epidemic is still ongoing. It is essential to understand the temporal dynamics of the monkeypox epidemic in 2022 and its relationship with the dynamics of the COVID-19 epidemic. In this study, we aimed to explore the temporal dynamic characteristics of the human monkeypox epidemic in 2022 and its relationship with those of the COVID-19 epidemic.

Methods

We used publicly available data of cumulative monkeypox cases and COVID-19 in 2022 and COVID-19 at the beginning of 2020 for model validation and further analyses. The time series data were fitted with a descriptive model using the sigmoid function. Two important indices (logistic growth rate and semi-saturation period) could be obtained from the model to evaluate the temporal characteristics of the epidemic.

Results

As for the monkeypox epidemic, the growth rate of infection and semi-saturation period showed a negative correlation (r = 0.47, p = 0.034). The growth rate also showed a significant relationship with the locations of the country in which it occurs [latitude (r = -0.45, p = 0.038)]. The development of the monkeypox epidemic did not show significant correlation compared with the that of COVID-19 in 2020 and 2022. When comparing the COVID-19 epidemic with that of monkeypox, a significantly longer semi-saturation period was observed for monkeypox, while a significant larger growth rate was found in COVID-19 in 2020.

Conclusions

This novel study investigates the temporal dynamics of the human monkeypox epidemic and its relationship with the ongoing COVID-19 epidemic, which could provide more appropriate guidance for local governments to plan and implement further fit-for-purpose epidemic prevention policies.

Regulating the product quality of COVID-19 antigen testing reagents: A tripartite evolutionary game analysis under China's legal framework

Personal purchases of novel coronavirus antigen detection reagents (ADRs) for self-detection have contributed to the optimization of medical resources and containment of the COVID-19 pandemic. The recurring occurrence of false testing results in China has generated concerns regarding the quality of ADRs and the testing mechanism for medical devices. Academic viewpoints and remarks on the sensitivity, application possibilities, and product innovation of ADRs may be found in the extant scientific literature. However, the current research does not explore the microscopic product quality concerns that emerge throughout the production and marketing of ADRs. To explore strategic equilibrium circumstances and behavioral evolution processes, an evolutionary game model was developed to include ADR manufacturers, third-party medical device inspection agencies, and regulatory authorities. The results reveal that the quantity of illegal incentives, the cost of regulation, and the loss of government credibility have a major impact on the decisions of regulatory authorities and determine three potential systemic equilibrium states. To maximize social welfare, ADRs should be incorporated into China's medication price monitoring system in order to manage market prices. To cut regulatory expenses, the government should employ blockchain technology for traceable network regulation of ADR product quality. The government should also protect the people's right to free speech and encourage online reporting of adverse incidents caused by ADRs. The conclusions of this article can provide many developing nations with important insights for regulating the quality of ADR products.

Pakistan's COVID-19 Prevention and Control Response Using the World Health Organization's Guidelines for Epidemic Response Interventions

Massive coronavirus disease 2019 (COVID-19) devastation was anticipated in Pakistan due to poor track record of responding to epidemics. However, by adopting effective and timely response measures under strong government leadership, Pakistan averted a significant number of infections. We present the government of Pakistan's efforts to curb the spread of COVID-19, using the World Health Organization's guidelines for epidemic response intervention. The sequence of interventions is presented under the epidemic response stages, namely anticipation, early detection, containment-control, and mitigation. Key factors of Pakistan's response included decisive political leadership and implementation of a coordinated and evidence-informed strategy. Moreover, early control measures, mobilization of front-line health workers for contact tracing, public awareness campaigns, 'smart lockdowns', and massive vaccination drives are key strategies that helped flatten the curve. These interventions and lessons learnt can help countries and regions struggling with COVID-19 to develop successful strategies to flatten the curve and enhance disease response preparedness.

Interactions among the human and organizational factors within the public sector regarding epidemic prevention and control

The management of human and organizational factors (HOFs) within the public sector directly concerns the efficacy of epidemic prevention and control (EPC). Insufficient examination of such HOFs has led to defective countermeasures. This study attempts to comprehensively identify the HOFs within the public sector critical to EPC and investigate their interactions with the weighted network theory. A total of 55 HOFs were identified, and their interactions were assessed and visualized in the Chinese context. Then, the established weighted network was analyzed to investigate the interactions and diagnose critical factors and sectors. The analysis shows that there are strong interactions among HOFs, and that the human and organizational risks emerging from administrative departments of public health, centers for disease control and prevention, and medical institutions act as the key risk sources in the complex interconnected EPC system, exacerbating risk and causing a significant domino effect. It is recommended that the authorities devote more resources to the core sectors and endeavor to reinforce those critical HOFs by implementing closer risk communication, collaboration, and response. This study may deepen and broaden the authorities' awareness and understanding of interactions among HOFs regarding epidemic mitigation, and strengthen their capacity to perceive, evaluate, and manage these factors in a proactive and effective way, thereby facilitating the success of EPC.

Lessons from China's Experience: Legal Analysis of Health Risks and Medical Obstacles of Personnel in COVID-19 Control Areas

Purpose

Individuals in controlled areas often face restrictions on their personal freedom, and if they are unable to receive medical treatment when needed, it can significantly increase their health risks. However, current epidemic prevention and control policies do not provide clear guidelines on how to ensure individuals in controlled areas to seek medical attention when faced with health problems. By implementing specific measures that local governments must take in order to protect the health of those in controlled areas, the risks to their health can be greatly reduced.

Patients and Methods

Our research utilizes a comparative approach to analyze the measures adopted by various regions for safeguarding the health of individuals in control areas, and the diverse outcomes they produce. We conduct empirical analysis and present examples of severe health risks that individuals in control areas face due to inadequate health protection measures. Furthermore, we conduct a critical evaluation of China's legal management of control areas, identifying both its principles and shortcomings.

Results

The lack of unified legal regulations has led some local governments to make some shortcomings in making decisions on epidemic prevention and control. Specifically, some governments have neglected to provide adequate medical protection for individuals in controlled areas, limited the authority of specific implementers of prevention policies, and failed to establish fair punishment mechanisms. These shortcomings have a direct impact on the health of those in controlled areas and can even lead to tragic outcomes.

Conclusion

Effective management of individuals in control areas during public health emergencies is crucial in reducing health risks. To achieve this, China needs to establish unified regulations and requirements, particularly with regards to medical protection, for individuals in control areas. Such measures can be achieved through the improvement of legislation, which can significantly reduce health risks faced by individuals in control areas during public health emergencies.

Social Behavior and COVID-19: Analysis of the Social Factors behind Compliance with Interventions across the United States

Since its emergence, COVID-19 has caused a great impact in health and social terms. Governments and health authorities have attempted to minimize this impact by enforcing different mandates. Recent studies have addressed the relationship between various socioeconomic variables and compliance level to these interventions. However, little attention has been paid to what constitutes people's response and whether people behave differently when faced with different interventions. Data collected from different sources show very significant regional differences across the United States. In this paper, we attempt to shed light on the fact that a response may be different depending on the health system capacity and each individuals' social status. For that, we analyze the correlation between different societal (i.e., education, income levels, population density, etc.) and healthcare capacity-related variables (i.e., hospital occupancy rates, percentage of essential workers, etc.) in relation to people's level of compliance with three main governmental mandates in the United States: mobility restrictions, mask adoption, and vaccine participation. Our aim was to isolate the most influential variables impacting behavior in response to these policies. We found that there was a significant relationship between individuals' educational levels and political preferences with respect to compliance with each of these mandates.

Crisis communication strategies for health officials

Background

Mixed messaging among health officials are prevalent amid COVID-19. Crisis communication strategies have the potential to help health officials effectively address issues such as mixed messages and improve their crisis communication efficacy. However, there is a dearth of insights in the literature. Therefore, to bridge the research gap, this study aims to examine practical strategies health officials can utilize to improve their crisis communication efficacy.

Methods

A literature review on effective crisis communication strategies amid COVID-19 was conducted in PubMed, Scopus, and PsycINFO, with a focus on scholarly literature published in English.

Results

The findings of the study identified the following strategies that health officials can utilize to improve their crisis communication capabilities: (1) develop fact-based, transparent, and accountable messaging, (2) utilize people-centered and empathetic persuasive strategies, and (3) leverage international collaboration for consistent messaging and comprehensive crisis communication.

Conclusion

COVID-19 has challenged health officials with unprecedented crisis communication duties and responsibilities. In this study, we underscored the importance of effective crisis communication amid global health emergencies like COVID-19, and identified communication strategies health officials could adopt or adapt to improve their crisis communication efficacy. Future research could explore strategies health officials can use to better communicate with government officials and media professionals to further help health officials improve their crisis communication capabilities, their abilities to avoid preventable miscommunication or mixed messaging, and in turn, society's collective strengthen in curbing and controlling the pandemic.

The Recovery of China's Industrial Parks in the First Wave of COVID-19

Industrial parks are functional urban areas that carry the capacity to support highly concentrated production activities. The robustness and anti-interference ability of these areas are of great importance to maintaining economic vitality of a country. Focusing on the rate of production recovery (RPR), this paper examines the recovery of 436 major industrial parks in mainland China during the first wave of COVID-19. Leveraging spatio-temporal big data, we measured 14 attributes pertaining to industrial parks, covering four categories, namely spatial location, central city, park development, and public service. We focused on the spatial association and heterogeneity of the recovery patterns and identified the factors that truly affected the recovery of industrial parks with quantitative evaluation of their effects. The results reveal that: (1) RPR of industrial parks are significantly spatially clustered, with an obvious "cold spot" in the early outbreak area of Hubei Province and a prominent "center-periphery" pattern in developed areas, which is highly correlated with the spread of the epidemic. (2) The mechanisms driving the resumption of industrial parks are complex and versatile. All four categories in the variable matrix are related to RPR, including up to eight effective influencing factors. The effect of influencing factors is spatially heterogeneous, and its intensity varies significantly across regions. What is more interesting is that some impact factors show positive effects in some industrial parks while inhibiting the recovery in others. On the basis of the discussion of those findings with practical experiences, the planning and construction strategies of industrial park are suggested to mitigate the impact of similar external shocks.

Food insecurity and level of depression among patients with chronic diseases, and associated factors during the COVID-19 lockdown: a cross-sectional study in rural Rwanda

OBJECTIVES

We aimed to describe access to food and symptoms of depression among patients with chronic diseases or their caregivers, and assess associated factors during the COVID-19 lockdown in rural Rwanda.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A stratified random sampling technique was used to recruit 220 patients enrolled in the HIV, non-communicable diseases, mental health, paediatric development clinic and oncology programmes in three rural districts of Rwanda.

OUTCOME MEASURES

Telephone-based interviews were conducted to collect data on the number of daily meals before and during the COVID-19, and depression was assessed using the Patient Health Questionnaire-9. We used logistic regression analysis to investigate factors associated with households reporting a reduction in daily meals and with the survey respondent reporting symptoms of depression.

RESULTS

Of the participants, 19.1% reported a reduction in daily number of meals for either adults or children in their households during lockdown and 24.6% had depression. Reporting a reduction in daily meals was associated with the district of residence and estimated household's monthly income. Self-reported depression was significantly associated with negative experiences during lockdown, including reporting feeling depressed or fear (AOR 4.82; 95% CI 2.08 to 11.21), loneliness (AOR 4.33; 95% CI 1.32 to 14.13), reduction in daily meals (AOR 4.15; 95% CI 1.56 to 11.00) and lack of access to healthcare (OR 3.29; 95% CI 1.32 to 8.23).

CONCLUSIONS

Our findings suggest that significant reduction in access to food affected rural Rwandans with chronic diseases during COVID-19 lockdown, and the lockdown effect varied by household's pre-pandemic level of vulnerability to food insecurity. Reduction in household meals, as well as other self-reported effects of the lockdown, were associated with worse psychological status of survey respondents. Economic and food support should be considered by governments and non-governmental organisations to protect those most vulnerable including patients with chronic diseases against the effects of pandemics and their associated containment measures.

Understanding the COVID-19 pandemic prevalence in Africa through optimal feature selection and clustering: evidence from a statistical perspective

The COVID-19 pandemic, which outbroke in Wuhan (China) in December 2019, severely hit almost all sectors of activity in the world as a consequence of the restrictive measures imposed. Two years later, Africa still emerges as the least affected continent by the pandemic. This study analyzed COVID-19 prevalence across African countries through country-level variables prior to clustering. Using Spearman-rank correlation, multicollinearity analysis and univariate filtering, 9 country-level variables were identified from an initial set of 34 variables. These variables relate to socioeconomic status, population structure, healthcare system and environment and the climatic setting. A clustering of the 54 African countries is further carried out through the use of agglomerative hierarchical clustering (AHC) method, which generated 3 distinctive clusters. Cluster 1 (11 countries) is the most affected by COVID-19 (median of 63,508.6 confirmed cases and 946.5 deaths per million) and is composed of countries with the highest socioeconomic status. Cluster 2 (27 countries) is the least affected (median of 4473.7 confirmed cases and 81.2 deaths per million), and mainly features countries with the least socioeconomic features and international exposure. Cluster 3 (16 countries) is intermediate in terms of COVID-19 prevalence (median of 2569.3 confirmed cases and 35.7 deaths per million) and features countries the least urbanized and geographically close to the equator, with intermediate international exposure and socioeconomic features. These findings shed light on the main features of COVID-19 prevalence in Africa and might help refine effectively coping management strategies of the ongoing pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10668-022-02646-3.

Development and preliminary validation of a public health emergency competency model for medical staffs of national health emergency teams in China

Background

In the present study, we attempted to develop and validate a participatory competency model for medical workers and then evaluate the current status of competency characteristics of Chinese medical workers.

Methods

The competency model was constructed in a multistage process, including literature review, expert consultation, critical incident and focus group interview. A pilot study was conducted to refine the initial model among 90 participators and the viability and reliability were evaluated by a questionnaire survey among 121 medical workers. Then, the current status of competency characteristics was measured based on the final version of competency model.

Results

In the pilot study, ten questionnaires were dropped for the poor quality and thus the eligible rate was 92% (138/150). KMO value was 0.785 and Bartlett test showed that the χ² = 6464.546 (df = 903) and p value < 0.001. Then, 10 items with double loading and factor loading < 0.4 were deleted. Finally, 33 items were retained with the lowest factor loading value of 0.465. The validity and reliability of competency model were determined with Cronbach’s α coefficient of 0.975 and ICC value of 0.933. Finally, a revised competency model with 5 dimensions and 31 items was obtained. The overall competencies of current medical workers were in a high level, except for emergency knowledge related competencies. Age was an independent factor affecting the competencies.

Conclusions

Our competency model was a reliable and validated tool for assessing the competences of medical staffs against public health emergencies, and the overall competencies of current medical workers in China were in a high level, except for emergency knowledge related competencies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08361-z.

Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method

Background

The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA.

Objective

The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19.

Methods

We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages.

Results

We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between –0.05 and –1.46 due to the assistance of continuous restrictions. However, 58.6% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic.

Conclusions

The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19.

Mental fatigue and negative emotion among nurses during the COVID-19 pandemic

COVID-19 is a major public health event affecting the people worldwide. Nurses are still under immense psychological pressure. This study aimed to explore the relationship between mental fatigue and negative emotions among frontline medical staff during the COVID-19 pandemic. The study was conducted in August 2020, which included 419 medical staff between 17 to 28 years. The Fatigue Scale, Multidimensional Mental Flexibility Questionnaire, Cognitive Fusion Scale, and Depression-Anxiety-Stress Brief Version Scale were used. During the data collection period, the pandemic was under control in China and continued worldwide. The results indicated that 27.7% of the medical staff experienced depression, and 32.3% of them feel stressed. Specifically, first, correlation analyses showed significant positive pairwise correlations between mental fatigue, psychological inflexibility, cognitive fusion, and negative emotions among nurses. Second, mediation model tests showed statistically significant mediating effects of psychological inflexibility and cognitive fusion between mental fatigue on nurses' negative emotions, and statistically, significant chain mediating effects of psychological inflexibility and cognitive fusion. Mental fatigue indirectly affects nurses' negative effects through the mediating effects of psychological inflexibility, cognitive fusion, and the chain mediating effects of psychological inflexibility and cognitive fusion, respectively. the negative effects of mental fatigue come from impairment of cognitive functioning, and interventions using acceptance and commitment therapy for mental fatigue and negative emotions are more effective since both psychological inflexibility and cognitive fusion are important components of the therapy.

International Trade of Masks and COVID-19 Pandemic Containment

This study analyzes the impact of the exports of China’s masks and other antivirus supplies on the people from the importing countries who are subject to the severe pandemic during the coronavirus disease 2019 (COVID-19) pandemic. Our main data include the COVID-19 cases data of countries around the world published by Johns Hopkins University and the data of China’s exports of masks or other antivirus supplies to these countries from the Chinese Customs Database. Using cross-sectional data of about 180 countries and multiple regression analysis, we find that the antivirus supplies from China have played an important role in combating the COVID-19 pandemic. Specifically, China’s masks are shipped to countries around the world, and these masks can improve the recovery rate and protect people against the COVID-19 pandemic. Our findings are relevant to global efforts in the COVID-19 pandemic containment.

Relationships between urban form and air quality: A reconsideration based on evidence from China's five urban agglomerations during the COVID-19 pandemic

The outbreak of Coronavirus disease 2019 (COVID-19) led to the widespread stagnation of urban activities, resulting in a significant reduction in industrial pollution and traffic pollution. This affected how urban form influences air quality. This study reconsiders the influence of urban form on air quality in five urban agglomerations in China during the pandemic period. The random forest algorithm was used to quantitate the urban form-air quality relationship. The urban form was described by urban size, shape, fragmentation, compactness, and sprawl. Air quality was evaluated by the Air Quality Index (AQI) and the concentration of six pollutants (CO, O₃, NO₂, PM_2.5, PM₁₀, SO₂). The results showed that urban fragmentation is the most important factor affecting air quality and the concentration of the six pollutants. Additionally, the relationship between urban form and air quality varies in different urban agglomerations. By analyzing the extremely important indicators affecting air pollution, the urban form-air quality relationship in Beijing-Tianjin-Hebei is rather complex. In the Chengdu-Chongqing and the Pearl River Delta, urban sprawl and urban compactness are extremely important indicators for some air pollutants, respectively. Furthermore, urban shape ranks first for some air pollutants both in the Triangle of Central China and the Yangtze River Delta. Based on the robustness test, the performance of the random forest model is better than that of the multiple linear regression (MLR) model and the extreme gradient boosting (XGBoost) model.

Spatial variation of covid-19 morbidity status and identification of risk zone in Tamil Nadu (India) during first wave

COVID-19 is a pandemic disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). The study area, Tamilnadu, is a southern state in India. The present study demonstrates the significance of mapping in identifying the risk zones of COVID-19 disease by taking a study of COVID-19 cases in Tamilnadu state. The main objective of the study was to identify the risk zone of COVID-19 disease in the first wave of Tamilnadu through geospatial mapping. Data on COVID-19 cases collected during March 2020 to March 2021 month wise in all 37 districts (unit area) of Tamilnadu in two-month interval wise was analysed. The study is based on secondary sources from respective office in Tamilnadu. Z-score techniques were used for standardizing data. Correlation analysis provided a measure of correlation between COVID-19 and working population. Location Quotient analysis aided the identification of COVID-19 risk zones in Tamilnadu. Present study indicates tertiary workers are more vulnerable to COVID-19 disease.

The Impact of COVID-19 Restrictions on Physical Activity among Chinese University Students: A Retrospectively Matched Cohort Study

Objectives: In this study, we estimated the impact of COVID-19 on physical activity (PA) for Chinese university students during the pandemic period. Methods: The International Physical Activity Questionnaire was completed online by 1487 students (947 males and 513 females; age 19.72 ± 1.32 years, BMI = 21.12 ± 4.50) from one university in China during the pandemic period, and students retrospectively recalled pre-pandemic PA levels (March 29- April 15, 2020). We analyzed the data using a paired-samples t-test. Results: Overall, COVID-19 produced a 27.89% reduction in total weekly minutes (40.62) of vigorous PA, a 43.38% reduction in total weekly minutes (73.92) of moderate PA, and a 24.36% reduction in total weekly minutes of walking (44.69). Results by sex showed that moderate PA decreased the most, by 47.15% (males) and 37.13% (females), and total PA decreased by 48.29% (males) and 40.18% (females). Conclusions: COVID-19 led to a reduction in PA among Chinese university students. PA decreased more for male than female students. Public policy action might be needed to increase the level of PA of Chinese university students.

Community Mobility and COVID-19 Dynamics in Jakarta, Indonesia

In response to the COVID-19 pandemic, mobile-phone data on population movement became publicly available, including Google Community Mobility Reports (CMR). This study explored the utilization of mobility data to predict COVID-19 dynamics in Jakarta, Indonesia. We acquired aggregated and anonymized mobility data sets from 15 February to 31 December 2020. Three statistical models were explored: Poisson Regression Generalized Linear Model (GLM), Negative Binomial Regression GLM, and Multiple Linear Regression (MLR). Due to multicollinearity, three categories were reduced into one single index using Principal Component Analysis (PCA). Multiple Linear Regression with variable adjustments using PCA was the best-fit model, explaining 52% of COVID-19 cases in Jakarta (R-Square: 0.52; p < 0.05). This study found that different types of mobility were significant predictors for COVID-19 cases and have different levels of impact on COVID-19 dynamics in Jakarta, with the highest observed in “grocery and pharmacy” (4.12%). This study demonstrates the practicality of using CMR data to help policymakers in decision making and policy formulation, especially when there are limited data available, and can be used to improve health system readiness by anticipating case surge, such as in the places with a high potential for transmission risk and during seasonal events.

Impact of Digital Economy on the Provision Efficiency for Public Health Services: Empirical Study of 31 Provinces in China

The digital economy is booming in China and has become the world’s largest after the United States’. Since China entered the era of the digital economy, its digital technology has radiated into various fields. This study is to examine the impact of China’s digital economy on the provision efficiency of public health institutions and the mechanism of action between them. Specifically, it measures the development level of China’s digital economy, and the provision efficiency of public health institutions from 2009 to 2018. The research also explores the relationship between China’s digital economy and its provision efficiency, through the Tobit-DEA model. An analysis of the regional heterogeneity indicated that the performance of China’s digital economy in the eastern region has a significant positive effect on improving the efficiency of the public health sector. This further confirms that the digital economy has strengthened China’s ability to deal with public health crises during the COVID-19 pandemic. A further mediation effect analysis showed that China’s digital economy optimizes the efficiency of public health provision by improving governmental performance and regulatory quality. This shows that the development of the digital economy promotes the construction of digital government, and thus improves the quality of governmental supervision and governmental performance, which has a significant positive effect on the efficiency of the supply of public health services. During the COVID-19 pandemic especially, government delivery of public health services was critical in addressing public health crises. Therefore, based on the results of our empirical analysis, this study provides policy suggestions for improving the efficiency of public health service provision in the era of the digital economy.

Asymptomatic Transmissibility Calls for Implementing a Zero-COVID Strategy to End the Current Global Crisis

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented global challenges. A zero-COVID strategy is needed to end the crisis, but there is a lack of biological evidence. In the present study, we collected available data on SARS, MERS, and COVID-19 to perform a comprehensive comparative analysis and visualization. The study results revealed that the fatality rate of COVID-19 is low, whereas its death toll is high compared to SARS and MERS. Moreover, COVID-19 had a higher asymptomatic rate. In particular, COVID-19 exhibited unique asymptomatic transmissibility. Further, we developed a foolproof operating software in Python language to simulate COVID-19 spread in Wuhan, showing that the cumulative cases of existing asymptomatic spread would be over 100 times higher than that of only symptomatic spread. This confirmed the essential role of asymptomatic transmissibility in the uncontrolled global spread of COVID-19, which enables the necessity of implementing the zero-COVID policy. In conclusion, we revealed the triggering role of the asymptomatic transmissibility of COVID-19 in this unprecedented global crisis, which offers support to the zero-COVID strategy against the recurring COVID-19 spread.

Using the Theory of Planned Behaviour to explain junior nurses’ and final‐year student nurses’ intention to care for COVID‐19 patients in China: a multisite cross‐sectional study

Aim

To explore junior nurses' and final‐year student nurses' intention to care for COVID‐19 patients amidst the Delta COVID‐19 variant outbreak in China using the theory of planned behaviour (TPB) as a framework.

Background

The COVID‐19 pandemic has intensified global nursing shortage. Junior nurses and final‐year student nurses represent the backbone of the future frontline nursing workforce. The TPB is a valid theoretical model for predicting nurses' caring behaviours.

Methods

A 47‐item self‐administered questionnaire was disseminated online to a convenience sample of 547 junior nurses and final‐year student nurses located in 13 regions across mainland China.

Results

Approximately 63.4% of the participants intended to care for COVID‐19 patients voluntarily and 65.6% by non‐voluntary assignment. The TPB model significantly predicted 45% of the variance in behavioural intention, subjective norms being the strongest predictor. Gender, vaccination status and ethical perceptions regarding frontline work significantly correlated with the intention to provide care.

Conclusions

Our findings highlight the importance of social, organisational and family support underpinning future junior nurses' professional commitment in times of public health crisis.

Implications for nursing management

Pandemic‐tailored workplace training programmes for nurses/student nurses that emphasize on self‐care and ethical issue discussions are warranted. Hospital managers should collaborate with community partners to offer additional family support for nurses in need.

The impact of the COVID-19 on China's fisheries sector and its countermeasures

The COVID-19 pandemic has affected China's economic development, international exchanges and other aspects to varying degrees, among which the impact on China's fishery development should not be underestimated. The fishery is a traditional and vast industry in China. The ongoing COVID-19 outbreak has also exposed potential problems in China's fishery development, such as the lack of specialised aquatic product quality and safety supervision and testing institutions. New problems have also arisen, such as the decline in the market demand for fish and aquatic products, affecting fishers' income, livelihood and so on. These deficiencies require China to establish a matching legal system to correspondingly solve the current legal and political problems. This paper will systematically discuss the impact of the COVID-19 on China's fisheries sector from the perspectives of 'fishers' and 'aquatic products' after the outbreak of the COVID-19 pandemic and analyse how to deal with various problems by referring to relevant experience in light of China's national conditions and characteristics.

Estimating the Economic Effects of the Early Covid-19 Emergency Response in Cities Using Intracity Travel Intensity Data

In the early days of the Covid-19 pandemic, China implemented the most stringent and serious emergency response. To understand the effect of such an emergency response strategy on the economic system, this study proposed a simultaneous overall estimation method using intracity travel intensity data. The overall effect is represented by the difference between intracity travel intensity with and without the emergency response. Using historical data and time series analysis, we compared intracity travel intensity post China’s implementation of the emergency response with predicted intracity travel intensity without such a response. The loss rates, defined by the proportion of intracity travel intensity loss, were calculated for 360 cities within 33 provincial-level regions in China based on data availability. We found that 30 days after the emergency response, 21% of the cities saw over 80% recovery and 10% of the cities showed more than 90% recovery; 45 days after the emergency response, more than 83% of the 360 cities witnessed 80% recovery. The correlation between gross domestic production loss rate and travel intensity loss rate was studied quantitatively to demonstrate the representativeness of the intracity travel intensity loss rate. This indicator was also used to analyze the spatial and temporal patterns of the effects on the economy. The results of this study can help us understand the economic effects caused by the early Covid-19 emergency response and the method can be a reference for fast and real-time economic loss estimation to support emergency response decision making under pandemic conditions.

Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases

The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa's outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.

Control and Prevention of the COVID-19 Epidemic in China: A Qualitative Community Case Study

Background

Cross-infection among residents in communities is one of the most critical reasons for the rapid spread of the COVID-19 epidemic. The COVID-19 epidemic has been well controlled within Chinese communities, which has made important contributions to the country's fight against it.

Methods

In this study, a qualitative case study design, with mixed methods applied to data collection and analysis, was employed to explore epidemic prevention measures taken by a Chinese community, namely Mulin, during the pandemic.

Results

The Mulin community established an integrated plan for epidemic prevention, including the prevention of the invasion of COVID-19, the prevention of cross-infection within the community, gaining the residents' trust and support, and providing the residents with convenient services.

Conclusion

In the present work, the Mulin community was taken as a typical case study, and qualitative methods were employed to comprehensively summarize the practice and experience of the community's epidemic prevention. Mulin's practices could shed light on how communities in other countries, especially developing countries with large populations, can prevent the spread of COVID-19.

The Acceptance of COVID-19 Vaccination Under Different Methods of Investigation: Based on Online and On-Site Surveys in China

As Coronavirus Disease-2019 (COVID-19) vaccines became available in December 2020, increasingly more surveys were organized to examine the acceptance of vaccination, while most of them were conducted online. This study aimed to explore the difference between online and traditional on-site surveys in terms of COVID-19 vaccine acceptance. From November to December 2020, an online survey (n = 2013) and an on-site survey (n = 4,316) were conducted simultaneously in China. Multivariate logistic regression was used to identify influencing factors of acceptance, and propensity score matching (PSM) was adopted to balance the outcomes. As a result, 90.0% of the online respondents accepted COVID-19 vaccination, while it was only 82.1% in the on-site survey. After applying PSM, the acceptance rate of the on-site survey was declined to 78.6%. The age structure, residence location, education, and health status were observed as important factors in addressing vaccination acceptance, which needed to be specifically considered when designing online surveys.

Public Health and Private Life Under COVID-19 Vaccination Policies in China: A Legal Analysis

Vaccination against SARS-CoV-2 has been the most significant measure in the preventing and controlling the spread of COVID-19. The COVID-19 vaccination rate in China is relatively high worldwide. However, the vaccination policies behind China's effective containment of COVID-19 are not well known. Some local governments have mandated vaccination for citizens and limited the freedom of movement and other fundamental rights of the unvaccinated. This paper examines the legitimacy of mandatory vaccination policies and their institutional logic within the Chinese legal framework. China prioritizes collective rights such as health over individual rights such as privacy. However, the mandatory vaccination policies lack statutory authorization and will restrict Chinese citizens' autonomy and compromise their privacy.

Materials in advanced design of personal protective equipment: a review

The outbreak of the Covid-19 pandemic has aroused tremendous attention toward personal protective equipment (PPE) in both scientific research and industrial manufacture. Despite decades of development in PPE design and fabrication, there's still much room for further optimization, in terms, of both protection performance and wear comfort. Interdisciplinary efforts have been devoted to this research field in recent years. Significantly, the innovation of materials, which brings about improved performance and versatile new functions for PPEs, has been widely adopted in PPE design. In this minireview, recent progress in the development of novel materials and structural designs for PPE application are presented in detail with the introduction of various material-based strategies for different PPE types, as well as the examples, which apply auxiliary components into face masks to enrich the functionalities and improve the personal feelings in the pandemic period.

Loneliness, depression, anxiety, and post-traumatic stress disorder among Chinese adults during COVID-19: A cross-sectional online survey

OBJECTIVES

This study aims to investigate the potential factors associated with mental health outcomes among Chinese adults during the Coronavirus disease 2019 (COVID-19) epidemic.

METHODS

This is an online cross-sectional survey conducted among Chinese adults in February 2020. Outcome measurements included the three-item UCLA Loneliness Scale (UCLA-3), two-item Patient Health Questionnaire (PHQ-2), two-item Generalized Anxiety Disorder Questionnaire (GAD-2), and two items from the Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale. COVID-19 related factors, physical health, lifestyle, and self-efficacy were also measured. Univariable and multivariable logistic regressions were performed.

RESULTS

This study included 1456 participants (age: 33.8±10.5 years; female: 59.1%). The prevalence of depressive symptoms, anxiety symptoms, loneliness, and PTSD symptoms were 11.3%, 7.6%, 38.7%, and 33.9%, respectively. In multivariable analysis, loneliness was associated with being single, separated/divorced/widowed, low level of education, current location, medication, more somatic symptoms, lower self-efficacy, and going out frequently. Depression was associated with fear of infection, binge drinking, more somatic symptoms, lower self-efficacy, and longer screen time. Anxiety was associated with more somatic symptoms and lower self-efficacy. PTSD symptoms were associated with more somatic symptoms, lower self-efficacy, higher perceived risk of infection, fear of infection, and self-rated more negative influence due to the epidemic (p<0.05).

CONCLUSIONS

Mental health problems during the COVID-19 epidemic were associated with various biopsychosocial and COVID-19 related factors. Psychological interventions should be aware of these influencing factors and prioritize support for those people at higher risk.

Extended Epidemiological Models for Weak Economic Region: Case Studies of the Spreading of COVID-19 in the South Asian Subcontinental Countries

The ascendancy of coronavirus has become widespread all around the world. For the prevention of viral transmission, the pattern of disease is explored. Epidemiological modeling is a vital component of the research. These models assist in studying various aspects of infectious diseases, such as death, recovery, and infection rates. Coronavirus trends across several countries may analyze sufficiently using SIR, SEIR, and SIQR models. Across this study, we propose two modified versions of the SEIRD method for evaluating the transmission of this infectious disease in the South Asian countries, more precisely, in the south Asian subcontinent. The SEIRD model is updated further by fusing some new factors, namely, isolation for the suspected people and recovery and death of the people who are not under the coverage of healthcare schemes or reluctant to receive treatment for various catastrophes. We will investigate the influences of those ingredients on public health-related issues. Finally, we will predict and display the infection scenario and relevant elements with the concluding remarks through the statistical analysis.

Decrease in the chronic health effects from PM2.5 during the 13th Five-Year Plan in China: Impacts of air pollution control policies

The Chinese government implemented a series of policies to improve air quality during the Thirteenth Five-Year Plan (13^th FYP). However, the long-term health effects of the 13^th FYP air pollution control policies have not been evaluated, and the outbreak of coronavirus disease 2019 (COVID-19) has brought great uncertainty regarding the evaluation of the effects. In this study, we selected 329 cities in mainland China to study the chronic health effects due to the decrease in fine particulate matter (PM_2.5) during the 13^th FYP. The relative risk (RR) of PM_2.5 exposure was obtained from a previous study, and the total premature deaths were calculated. We also applied the grey prediction model to predict the PM_2.5 concentration in each city in 2020 to evaluate the impacts of COVID-19. The results showed that the annual PM_2.5 concentration was reduced from 49.7 μg/m³ in 2015 to 33.2 μg/m³ in 2020, and premature deaths were reduced from 1,186,201 (95% CI: 910,339-1,451,102) and 446,415 (in key regions, 95% CI: 343,426-544,813) in 2015 to 997,955 (95% CI: 762,167-1,226,652) and 368,786 (in key regions, 95% CI: 282,114-452,567) in 2020, respectively. A total of 188,246 (95% CI: 148,172-224,450) people avoided premature deaths due to the reduction in PM_2.5 concentrations from 2015 to 2020. Although the impacts of COVID-19 in 2020 brought a significant reduction of 35.3% in February (14.2 μg/m³, p < 0.0001) and in March by 17.6% (5.8 μg/m³, p = 0.001), we found that COVID-19 showed few obvious influences on China's long-term air pollution control plans. The observed data and predicted data are very close in annual mean values and showed no statistical significance both in all cities (p = 0.98) and in key regions (p = 0.56) in 2020.

The First Intra-Action Review of Indonesia's Response to the COVID-19 Pandemic, August 2020

The COVID-19 pandemic has had an unprecedented impact on health, society, and the economy globally and in Indonesia. The World Health Organization (WHO) recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 response. The Emergency Committee of the International Health Regulations (2005) has recommended that countries share COVID-19 best practices and lessons learned with peer countries through IARs. Using WHO-established methodology, we conducted the first IAR of Indonesia's COVID-19 response from January through August 2020. The review covered 10 thematic areas (pillars): (1) command and coordination; (2) operational support and logistics; (3) surveillance, rapid response teams, risk assessment, and field investigation; (4) laboratories; (5) case management; (6) infection prevention and control; (7) risk communication and community empowerment; (8) points of entry, international travel, and transportation; (9) large-scale social restrictions; and (10) maintaining essential health services and systems. We held focus group discussions with a variety of stakeholders from a range of government departments, provincial health offices, and nongovernmental organizations. We used the results of the focus group discussions and other key findings from the IAR to formulate recommendations. The IAR identified key areas for improvement at national and subnational levels across all 10 pillars. Priority recommendations included improving multisectoral coordination and monitoring of COVID-19 response plan indicators; strengthening implementation of public health response measures, including case detection, isolation, infection prevention and control, contact tracing, and quarantine; and improving data collection, analysis, and reporting to inform public health risk assessment and response. The IAR is a useful tool for reviewing progress and identifying areas to improve the COVID-19 response in real time and provides a means to share information on areas of need with COVID-19 response partners and contributes to International Health Regulations (2005) core capacity development.

Emergence of universality in the transmission dynamics of COVID-19

The complexities involved in modelling the transmission dynamics of COVID-19 has been a roadblock in achieving predictability in the spread and containment of the disease. In addition to understanding the modes of transmission, the effectiveness of the mitigation methods also needs to be built into any effective model for making such predictions. We show that such complexities can be circumvented by appealing to scaling principles which lead to the emergence of universality in the transmission dynamics of the disease. The ensuing data collapse renders the transmission dynamics largely independent of geopolitical variations, the effectiveness of various mitigation strategies, population demographics, etc. We propose a simple two-parameter model-the Blue Sky model-and show that one class of transmission dynamics can be explained by a solution that lives at the edge of a blue sky bifurcation. In addition, the data collapse leads to an enhanced degree of predictability in the disease spread for several geographical scales which can also be realized in a model-independent manner as we show using a deep neural network. The methodology adopted in this work can potentially be applied to the transmission of other infectious diseases and new universality classes may be found. The predictability in transmission dynamics and the simplicity of our methodology can help in building policies for exit strategies and mitigation methods during a pandemic.

Nutraceuticals and Herbs in Reducing the Risk and Improving the Treatment of COVID-19 by Targeting SARS-CoV-2

The worldwide transmission of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a deadly or devastating disease is known to affect thousands of people every day, many of them dying all over the planet. The main reason for the massive effect of COVID-19 on society is its unpredictable spread, which does not allow for proper planning or management of this disease. Antibiotics, antivirals, and other prescription drugs, necessary and used in therapy, obviously have side effects (minor or significant) on the affected person, there are still not clear enough studies to elucidate their combined effect in this specific treatment, and existing protocols are sometimes unclear and uncertain. In contrast, it has been found that nutraceuticals, supplements, and various herbs can be effective in reducing the chances of SARS-CoV-2 infection, but also in alleviating COVID-19 symptoms. However, not enough specific details are yet available, and precise scientific studies to validate the approved benefits of natural food additives, probiotics, herbs, and nutraceuticals will need to be standardized according to current regulations. These alternative treatments may not have a direct effect on the virus or reduce the risk of infection with it, but these products certainly stimulate the human immune system so that the body is better prepared to fight the disease. This paper aims at a specialized literary foray precisely in the field of these “cures” that can provide real revelations in the therapy of coronavirus infection

Stakeholder efforts to mitigate antiretroviral therapy interruption among people living with HIV during the COVID-19 pandemic in China: a qualitative study

Introduction

The COVID‐19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID‐19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders.

Methods

Between 11 February and 15 February 2020, we interviewed PLHIV, community‐based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi‐structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID‐19 pandemic were discussed. Themes were identified by transcript coding and mindmaps.

Results

Sixty‐four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID‐19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out‐of‐pocket ART.

Conclusions

Social and institutional disruption from COVID‐19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China.

COVID-19, poverty and inclusive development

The COVID-19 epidemic provides yet another reason to prioritize inclusive development. Current response strategies of the global community and countries expose a low level of solidarity with poorer nations and poorer people in all nations. Against this background, this paper addresses the question: What are the development challenges that the COVID-19 pandemic lays bare and what lessons can be learnt for the way recovery processes are designed? Using an inclusive development and DPSIR lens to assess the literature, our study finds that, first, the current response prioritises the 'state' and 'impact' concerns of wealthier classes at the expense of the remainder of the world population. Second, responses have ignored underlying 'drivers' and 'pressures', instead aiming at a quick recovery of the economy. Third, a return to business-as-usual using government funding will lead to a vicious cycle of further ecological degradation, socio-economic inequality and domestic abuse that assist in exacerbating the drivers of the pandemic. We argue instead for an inclusive development approach that leads to a virtuous cycle by emphasizing human health, well-being and ecosystem regeneration. We conclude that the lost years for development did not commence in 2020 with the onset of COVID-19; the downward trend has actually been waxing over the past three decades. From this perspective, COVID-19 may be the shock needed to put the last first and transform vicious into virtuous cycles of inclusive development.

Stakeholder efforts to mitigate antiretroviral therapy interruption among people living with HIV during the COVID-19 pandemic in China: a qualitative study

INTRODUCTION

The COVID-19 pandemic has affected antiretroviral therapy (ART) continuity among people living with HIV (PLHIV) worldwide. We conducted a qualitative study to explore barriers to ART maintenance and solutions to ART interruption when stringent COVID-19 control measures were implemented in China, from the perspective of PLHIV and relevant key stakeholders.

METHODS

Between 11 February and 15 February 2020, we interviewed PLHIV, community-based organization (CBO) workers, staff from centres for disease control and prevention (CDC) at various levels whose work is relevant to HIV care (CDC staff), HIV doctors and nurses and drug vendors from various regions in China. Semi-structured interviews were conducted using a messaging and social media app. Challenges and responses relevant to ART continuity during the COVID-19 pandemic were discussed. Themes were identified by transcript coding and mindmaps.

RESULTS

Sixty-four stakeholders were recruited, including 16 PLHIV, 17 CBO workers, 15 CDC staff, 14 HIV doctors and nurses and two drug vendors. Many CDC staff, HIV doctors and nurses responsible for ART delivery and HIV care were shifted to COVID-19 response efforts. Barriers to ART maintenance were (a) travel restrictions, (b) inadequate communication and bureaucratic obstacles, (c) shortage in personnel, (d) privacy concerns, and (e) insufficient ART reserve. CBO helped PLHIV maintain access to ART through five solutions identified from thematic analysis: (a) coordination to refill ART from local CDC clinics or hospitals, (b) delivery of ART by mail, (c) privacy protection measures, (d) mental health counselling, and (e) providing connections to alternative sources of ART. Drug vendors contributed to ART maintenance by selling out-of-pocket ART.

CONCLUSIONS

Social and institutional disruption from COVID-19 contributed to increased risk of ART interruption among PLHIV in China. Collaboration among key stakeholders was needed to maintain access to ART, with CBO playing an important role. Other countries facing ART interruption during current or future public health emergencies may learn from the solutions employed in China.

The associations of geographic location and perceived risk of infection with the intentions to get vaccinated against COVID-19 in China

BACKGROUND

Vaccines are a critical tool against coronavirus disease 2019 (COVID-19) pandemic, yet little is known regarding the associations of geographic location and perceived risk with the intentions to get vaccinated against COVID-19 in China.

METHODS

An on-site survey of adults aged 18 or older (n = 7261) was conducted from November to December, 2020 in China, and this survey selected six provinces based on the geographic location.

RESULTS

In the total sample, 82.5% reported that they would intend to get vaccinated against COVID-19. Compared with Hubei province, respondents' intentions to get vaccinated decreased by 70% in Zhejiang, 61% in Guangdong, 87% in Gansu, and 71% in Jilin, respectively. However, within Hubei province, compared with Wuhan city, respondents' intentions to get vaccinated in other cities were not significantly different. Respondents with higher perceived risk of infection were associated with increased odds of intentions to get vaccinated against COVID-19.

CONCLUSION

Our study identified priority geographic regions that need to pay attention on the vaccination campaign and help design effective immunization strategies to increase the vaccine uptake against COVID-19. More attention should be paid to adults residing farther from the epicenter of the outbreak and having lower perceived risk of infection.

Psychological Impact of COVID-19 Pandemic in Bangladesh: Analysis of a Cross-Sectional Survey

The COVID-19 pandemic has generated fear, panic, distress, anxiety, and depression among many people in Bangladesh. In this cross-sectional study, we examined factors associated with different levels of psychological impact as a result of COVID-19 in Bangladesh. From April 1 to 30, 2020, we used a self-administered online questionnaire to collect data from 10,609 respondents. Using the Impact of Event Scale-Revised to assess the psychological impact of the COVID-19 pandemic on respondents, we categorized the levels of impact as normal, mild, moderate, or severe. Ordinal logistic regression was used to examine the associated factors. The prevalence of mild, moderate, and severe psychological impact was 10.2%, 4.8%, and 45.5%, respectively. Multivariate analysis revealed that the odds of reporting normal vs mild, moderate, or severe psychological impact were 5.9 times higher for people living in the Chittagong Division, 1.7 times higher for women with lower education levels, 3.0 times higher among those who were divorced or separated, 1.8 times higher for those working full time, and 2.4 times higher for those living in shared apartments. The odds of reporting a psychological impact were also higher among people who did not enforce protective measures inside the home, those in self-quarantine, those who did not wear face masks, and those who did not comply with World Health Organization precautionary measures. Increased psychological health risks due to COVID-19 were significantly higher among people who experienced chills, headache, cough, breathing difficulties, dizziness, and sore throat before data collection. Our results showed that 1 in 2 respondents experienced a significant psychological impact as a result of the COVID-19 pandemic. Public health researchers should consider these factors when targeting interventions that would have a protective effect on the individual's psychological health during a pandemic or future disease outbreak.

Efficacy of Government Responses to COVID-19 in Mediterranean Countries

Objective

This article aims to provide empirical evidence on the effectiveness of the governments' policy measures in response to the COVID-19 pandemic in the Mediterranean countries.

Methods

We considered five categories of response: lockdowns, social distancing, movement restrictions, public health measures, and governance and socio-economic measures. Our main research question is, How long do these measures take to become effective? Our analysis, by longitudinal regressions and panel count data analyses, focuses on one region-the Mediterranean countries-to avoid differences, such as cultural factors, that may influence the evolution of the viral pandemic. We start by investigating heteroscedasticity, and both serial and contemporaneous correlation of the disturbance term across cross-sectional countries.

Results

Our different estimation methods paint very similar trajectories of the efficacy of governments' response measures. The benefits of these measures increase exponentially with time. We find that the net effects can be divided into three phases. In the first week, the benefits are not guaranteed unless the total number of contamination cases is less than some threshold values, ie if the spread of the virus is not already advanced. Then, indirect effects are revealed. After three weeks, we observe a reduction in the number of the new confirmed viral cases and, thus, the direct net benefits are observed.

Conclusion

The earlier governments act, in relation to the evolution of the epidemic, the lower the total cumulative incidence due to the epidemic wave.