Understanding the emerging coronavirus: what it means for health security and infection prevention

COVID-19 crisis interlinkage with past pandemics and their effects on food security

BACKGROUND

Pandemics as health and humanitarian crises have exerted traceable impacts on food security. Almost all past and current pandemics have created a food crisis that affects a share of the global population and threaten global food security. With the more frequent outbreaks of emerging and re-emerging diseases or pandemics, this paper looks at the various types of impacts from the current coronavirus crisis and past pandemics to identify their major impact on food security.

SCOPE

To this effect, key strategies that could be put in place to ensure the efficient resilience of food systems before, during, and after the pandemics to mitigate the negative impact of the pandemics on global food security are recommended. The most recent effects of the current coronavirus crisis have been disruptions in the flow of farm labourers and inefficient farm operations leading to postharvest food losses.

KEY FINDINGS AND CONCLUSIONS

Modification of diets between social groups has also been observed. Future response orientations to prevent and mitigate the effects of pandemics on food security will consider pro-active and adapted policy, program, and institutional actions towards the systemic development of global food systems as an interconnected network.

Resilience level and its association with maladaptive coping behaviours in the COVID-19 pandemic: a global survey of the general populations

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has induced a significant global concern on mental health. However few studies have measured the ability of individuals to "withstand setbacks, adapt positively, and bounce back from adversity" on a global scale. We aimed to examine the level of resilience, its determinants, and its association with maladaptive coping behaviours during the pandemic.

METHODS

The Association of Pacific Rim Universities (APRU) conducted a global survey involving 26 countries by online, self-administered questionnaire (October 2020-December 2021). It was piloted-tested and validated by an expert panel of epidemiologists and primary care professionals. We collected data on socio-demographics, socioeconomic status, clinical information, lifestyle habits, and resilience levels measured by the Brief Resilience Scale (BRS) among adults aged ≥ 18 years. We examined factors associated with low resilience level, and evaluated whether low resilience was correlated with engagement of maladaptive coping behaviours.

RESULTS

From 1,762 surveys, the prevalence of low resilience level (BRS score 1.00-2.99) was 36.4% (America/Europe) and 24.1% (Asia Pacific). Young age (18-29 years; adjusted odds ratio [aOR] = 0.31-0.58 in older age groups), female gender (aOR = 1.72, 95% C.I. = 1.34-2.20), poorer financial situation in the past 6 months (aOR = 2.32, 95% C.I. = 1.62-3.34), the presence of one (aOR = 1.56, 95% C.I. = 1.19-2.04) and more than two (aOR = 2.32, 95% C.I. = 1.59-3.39) medical conditions were associated with low resilience level. Individuals with low resilience were significantly more likely to consume substantially more alcohol than usual (aOR = 3.84, 95% C.I. = 1.62-9.08), take considerably more drugs (aOR = 12.1, 95% C.I. = 2.72-54.3), buy supplements believed to be good for treating COVID-19 (aOR = 3.34, 95% C.I. = 1.56-7.16), exercise less than before the pandemic (aOR = 1.76, 95% C.I. = 1.09-2.85), consume more unhealthy food than before the pandemic (aOR = 2.84, 95% C.I. = 1.72-4.67), self-isolate to stay away from others to avoid infection (aOR = 1.83, 95% C.I. = 1.09-3.08), have an excessive urge to disinfect hands for avoidance of disease (aOR = 3.08, 95% C.I. = 1.90-4.99) and transmission (aOR = 2.54, 95% C.I. = 1.57-4.10).

CONCLUSIONS

We found an association between low resilience and maladaptive coping behaviours in the COVID-19 pandemic. The risk factors identified for low resilience in this study were also conditions known to be related to globalization-related economic and social inequalities. Our findings could inform design of population-based, resilience-enhancing intervention programmes.

Analysis of CT scan images for COVID-19 pneumonia based on a deep ensemble framework with DenseNet, Swin transformer, and RegNet

COVID-19 has caused enormous challenges to global economy and public health. The identification of patients with the COVID-19 infection by CT scan images helps prevent its pandemic. Manual screening COVID-19-related CT images spends a lot of time and resources. Artificial intelligence techniques including deep learning can effectively aid doctors and medical workers to screen the COVID-19 patients. In this study, we developed an ensemble deep learning framework, DeepDSR, by combining DenseNet, Swin transformer, and RegNet for COVID-19 image identification. First, we integrate three available COVID-19-related CT image datasets to one larger dataset. Second, we pretrain weights of DenseNet, Swin Transformer, and RegNet on the ImageNet dataset based on transformer learning. Third, we continue to train DenseNet, Swin Transformer, and RegNet on the integrated larger image dataset. Finally, the classification results are obtained by integrating results from the above three models and the soft voting approach. The proposed DeepDSR model is compared to three state-of-the-art deep learning models (EfficientNetV2, ResNet, and Vision transformer) and three individual models (DenseNet, Swin transformer, and RegNet) for binary classification and three-classification problems. The results show that DeepDSR computes the best precision of 0.9833, recall of 0.9895, accuracy of 0.9894, F1-score of 0.9864, AUC of 0.9991 and AUPR of 0.9986 under binary classification problem, and significantly outperforms other methods. Furthermore, DeepDSR obtains the best precision of 0.9740, recall of 0.9653, accuracy of 0.9737, and F1-score of 0.9695 under three-classification problem, further suggesting its powerful image identification ability. We anticipate that the proposed DeepDSR framework contributes to the diagnosis of COVID-19.

Psychological Experiences and Reactions of Physicians with COVID-19: A Qualitative Study

Doctors are the first to fight COVID-19 and their mental health is at risk. This article aimed to investigate the psychological experiences of physicians recovered from COVID-19 disease. Phenomenological method was carried out to analyze the obtained data. Participants were 16 physicians recovered from COVID-19 disease in Yazd City from January 20th to March 1st, 2020. Samples were selected via purposive sampling and the subjects participated in-depth semi-structured interviews. Twelve main themes and 48 sub-themes were extracted, including 1- Adaptive emotional reactions, 2- Adaptive cognitive reactions, 3- Adaptive behavioral reactions, 4- Adaptive communicative reactions, 5- Adaptive spiritual reactions, 6- Adaptive copings, 7- Maladaptive Emotional reactions, 8- Maladaptive Cognitive reactions, 9- Maladaptive Behavioral reactions, 10- Maladaptive Communicative reactions, 11- Maladaptive spiritual reactions, and 12- Maladaptive Copings. According to the findings, adaptive psychological reactions and maladaptive psychological reactions can affect the psychological well-being of physicians.

Microbial ecology and evolution is key to pandemics: using the coronavirus model to mitigate future public health challenges

Pandemics are global challenges that lead to total disruption of human activities. From the inception of human existence, all pandemics have resulted in loss of human lives. The coronavirus disease caused by SAR-CoV-2 began in China and is now at the global scale with an increase in mortality and morbidity. Numerous anthropogenic activities have been implicated in the emergence and severity of pandemics, including COVID-19. These activities cause changes in microbial ecology, leading to evolution due to mutation and recombination. This review hypothesized that an understanding of these anthropogenic activities would explain the dynamics of pandemics. The recent coronavirus model was used to study issues leading to microbial evolution, towards preventing future pandemics. Our review highlighted anthropogenic activities, including deforestation, mining activities, waste treatment, burning of fossil fuel, as well as international travels as drivers of microbial evolution leading to pandemics. Furthermore, human-animal interaction has also been implicated in pandemic incidents. Our study recommends substantial control of such anthropogenic activities as having been highlighted as ways to reduce the frequency of mutation, reduce pathogenic reservoirs, and the emergence of infectious diseases.

Urban diversity and epidemic resilience: The case of the COVID-19

The spread of the coronavirus pandemic offers a unique opportunity to improve our understanding of the role of urban planning strategies in the resilience of urban communities confronting a pandemic. This study examines the relationship between urban diversity and epidemiological resilience by empirically assessing the relation between the level of neighborhood homogeneity and the probability of being infected by the coronavirus. We focus on the ultra-Orthodox Jewish community in Israel, a relatively closed community that was disproportionately and severely affected by the pandemic. The findings indicate a monotonic but nonlinear relationship between the level of ultra-Orthodox prevalence in a neighborhood and a resident's probability of contracting COVID-19. As the fraction of ultra-Orthodox individuals in the neighborhood decreases, the fraction of infected population decreases significantly and more strongly that can be explained without recourse to urban diversity considerations. This relationship is found to be significant and strong, even when other variables are accounted for that had hitherto been perceived as central to coronavirus distribution, such as housing density, socioeconomic level of the neighborhood, and number of people per household. The findings are important and relevant to many societies around the globe in which a variety of populations have a separatist lifestyle.

Herding behavior during the Covid-19 pandemic: a comparison between Asian and European stock markets based on intraday multifractality

With the spread of Covid-19, investors’ expectations changed during 2020, as well as financial markets’ policy responses and the structure of global financial intermediation itself. These dynamics are studied in this paper, which analyzes quarterly changes in herding behavior by quantifying the self-similarity intensity of six stock markets in Asia and Europe. A multifractal detrended fluctuation analysis (MFDFA) is applied, using intraday trade prices with a 15-min frequency from Jan-2020 to Dec-2020. The empirical results confirm that Covid-19 had a significant impact on the efficiency of the stock markets under study, although with a quarterly varying impact. During the first quarter of the year, European stock markets remained efficient compared to Asian markets; in the subsequent two quarters, the Chinese stock market showed significant improvement in its efficiency and became the least inefficient market, with a decline in the market efficiency of the UK and Japan. Furthermore, European markets are more sensitive to asset losses than Asian markets, so investors are more likely to show herding in the former. Herding was at its peak during the 2nd quarter of 2020. These findings could be related to possible market inefficiencies and herding behavior, implying the possibility of investors forming profitable trading strategies.

Clinical manifestation, laboratory and radiology finding, treatment and outcomes of COVID-19: A systematic review and meta-analysis

BACKGROUND

Since December 2019, coronavirus (COVID-19) spread throughout the world. The high rate of infection and its unknown nature led specialists to report the condition of patients. The aim of this study is to systematically review of symptoms, laboratory and radiologic findings, treatment, and outcomes of patients with COVID-19.

MATERIALS AND METHODS

Databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and Cochrane were searched. Finally, 46 articles were appropriate for the aim of the study. After quality evaluation, the necessary data were extracted and meta-analysis was performed.

RESULTS

4858 articles were retrieved until March 30, 2020. After screening, the full-text of 46 articles was assessed. Of the reported cases, 31.7% had no comorbidities, 21.4% had high blood pressure, 70.6% had fever, and lymphopenia was reported in 55.2% of patients. For 16% bilateral patchy shadowing in radiography and for 51% ground-glass opacity was reported. Outcomes were remarkable for recover to death.

CONCLUSION

COVID-19 leads to healthcare problems for countries. Nonspecific symptoms have made it difficult for differential diagnoses without computed tomography-scan or corona Test, but they are not available in many countries. Therefore, this systematic review can help health care staff to make decisions based on symptoms, treatments, and outcomes..

Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy

Background and Aims: The Coptic clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and to identify predictors of clinical adverse events. Methods: Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt, and Group III: Southern Egypt. Participants’ demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management, and major adverse events (MAEs), comprising death, or mechanical ventilation, were assessed. Results: Out of the 1570 clergy serving in 25 dioceses, 255 (16.2%) were infected. Their mean age was 49.5 ± 12 years and mean weekly number of liturgies was 3.44 ± 1.0. The overall prevalence rate was 16.2% and did not differ between Egypt as a whole and overseas (p = 0.23). Disease prevalence was higher in Northern Egypt clergy compared with Europe and USA combined (18.4% vs. 12.1%, p = 0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p = 0.09). Ten priests (3.92%) died of COVID-19-related complications, and 26 (10.2) suffered a MAE. The clergy from Southern Egypt were more obese, but the remaining risk factors were less prevalent compared with those in Europe and USA (p = 0.01). In multivariate analysis, obesity (OR = 4.180; 2.479 to 12.15; p = 0.01), age (OR = 1.055; 0.024 to 1.141; p = 0.02), and systemic hypertension (OR = 1.931; 1.169 to 2.004; p = 0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p < 0.05 for both). Conclusion: Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. Coptic clergy should be encouraged to follow the WHO recommendations for cardiovascular disease and COVID-19 prevention.

Public health awareness: knowledge, attitude and behaviors of the public on health risks during COVID-19 pandemic in sultanate of Oman

Purpose

This study aims to measure the level of public awareness about the threat of the emerging coronavirus (COVID-19) pandemic among the Omani population. It also aims to investigate the mediating effect of the Omanis’ attitudes and behaviors with underlying conditions of COVID-19.

Design/methodology/approach

A cross-sectional study was conducted to collect data via an online survey of Omani citizens and residents from various geographic areas in Oman, 305 responses were received. SPSS and partial least square-structural equation modeling were used for data analysis.

Findings

The study revealed that public awareness regarding the COVID-19 pandemic was significantly influenced by people’s perceived risk, information source and health-related knowledge. Further, preventive behavior during the disease spread has a significant direct and indirect impact on their awareness. However, an insignificant mediation effect of public attitude was found between the source of information and public awareness.

Research limitations/implications

This study is limited by the scarcity of related literature in the Omani context. It is recommended that future research complete an in-depth study of public awareness regarding COVID-19, using other constructs and/or other data collection techniques.

Practical implications

This research will provide governmental health authorities and policymakers with a guideline to establish more efficient pandemic containment strategies to control public behavior toward the COVID-19 pandemic and curb viral prevalence.

Social implications

This research will help in improving prevention measures against COVID-19 are recommended to be more educated through a more effective mechanism to raise public attitude regarding pandemic prevalence positively.

Originality/value

The originality of this research can be drawn from key findings that indicate that people overall gained knowledge about how to deal with the COVID-19 pandemic and the accuracy of information significantly impacts public awareness.

The Management and Outcomes of Coronavirus Disease 2019 Infection in a Series of Neurosurgical Patients

Background

The coronavirus disease 2019 (COVID-19) pandemic has impacted neurosurgical practice worldwide. In Iran, hospitals have halted their routine activities, and most hospital beds have been assigned to COVID-19 patients. Here, we share our experience with 10 neurosurgical cases with confirmed COVID-19.

Materials and Methods

From February 24, 2020 to April 20, 2020, we were able to obtain clinical data on ten neurosurgical patients with COVID-19 through a predefined electronic form.

Results

Of the 10 patients with COVID-19 on neurosurgical units, eight underwent surgical interventions. The age of the patients ranged from 21 to 75 years and 70% were males. The diagnosis of COVID-19 was based on chest imaging findings and reverse transcriptase-polymerase chain reaction for coronavirus and an infectious disease specialist and a pulmonologist confirmed the diagnoses. In two cases, there was a significant decrease in O2 saturation intraoperatively. Three patients in this series died during the assessment period. One death was due to respiratory failure induced by the coronavirus infection. The cause of death in other two patients was cardiovascular failure not related to COVID-19.

Conclusions

We hope we can provide a reference for future studies and help develop a clearer understanding of neurosurgical practice and outcomes in patients with COVID-19. In the time of COVID-19 pandemic when dealing with neurosurgical emergencies, a conservative approach is recommended. Using committed personal protective equipment, short-time operating procedures or minimally invasive surgery must be considered in the management of emergent patients. Resuming elective surgeries need defining measures needed to ensure patients and health-care providers' safety. Reorganizing the health-care system for telemonitoring released patients can lessen hospital visits.

Public opinion regarding government response to COVID-19: case study of a large commercial city in Nigeria

INTRODUCTION

government measures to contain the COVID-19 pandemic cannot be effective without widespread compliance by the public. A greater understanding of citizens' perceptions of these measures can help government agencies adapt their strategies to boost compliance. We examined citizens' perceptions of government's measures to contain the COVID-19 pandemic and its implications on compliance using data from Onitsha city, Anambra State Nigeria.

METHODS

data was obtained through in-person interviews of 140 consenting adults in March 2020. Descriptive and inferential statistics were used to summarize the data.

RESULTS

most participants (84.7%) doubted government's ability to manage the COVID-19 outbreak, raising concerns about ineffective governance (25.7%) and inadequate health facilities (20.7%). However, participants expressed a favorable perception of school closures (92.3%) and a ban on large gatherings (83.9%), driven mostly by the need to contain the COVID-19 and avoid its spread. But, they were generally indifferent about the closure of the markets and workplaces due to concerns for food insecurity and lack of government's relief programs. Participants who had a positive perception of the ban on large gatherings were more likely to have high knowledge and to adopt good COVID-19 preventive practices.

CONCLUSION

the study showed a lack of public's confidence in the government's ability to manage the pandemic. This provides an opportunity for the city government and the public to reflect on the existing relationships, build mutual trust, and devise collaborative engagement that will boost compliance and help contain the devastating impact of COVID-19 pandemic.

Pandemics: past, present, future: That is like choosing between cholera and plague

The major epidemic and pandemic diseases that have bothered humans since the Neolithic Age and Bronze Age are surveyed. Many of these pandemics are zoonotic infections, and the mathematical modeling of such infections is illustrated. Plague, cholera, syphilis, influenza, SARS, MERS, COVID‐19, and new potential epidemic and pandemic infections and their consequences are described and the background for the spread of acute and chronic infections and the transition to endemic infections is discussed. The way we can prevent and fight pandemics is illustrated from the old and new well‐known pandemics. Surprisingly, the political reactions through different periods have not changed much during the centuries.

Addressing the global challenge of access to supplies during COVID-19

The current COVID-19 pandemic has presented unprecedented challenges for health care facilities worldwide. Global production and shipping routes were disrupted, and health care institutions, even in high resource areas, found themselves lacking the basic supplies for effective infection prevention and control. One major hurdle was the global access to supplies, particularly N95/FFP2 masks and alcohol-based hand rub (ABHR) for performing hand hygiene.

This chapter explores how the lack of masks and ABHR were addressed through local production and the disinfection and reuse of disposable N95 masks. Although the global situation is no longer dire, the pandemic is currently still underway, and access to sufficient and high-quality supplies still is an important challenge faced by health care institutions.

Previously, local production was mainly promoted by the World Health Organization (WHO) as a social business venture for helping developing countries. Disposable mask reuse was barely studied until this pandemic, because there was never really a need to. Thus the literature in these fields are mostly quite new. This chapter reviews the introduction and state of the art of the field, the evidence for hand hygiene and masking in the literature, the global situation since the pandemic and strategies that countries have taken to adapt. It then concentrates further on the specifics of local production, both for ABHR and for masks, and on the issues surrounding mask reuse. The chapter concludes with putting these technologies in the larger context of the pandemic, and how learning how the world tried to implement solutions can teach us lessons for future emergencies.

The impact of Coronavirus (COVID-19) outbreak on faith-based investments: An original analysis

This paper examines the rapid spread of Coronavirus (COVID-19) and its short-term impact on the Shariah-compliant UK Dow Jones market index to capture the dynamic behavior of stock returns at economy and industry levels. Using daily data over the period January 20 to May 20 and ten UK industrial sector groupings, the findings suggest a strong and statistically significant relationship between the COVID-19 pandemic and the performance of the conventional stock market index. The findings also suggest that the disease interacts negatively but insignificantly with the Dow Jones faith-based ethical (Islamic) index compared to its UK counterpart. In addition, through an analysis of sector groupings, the paper shows that the stock returns of the information technology sector performed significantly better than the market, while stock returns of consumer discretionary sector, which includes transportation, beverages, tourism and leisure, consumer services performed significantly worse than the market during the COVID-19 outbreak. Other sector groupings fail to yield significantly plausible parameter values.

Repurposed drugs and nutraceuticals targeting envelope protein: A possible therapeutic strategy against COVID-19

COVID-19 pandemic caused by SARS-CoV-2 has already claimed millions of lives worldwide due to the absence of a suitable anti-viral therapy. The CoV envelope (E) protein, which has not received much attention so far, is a 75 amino acid long integral membrane protein involved in assembly and release of the virus inside the host. Here we have used artificial intelligence (AI) and pattern recognition techniques for initial screening of FDA approved pharmaceuticals and nutraceuticals to target this E protein. Subsequently, molecular docking simulations have been performed between the ligands and target protein to screen a set of 9 ligand molecules. Finally, we have provided detailed insight into their mechanisms of action related to the varied symptoms of infected patients.

The impact of COVID-19 on globalization

Globalization has altered the way we live and earn a livelihood. Consequently, trade and travel have been recognized as significant determinants of the spread of disease. Additionally, the rise in urbanization and the closer integration of the world economy have facilitated global interconnectedness. Therefore, globalization has emerged as an essential mechanism of disease transmission. This paper aims to examine the potential impact of COVID-19 on globalization and global health in terms of mobility, trade, travel, and countries most impacted.

The effect of globalization were operationalized in terms of mobility, economy, and healthcare systems. The mobility of individuals and its magnitude was assessed using airline and seaport trade data and travel information. The economic impact was measured based on the workforce, event cancellations, food and agriculture, academic institutions, and supply chain. The healthcare capacity was assessed by considering healthcare system indicators and preparedness of countries. Utilizing a technique for order of preference by similarity to ideal solution (TOPSIS), we calculated a pandemic vulnerability index (PVI) by creating a quantitative measure of the potential global health. The pandemic has placed an unprecedented burden on the world economy, healthcare, and globalization through travel, events cancellation, employment workforce, food chain, academia, and healthcare capacity. Based on PVI results, certain countries were more vulnerable than others. In Africa, more vulnerable countries included South Africa and Egypt; in Europe, they were Russia, Germany, and Italy; in Asia and Oceania, they were India, Iran, Pakistan, Saudi Arabia, and Turkey; and for the Americas, they were Brazil, USA, Chile, Mexico, and Peru. The impact on mobility, economy, and healthcare systems has only started to manifest. The findings of this study may help in the planning and implementation of strategies at the country level to help ease this emerging burden.

What can we learn from previous pandemics to reduce the frequency of emerging infectious diseases like COVID-19?

The global risks report of 2020 stated, climate-related issues dominate all of the top-five long-term critical global risks burning the planet and according to the report, "as existing health risks resurge and new ones emerge, humanity's past successes in overcoming health challenges are no guarantee of future results." Over the last few decades, the world has experienced several pandemic outbreaks of various pathogens and the frequency of the emergence of novel strains of infectious organisms has increased in recent decades. As per expert opinion, rapidly mutating viruses, emergence and re-emergence of epidemics with increasing frequencies, climate-sensitive vector-borne diseases are likely to be increasing over the years and the trends will continue and intensify. Susceptible disease hosts, anthropogenic activities and environmental changes contribute and trigger the 'adaptive evolution' of infectious agents to thrive and spread into different ecological niches and to adapt to new hosts. The overarching objective of this paper is to provide insight into the human actions which should be strictly regulated to help to sustain life on earth. To identify and categorize the triggering factors that contribute to disease ecology, especially repeated emergence of disease pandemics, a theory building approach, 'Total Interpretive Structural Modeling' (TISM) was used; also the tool, 'Impact Matrix Cross-Reference Multiplication Applied to a Classification' analysis (MICMAC) was applied to rank the risk factors based on their impacts on other factors and on the interdependence among them. This mathematical modeling tool clearly explains the strength, position and interconnectedness of each anthropogenic factor that contributes to the evolution of pathogens and to the frequent emergence of pandemics which needs to be addressed with immediate priority. As we are least prepared for another pandemic outbreak, significant policy attention must be focused on the causative factors to limit emerging outbreaks like COVID 19 in the future.

Country-level factors associated with the early spread of COVID-19 cases at 5, 10 and 15 days since the onset

The COVID-19 pandemic is causing a significant global health crisis. As the disease continues to spread worldwide, little is known about the country-level factors affecting the transmission in the early weeks. The present study objective was to explore the country-level factors, including government actions that explain the variation in the cumulative cases of COVID-19 within the first 15 days since the first case reported. Using publicly available sources, country socioeconomic, demographic and health-related risk factors, together with government measures to contain COVID-19 spread, were analysed as predictors of the cumulative number of COVID-19 cases at three time points (t = 5, 10 and 15) since the first case reported (n = 134 countries). Drawing on negative binomial multivariate regression models, HDI, healthcare expenditure and resources, and the variation in the measures taken by the governments, significantly predicted the incidence risk ratios of COVID-19 cases at the three time points. The estimates were robust to different modelling techniques and specifications. Although wealthier countries have elevated human development and healthcare capacity in respect to their counterparts (low- and middle-income countries) the early implementation of effective and incremental measures taken by the governments are crucial to controlling the spread of COVID-19 in the early weeks.

Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study

Introduction

Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland.

Methods

A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison.

Results

A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms.

Conclusion

Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.

The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper

What started as a cluster of patients with a mysterious respiratory illness in Wuhan, China, in December 2019, was later determined to be coronavirus disease 2019 (COVID-19). The pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel Betacoronavirus, was subsequently isolated as the causative agent. SARS-CoV-2 is transmitted by respiratory droplets and fomites and presents clinically with fever, fatigue, myalgias, conjunctivitis, anosmia, dysgeusia, sore throat, nasal congestion, cough, dyspnea, nausea, vomiting, and/or diarrhea. In most critical cases, symptoms can escalate into acute respiratory distress syndrome accompanied by a runaway inflammatory cytokine response and multiorgan failure. As of this article's publication date, COVID-19 has spread to approximately 200 countries and territories, with over 4.3 million infections and more than 290,000 deaths as it has escalated into a global pandemic. Public health concerns mount as the situation evolves with an increasing number of infection hotspots around the globe. New information about the virus is emerging just as rapidly. This has led to the prompt development of clinical patient risk stratification tools to aid in determining the need for testing, isolation, monitoring, ventilator support, and disposition. COVID-19 spread is rapid, including imported cases in travelers, cases among close contacts of known infected individuals, and community-acquired cases without a readily identifiable source of infection. Critical shortages of personal protective equipment and ventilators are compounding the stress on overburdened healthcare systems. The continued challenges of social distancing, containment, isolation, and surge capacity in already stressed hospitals, clinics, and emergency departments have led to a swell in technologically-assisted care delivery strategies, such as telemedicine and web-based triage. As the race to develop an effective vaccine intensifies, several clinical trials of antivirals and immune modulators are underway, though no reliable COVID-19-specific therapeutics (inclusive of some potentially effective single and multi-drug regimens) have been identified as of yet. With many nations and regions declaring a state of emergency, unprecedented quarantine, social distancing, and border closing efforts are underway. Implementation of social and physical isolation measures has caused sudden and profound economic hardship, with marked decreases in global trade and local small business activity alike, and full ramifications likely yet to be felt. Current state-of-science, mitigation strategies, possible therapies, ethical considerations for healthcare workers and policymakers, as well as lessons learned for this evolving global threat and the eventual return to a "new normal" are discussed in this article.

WHAT HAS THE COVID-19 PANDEMIC TAUGHT US ABOUT ADOPTING PREVENTIVE MEASURES?

ABSTRACT Objective: to analyze the COVID-19 pandemic and what we have (re)learned from the world experience of adopting prevention measures recommended by the World Health Organization as well as the epidemiological overview in the world, in Latin America and in Brazil. Results: the World Health Organization has pointed out that the path to reduce the speed of circulation of the virus, control and decrease in the number of cases and deaths resulting from this pandemic can only be accomplished with mass adoption of fundamental measures that include hand hygiene, alcohol gel use, cough etiquette, cleaning surfaces, avoiding agglomerations and social distancing. The epidemiological curve of the disease clearly shows the devastating proportions in Italy, Spain and the United States, surpassing China in death records, due to the delay in adopting the aforementioned measures. In Brazil, the rapid progression in relation to the world and Latin America points to an important increase in the number of cases. Conclusion: this is possibly the most serious pandemic in recent human history, and its course can be influenced by the rigor in adopting individual and collective behavioral measures.