Burden of Middle East respiratory syndrome coronavirus infection in Saudi Arabia

One Pandemic, Two Solutions: Comparing the U.S.-China Response and Health Priorities to COVID-19 from the Perspective of "Two Types of Control"

After three years of global rampage, the COVID-19 epidemic, the most serious infectious disease to occur worldwide since the 1918 influenza pandemic, is nearing its end. From the global experience, medical control and social control are the two main dimensions in the prevention and control of COVID-19. From the perspective of "two types of control", namely medical control and social control, this paper finds that the political system, economic structure, and cultural values of the United States greatly limit the government's ability to impose social control, forcing it to adopt medical control to fight the virus in a single dimension. In contrast, China's political system, economic structure, and cultural values allow its government to adopt stringent, extensive, and frequent social control, as well as medical control to fight the virus. This approach departs from the traditional pathway of fighting the epidemic, i.e., "infection-treatment-immunization", thereby outpacing the evolution of the virus and controlling its spread more rapidly. This finding helps explain why the Chinese government adopted a strict "zeroing" and "dynamic zeroing" policy during the first three years, at the cost of enormous economic, social, and even political legitimacy. It was not until late 2022, when the Omicron variant with the waning virulence became prevalent, that China chose to "coexist" with the virus, thus avoiding a massive epidemic-related death. While the United States adopted a pulsed-style strategy at the beginning of the epidemic, i.e., "relaxation-suppression-relaxation-suppression", and began to "coexist" with the virus in just one year, resulting in a large number of excess deaths associated with the epidemic. The study contributes to explaining the difference in the interplay between public health priorities and COVID-19 response strategies in China and the United States, based on the specific public health context and the perspective of "medical control" and "social control".

Identification of new cases of tuberculosis during the COVID-19 pandemic using model strategic management

Introduction: Tuberculosis (TB) is a world health problem that causes the third-largest death after cardiovascular and respiratory diseases. One of the causes of transmission of environmental factors is controlling the mobilization of individuals suffering from tuberculosis. This research aims to develop a strategic model of finding new TB cases based on region. Method: This descriptive research utilizes primary and secondary data. Variables consist of geographical and demographic characteristics, resources, tuberculosis prevalence, and indicators of tuberculosis response processes. The TB management planning model document is based on the experiences of health centers Perak Timur, Wonokromo, and Siwalankerto in maximizing TB case detection. Results: The management model outlines policies and procedures based on the variables. For example, the detection of new TB patients became a priority at the health center in Perak Timur. In contrast, the health center in Wonokromo focused on developing cadres and private practice physicians. Conclusions: This research provides an overview of the aspects that need attention and improvement by discovering different new cases in each region.  

Tracing the origin of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): A systematic review and narrative synthesis

The aim of the study was to trace and understand the origin of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through various available literatures and accessible databases. Although the world enters the third year of the coronavirus disease 2019 pandemic, health and socioeconomic impacts continue to mount, the origin and mechanisms of spill-over of the SARS-CoV-2 into humans remain elusive. Therefore, a systematic review of the literature was performed that showcased the integrated information obtained through manual searches, digital databases (PubMed, CINAHL, and MEDLINE) searches, and searches from legitimate publications (1966-2022), followed by meta-analysis. Our systematic analysis data proposed three postulated hypotheses concerning the origin of the SARS-CoV-2, which include zoonotic origin (Z), laboratory origin (L), and obscure origin (O). Despite the fact that the zoonotic origin for SARS-CoV-2 has not been conclusively identified to date, our data suggest a zoonotic origin, in contrast to some alternative concepts, including the probability of a laboratory incident or leak. Our data exhibit that zoonotic origin (Z) has higher evidence-based support as compared to laboratory origin (L). Importantly, based on all the studies included, we generated the forest plot with 95% confidence intervals (CIs) of the risk ratio estimates. Our meta-analysis further supports the zoonotic origin of SARS/SARS-CoV-2 in the included studies.

Clinical Characteristics among Patients with COVID-19: A Single-Center Experience from Medina, Saudi Arabia

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). To assess the effect of COVID-19 disease on hematology, coagulation profiles, renal and liver function over the course of the disease, the following laboratory tests were performed: WBCs per mm3, lymphocytes count, Platelet, D-dimmer, AST, Albumin, LDH, Ferritin, CRP, blood culture and viral loads. Patients were grouped according to their initial viral load (Group1: low viral load (L), Group 2: moderate viral load (I), and Group 3, high viral load (H)). The study population median age of the patients was 58 years, and 69% were male. Generally, all patients were admitted to the intensive care unit. Most of the patients (79.5%) had an intermediate viral load, 14.5% had a high viral load, and 5.7% had a low viral load. The Kusakal-Walli’s test revealed a significant difference in the levels of white blood cells, lymphocytes, platelet, D-dimer, AST, CRP, and ferritin (p <0.0001). One hundred twenty-two isolates were recovered from 5362 blood cultures; where as 75% were multiple resistant to three classes of antibiotics and more. True bacteremia was most commonly caused by Klebsiella pneumoniae (45%), Acinetobacter baumannii (30%), and C. albicans (7%). The potential risk factors of advanced age, lymphopenia, D-dimer concentrations greater than 2µg/mL, and ferritin concentrations greater than 400ng/mL may assist clinicians to improve the management of the case and reduce mortality.

The Impact of Estrogens and Their Receptors on Immunity and Inflammation during Infection

Simple Summary

Human health is significantly affected by microbial infections. One of the largest determinants of the outcomes of such infections is the host immune response. Too weak of a response can lead to enhanced spread by the pathogen, while an overstimulated response can lead to immune-induced tissue damage. Thus, to effectively treat infected individuals, it is critical to understand the regulators that control inflammatory responses. Recently, it has become widely accepted that estrogens, a class of sex hormones, are capable of dramatically altering the responses of host cells to microbes. In this review, we discuss how estrogens change the host immune response, as well as how these changes can alter the outcome of the infection for the individual.

Abstract

Sex hormones, such as estrogen and testosterone, are steroid compounds with well-characterized effects on the coordination and development of vertebrate reproductive systems. Since their discovery, however, it has become clear that these “sex hormones” also regulate/influence a broad range of biological functions. In this review, we will summarize some current findings on how estrogens interact with and regulate inflammation and immunity. Specifically, we will focus on describing the mechanisms by which estrogens alter immune pathway activation, the impact of these changes during infection and the development of long-term immunity, and how different types of estrogens and their respective concentrations mediate these outcomes.

An overview of the preclinical discovery and development of remdesivir for the treatment of coronavirus disease 2019 (COVID-19)

INTRODUCTION

Remdesivir (RDV) is an inhibitor of the viral RNA-dependent RNA polymerases that are active in some RNA viruses, including the Ebola virus and zoonotic coronaviruses. When severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) was identified as the etiologic agent of the coronavirus disease 2019 (COVID-19), several investigations have assessed the potential activity of RDV in inhibiting viral replication, giving rise to hope for an effective treatment.

AREAS COVERED

In this review, the authors describe the main investigations leading to the discovery of RDV and its subsequent development as an antiviral agent, focusing on the main clinical trials investigating its efficacy in terms of symptom resolution and mortality reduction.

EXPERT OPINION

RDV is the most widely investigated antiviral drug for the treatment of COVID-19. This attention on RDV activity against SARS-CoV-2 is justified by promising in vitro studies, which demonstrated that RDV was able to suppress viral replication without significant toxicity. Such activity was confirmed by an investigation in an animal model and by the results of preliminary clinical investigations. Nevertheless, the efficacy of RDV in reducing mortality has not been clearly demonstrated.

COVID-19 Pandemic: Public Health Risk Assessment and Risk Mitigation Strategies

A newly emerged respiratory viral disease called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is also known as pandemic coronavirus disease (COVID-19). This pandemic has resulted an unprecedented global health crisis and devastating impact on several sectors of human lives and economies. Fortunately, the average case fatality ratio for SARS-CoV-2 is below 2%, much lower than that estimated for MERS (34%) and SARS (11%). However, COVID-19 has a much higher transmissibility rate, as evident from the constant increase in the count of infections worldwide. This article explores the reasons behind how COVID-19 was able to cause a global pandemic crisis. The current outbreak scenario and causes of rapid global spread are examined using recent developments in the literature, epidemiological features relevant to public health awareness, and critical perspective of risk assessment and mitigation strategies. Effective pandemic risk mitigation measures have been established and amended against COVID-19 diseases, but there is still much scope for upgrading execution and coordination among authorities in terms of organizational leadership's commitment and diverse range of safety measures, including administrative control measures, engineering control measures, and personal protective equipment (PPE). The significance of containment interventions against the COVID-19 pandemic is now well established; however, there is a need for its effective execution across the globe, and for the improvement of the performance of risk mitigation practices and suppression of future pandemic crises.

The psychological and emotional impact of coronavirus disease on COVID-19 patients in Najran Province, Saudi Arabia: An exploratory study

BACKGROUND

The COVID-19 pandemic contributes to a significant mental health crisis. This pandemic caused a widening economic crisis, growing financial loss, and numerous uncertainties. This pandemic brought alarming implications and overall increased risk for psychiatric illness. This study explores the psychological impact experienced by patients who tested positive from coronavirus disease in the Najran region, Saudi Arabia.

DESIGN AND METHODS

This exploratory analysis included 210 COVID-19 positive patients. The study was conducted during a six month period starting from March to September 2020, in two tertiary government hospitals in Najran, Saudi Arabia. Samples were selected using purposive sampling. The researches utilized survey questionnaire and face-to-face interview to collect the data. The statistical data were calculated using IBM Statistical Package for Social Sciences version 2.0 to compute the following statistical formulas: percentage distribution, mean, standard deviation, and Chi-square test of independence.

RESULTS

The findings of this study revealed that the majority of COVID-19 positive patients were middle-aged adults (n=98 or 46.7%), male (n=178 or 84.8%), and were non-Saudi nationals (n=132 or 62.9%). It was found out that COVID-19 patients experienced bothersome behaviour at a very high level (x̅=2.63 ± 0.6734). Meanwhile, depression (x̅=2.51 ± 0.7070), worry (x̅=2.23 ± 0.8811), and anxiety (x̅=2.21 ± 0.8719) was only at a high level.

CONCLUSIONS

The study findings revealed that the majority of participants had high levels of depression, anxiety and bothersome behaviours. However, demographic characteristics like age, sex, and nationality were not significantly related to coronavirus patients' psychological health problems during the pandemic. Assessment and interventions for psychosocial concerns, integration of mental health considerations, consultation with specialists, and treatment for severe psychosocial consequences must be administered in COVID-19 care facilities.

Risk factors on admission associated with hospital length of stay in patients with COVID-19: a retrospective cohort study

Treating patients with COVID-19 is expensive, thus it is essential to identify factors on admission associated with hospital length of stay (LOS) and provide a risk assessment for clinical treatment. To address this, we conduct a retrospective study, which involved patients with laboratory-confirmed COVID-19 infection in Hefei, China and being discharged between January 20 2020 and March 16 2020. Demographic information, clinical treatment, and laboratory data for the participants were extracted from medical records. A prolonged LOS was defined as equal to or greater than the median length of hospitable stay. The median LOS for the 75 patients was 17 days (IQR 13-22). We used univariable and multivariable logistic regressions to explore the risk factors associated with a prolonged hospital LOS. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated. The median age of the 75 patients was 47 years. Approximately 75% of the patients had mild or general disease. The univariate logistic regression model showed that female sex and having a fever on admission were significantly associated with longer duration of hospitalization. The multivariate logistic regression model enhances these associations. Odds of a prolonged LOS were associated with male sex (aOR 0.19, 95% CI 0.05-0.63, p = 0.01), having fever on admission (aOR 8.27, 95% CI 1.47-72.16, p = 0.028) and pre-existing chronic kidney or liver disease (aOR 13.73 95% CI 1.95-145.4, p = 0.015) as well as each 1-unit increase in creatinine level (aOR 0.94, 95% CI 0.9-0.98, p = 0.007). We also found that a prolonged LOS was associated with increased creatinine levels in patients with chronic kidney or liver disease (p < 0.001). In conclusion, female sex, fever, chronic kidney or liver disease before admission and increasing creatinine levels were associated with prolonged LOS in patients with COVID-19.

Association of Viral Load in SARS-CoV-2 Patients With Age and Gender

Background: The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a global public health emergency. Age and sex are two important factors associated with risks and outcomes of various diseases. COVID-19 morbidity also seems to be affected by patient age and sex. It has been found that older age groups have more severe COVID-19 symptoms and higher fatality rates while children tend to have lower prevalence and milder symptoms than adults.

Methods: The study reviewed electronic medical records of COVID-19 patients from Madinah city, Saudi Arabia. The study included all cases who tested positive (n = 3,006) between March 20 and May 22, 2020. Data were obtained from the Health Electronic Surveillance Network (HESN) database.

Results: Approximately 80% of the study sample were males and half were in the 30–40-year-old age group. The Ct value of the whole sample ranged from 15.08 to 35, with a mean of 27.44 (SD: 5.23; 95% C.I. = 27.25–27.66). The means of Ct values varied between age groups from 27.05 to 27.82. Analysis of the mean differences between age groups using one-way ANOVA indicated no statistically significant difference among the groups (F_6,2999 = 1.63; p-value = 0.135). A comparison of mean Ct values of males (n = 2,422) and females (n = 584) revealed that males had a statistically significant higher mean Ct value (27.61 ± 5.20) than females (26.72 ± 5.31). The difference between the means of the two groups was −0.89 (95% C.I. = −1.36 to −0.42; t-test −3.71; df = 3,004; p-value < 0.001).

Conclusion: The study found no statistically significant difference in viral loads between age groups. It showed that females had a higher SARS-CoV-2 viral load compared to males. The findings have implications for preventive strategies. Further studies are needed to correlate viral load with clinical symptoms and outcomes.

The seroprevalence of SARS-CoV-2 IgG antibodies among asymptomatic blood donors in Saudi Arabia

Background

In late 2019, cases of severe pneumonia with unidentified etiology began to emerge in Wuhan, China, before progressively spreading first nationally and then globally.The current study sought to investigate the seroprevalence of immunoglobulin G (IgG) antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among blood donors in Al-Madinah, Saudi Arabia. To our knowledge, this is the first study in Saudi Arabia to screen blood donors who were not known to be previously infected with SARS-CoV-2.

Methods

This study was a cross-sectional study to assess individuals who donated blood to the central blood bank in Al-Madinah between mid-May and mid-July 2020. An enzyme-linked immunosorbent assay (ELISA) was designed and established to detect antibodies directed against the SARS-CoV-2 spike protein in serum samples. A total of 1,212 healthy blood donors participated in this study. The donors were males and met the requirements for blood donation during the COVID-19 pandemic period in Saudi Arabia.

Results

The SARS-CoV-2 seroprevalence among blood donors in Al-Madinah was 19.31% (n = 234/1212; 95% confidence interval: 17.12%-21.64%). No statistically significant difference was identified in seropositivity according to age. However, significant differences (p < 0.001) were identified according to ABO blood groups, with those with type A blood presenting the highest rate of seropositivity (29.18%) compared with the other blood groups (12.65% for type B, 16.36% for type AB, and 15.11% for type O).

Conclusion

A high prevalence of SARS-CoV-2 antibodies was detected among blood donors in Al-Madinah, which indicated a high level of exposure to the virus within the population. This further suggested that as high as one-fifth of the population may have acquired innate immunity against the virus.

Modeling the Political Economy and Multidimensional Factors of COVID-19 Cases in Nigeria

Both the clinical and epidemiological significance attached to COVID-19 cases by a small, but growing literature on coronavirus are not in any way undermined by the relevance of political economy and multidimensional impacts of other factors on the virus, particularly from country specific stance. In light of the stark reality, this study unravels the political economy and multidimensional factors of COVID-19 cases in Nigeria using the daily data spanning 27th of February through 26th of May, 2020. This paper deploys a variety of count data estimators to estimate the effects of political economy and ethno-religious factors on COVID-19 cases in Nigeria. The parameter estimates reveal that the odds of the Hausa ethnic group in human-to-human transmission of the virus, to be in the "Certain Zero" group is relatively less as compared to other ethnic groups in the country. A plausible reason, particularly for the vulnerable group can be attributed, in part, to their low levels of educational attainment as well as their staunch religious belief with respect to the act of soul taking as being the exclusive property of the creator than the created. Thus, addressing ethno-religious concerns together with socioeconomic factors remain the formidable mitigation policy choices to combating the scourge of the global virus of COVID-19.

Estimating the impacts of lockdown on Covid-19 cases in Nigeria

The study examines the extent to which lockdown measures impact on COVID-19 confirmed cases in Nigeria. Six indicators of lockdown entailing retail and recreation, grocery and pharmacy, parks, transit stations, workplaces, and residential, are considered. The empirical evidence is anchored on the negative binomial regression estimator, due to the count nature of the dataset on the daily cases of the virus. The study established the key following findings: First, retail and recreation, grocery and pharmacy, parks, transit stations, and workplaces are statistically significant and negatively signed as relevant predictors of the virus. Second, the impact of residential is positive and statistically significant at the conventional level. Lastly, the results are robust to an alternative estimator of Poisson Regression. The emanated policy message centres on the need to direct efforts toward ensuring total compliance to the lockdown rules as it holds the key to keeping the virus under check.