Critical review of social, environmental and health risk factors in the Mexican indigenous population and their capacity to respond to the COVID-19

Impact of Coronavirus Disease (COVID)-19 on the Indigenous Population of Brazil: A Systematic Review

BACKGROUND

Indigenous peoples in Brazil were severely impacted by coronavirus disease (COVID)-19 pandemic, experiencing high rates of infection and mortality. Geographic isolation, limited access to healthcare, socio-economic disparities, and cultural factors, such as communal living and mistrust of state-led initiatives, heightened their vulnerability. Territorial invasions and oxygen shortages further exacerbated the crisis. Therefore, this systematic review aimed to explore the progression of COVID-19 in this population.

METHODS

A systematic review was conducted in PubMed-MEDLINE, SciELO (Scientific Electronic Library Online), and LILACS (Latin America and the Caribbean Health Sciences Literature) from the beginning of the pandemic in Brazil (2020) to March 2025. Studies addressing COVID-19 vaccination and epidemiological, social, and economic aspects among Indigenous populations in Brazil were included. Reviews and irrelevant studies were excluded. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 50 relevant studies were included, grouped into thematic blocks: mortality/infection, symptoms, vaccination/testing, social impacts, and birth outcomes. Several studies highlighted that being male, of Indigenous or other racial minority background, and having comorbidities increased mortality risk. In contrast, asthma was associated with reduced mortality. Pregnant Indigenous women in rural areas had 33 times higher odds of dying than their urban counterparts. Furthermore, there is a higher likelihood of very low birth weight and inadequate prenatal care among Indigenous mothers. Vaccination reduced the risk of death, particularly after full immunization, though it did not prevent hospitalization. A cohort study of 389,753 Indigenous people showed a lower full vaccination rate (48.7%) compared to the general population (74.8%). Complete vaccination reduced the risk of death by 96% among hospitalized patients. Regarding seroprevalence, Indigenous people had a 5.4% positivity rate, much higher than other racial groups, and were 4.71 times more likely to test positive than White, Black, or Mixed Individuals. Socioeconomic disparities also correlated with increased infection risk.

CONCLUSIONS

The COVID-19 pandemic worsened health disparities among Indigenous peoples in Brazil, revealing systemic inequalities, weak public policies, and limited healthcare access. This review urges culturally sensitive, community-led responses and highlights the need for disaggregated data and equitable, inclusive health strategies.

Evaluating COVID-19 impact, vaccination, birth registration, and underreporting in a predominantly indigenous population in Chiapas, Mexico

BACKGROUND

 Indigenous populations globally face significant health disparities compared to non-Indigenous groups, primarily due to marginalization and limited access to healthcare. In Mexico, which is home to the largest Indigenous population in the Americas, these disparities were further exacerbated by the COVID-19 pandemic, with impacts intensified by factors such as marginalization, discrimination, and inadequate access to essential services.

METHODS

This study aimed to investigate the COVID-19 pandemic's impact on mortality, vaccination access and uptake, and official birth registration among a predominantly Indigenous population in San Juan Chamula, Chiapas. We conducted an online survey among high school students at the Colegio de Bachilleres del Estado de Chiapas, supplemented with epidemiological and socio-demographic data (N = 107).

RESULTS

The survey revealed that 14% of respondents reported being infected with COVID-19, while national dashboard data indicated only 212 confirmed cases and one death in Chamula between April 2021 and June 2023. Additionally, 79.4% of respondents were unvaccinated, with significant communication barriers and a lack of information in Indigenous languages contributing to low vaccination rates. Additionally, 5.6% of surveyed family members and 4.7% of community residents lacked official birth certificates, significantly impeding their ability to access essential services such as education, healthcare, and vaccinations.

CONCLUSION

Our findings highlight significant underreporting of COVID-19 cases and deaths in Indigenous communities, likely due to inadequate diagnostic resources and medical evaluation. The study underscores the urgent need for tailored public health strategies that integrate local Indigenous languages, cultures, and knowledge systems supported by trusted Indigenous leaders. Investing in education in Indigenous languages is crucial for improving vaccination adherence and overall public health outcomes. These strategies can inform national preparedness and response plans to address the unique challenges faced by Indigenous populations during pandemics and other public health crises.

Massive open online course on breastfeeding during the COVID-19 pandemic in Mexico

BACKGROUND

COVID-19 virus was reported to be transmitted through breastfeeding (BF), creating the need for rapidly available, standardized information and training for health personnel and the community about BF as an urgent action to reduce misinformation and unethical promotion of breast milk substitutes (BMS). In Mexico, a massive open online course (MOOC) was designed and implemented to protect, promote and support BF in emergency contexts.

METHODS

MOOC registration consisted of collection of quantitative data regarding participant characteristics, MOOC coverage, scores achieved and completion rates. A multiple linear regression analysis was performed to relate the absolute and relative skills earned in the MOOC to participant characteristics. In addition, factors associated with completion rate and dissemination of information from the MOOC were analyzed using multiple logistic regression and presented as odds ratios.

RESULTS

During a period of 19 months, 52,426 participants across the country, including health personnel and general population, entered the Cursos en Linea del Instituto Mexicano del Seguro Social (CLIMSS) platform, of which 50.5% completed the MOOC. The level of participation was maintained from January 2021 to early 2022 when the perception of the risk of getting sick from COVID-19 and quarantining decreased. In adjusted analysis, completion rate was associated with being older or belonging to a health institution; furthermore, residing in the north of the country doubled the odds of completing the MOOC (odds ratio 2.24; 95% confidence interval 1.95-2.56).

CONCLUSIONS

A MOOC can be a useful training strategy to disseminate information, especially in emergencies where physical distancing is important and reaching the largest possible population is required.

Social inequalities in COVID-19 lethality among Indigenous peoples in Mexico

This study aimed to estimate the COVID-19 lethality in the Mexican Indigenous population from 2020 to 2022, considering clinical characteristics and social conditions. Data were retrieved from the Epidemiological Surveillance System of Respiratory Diseases, identifying the COVID-19-positive cases among the Indigenous population. Lethality was evaluated per clinical conditions and vulnerability due to social deprivation. The number of COVID-19-positive cases in the Indigenous population represented 0.7% of the total number of cases. The case fatality rate in the Indigenous population was 9.8% against 4.6% in the non-Indigenous population. Lethality was higher in men. However, the association with diabetes, hypertension, chronic kidney disease, obesity, and smoking was lower in the Indigenous population than in the non-Indigenous population. A greater vulnerability to social conditions was identified among the Indigenous population than the non-Indigenous population, mainly regarding income, education, and access to health services.

Government and community strategies in Pernambuco, Brazil, to face COVID-19

This case study analyzed arrangements and strategies of the network actors in the Special Indigenous Sanitary District (DSEI) Pernambuco's territory to guarantee the right to health of Indigenous populations during the COVID-19 pandemic. This work was carried out through document analysis, workshops, and field research. The Contingency Plan for COVID-19 in Indigenous Peoples of DSEI Pernambuco included surveillance actions, laboratory and pharmaceutical assistance, communication, and management. With the modeling of this document, it was noticed that actions aimed at local specificities were not integrated: in its initial design, at the national level, the voice of Indigenous leaders was not heard when formulating this plan. By contrast, the actions of these leaders and their mobilization to mitigate the effects of the pandemic on the Indigenous population stands out. Contextual factors were cited as facilitators and obstacles to the plan's implementation; the local sociotechnical network mapping also made it possible to identify strategic actors and actants in the face of the COVID-19 pandemic and verify their performance or ineffectiveness. The findings of this study reflect recurrent problems in the organization of the Indigenous health system.

COVID-19 vaccine uptake and barriers among Indigenous language speakers in Mexico: Results from a nationally representative survey

Mexico faced a significant burden from the COVID-19 pandemic. Since the pandemic's onset in 2020, numerous studies have underscored the substantial risk of COVID-19 death among Indigenous individuals. This study aims to assess COVID-19 vaccine uptake among Indigenous language speakers in Mexico, focusing on understanding the barriers they face in obtaining access to vaccines. We used Encuesta Nacional de Salud y Nutrición Continua (ENSANUT) 2022, a nationally representative health survey in Mexico to analyze data on self-reported COVID-19 vaccine status, reasons for not getting vaccinated, and other relevant covariates. We employed logistic regression to estimate odds ratios (ORs) for vaccine uptake and uptake barriers, all models were adjusted for potential confounders. Among 34,051 participants, 1793 individuals (5.23%) reported speaking an Indigenous language. Indigenous language speakers were found to have a lower vaccination rate (63%) compared to non-Indigenous language speakers (81%) (p <0.005). They were also 59% less likely to be vaccinated against COVID-19 (OR 0.41, 95% CI 0.27-0.62), even when adjusted for confounders. Among unvaccinated individuals, Indigenous language speakers were more likely to cite negative beliefs about the vaccine or fear as reasons for not being vaccinated (OR 1.82, 95% CI 1.11-3.00) while being less likely to report access barriers (OR 0.62, CI 95% 0.42-0.91). This study highlights disparities in COVID-19 vaccine uptake among Indigenous language speakers in Mexico. The findings underscore the urgent need for targeted, culturally appropriate public health interventions and the consideration of social and ethnic vulnerability in prioritizing vaccinations.

Vaccination against COVID-19 and socioeconomic inequalities: A cross-sectional study in Ecuador

Background

Equity in vaccination against COVID-19 is a public health concern. The objective of this study was to analyze socioeconomic inequalities related to vaccination for the first and second doses from primary series against COVID-19 in Ecuador.

Methods

Secondary database study in 12,743,507 respondents from 15 years and over. The COVID-19 section of the National Survey of Employment, Unemployment and Underemployment (ENEMDU) was analyzed. Socioeconomic characteristics and vaccination against COVID-19 were associated with the at least one dose and second dose. Poisson regressions for complex samples were obtained.

Results

As of the date of the survey, 87.3% of the sample (95% CI 86.7%-87.8%) had received at least one vaccine against COVID-19. A lower probability of having received at least one vaccine against COVID-19 was found in rural areas (PR 0.82, 95% CI 0.74-0.91), indigenous population (PR 0.43, 95% CI 0.29-0.64), no level of education (PR 0.25, 95% CI 0.14-0.43), and the lowest economic income (PR 0.42, 95% CI 0.35-0.52). A significantly lower probability of vaccination with two or more doses was found in rural vs urban area (PR 0.88, 95% CI 0.80-0.96), women vs men (PR 0.85, 95% CI 0.77-0.91), indigenous population vs white (PR 0.44, 95% CI 0.33-0.59) and individuals in the lowest income quartile vs highest income quartile (PR 0.48, 95% CI 0.42-0.55). Underemployment, population economically inactive (PR 0.77, 95% CI 0.67-0.88 and PR 0.71, 95% CI 0.61-0.83) and individuals with no level of education (PR 0.39, 95% CI 0.27-0.58) also were less likely to complete the primary phase of vaccination compared with individuals in the highest income quartile, employment and postgraduate level of education.

Conclusions

There were socioeconomic inequalities with the primary series of vaccine against COVID-19, with a greater disadvantage for rural residents, women, indigenous populations, lower economic income and lower levels of education.

Genomic characterization of SARS-CoV-2 from an indigenous reserve in Mato Grosso do Sul, Brazil

Background

The COVID-19 pandemic had a major impact on indigenous populations. Understanding the viral dynamics within this population is essential to create targeted protection measures.

Methods

A total of 204 SARS-CoV-2 positive samples collected between May 2020 and November 2021 from an indigenous area in Mato Grosso do Sul (MS), Midwestern Brazil, were screened. Samples were submitted to whole genome sequencing using the Nanopore sequencing platform. Clinical, demographic, and phylogenetic data were analyzed.

Results

We found the co-circulation of six main SARS-CoV-2 lineages in the indigenous population, with the Zeta lineage being the most prevalent (27.66%), followed by B.1.1 (an ancestral strain) (20.21%), Gamma (14.36%) and Delta (13.83%). Other lineages represent 45.74% of the total. Our phylogenetic reconstruction indicates that multiple introduction events of different SARS-CoV-2 lineages occurred in the indigenous villages in MS. The estimated indigenous population mortality rate was 1.47%. Regarding the ethnicity of our cohort, 64.82% belong to the Guarani ethnicity, while 33.16% belong to the Terena ethnicity, with a slightly higher prevalence of males (53.43%) among females. Other ethnicities represent 2.01%. We also observed that almost all patients (89.55%) presented signs and symptoms related to COVID-19, being the most prevalent cough, fever, sore throat, and headache.

Discussion

Our results revealed that multiple independent SARS-CoV-2 introduction events had occurred through time, probably due to indigenous mobility, since the villages studied here are close to urban areas in MS. The mortality rate was slightly below of the estimation for the state in the period studied, which we believe could be related to the small number of samples evaluated, the underreporting of cases and deaths among this population, and the inconsistency of secondary data available for this study.

Conclusion

In this study, we showed the circulation of multiple SARS-CoV-2 variants in this population, which should be isolated and protected as they belong to the most fragile group due to their socioeconomic and cultural disparities. We reinforce the need for constant genomic surveillance to monitor and prevent the spread of new emerging viruses and to better understand the viral dynamics in these populations, making it possible to direct specific actions.

Indigenous communities and influenza: protocol for a systematic review and meta-analysis

BACKGROUND

Several studies have documented that specific Indigenous groups have been disproportionately affected by previous pandemics. The objective of this paper is to describe the protocol to be used in a review and meta-analysis of the literature on Indigenous groups and influenza. Using this protocol as a guide, a future study will provide a comprehensive historical overview of pre-COVID impact of influenza on Indigenous groups by combining data from the last five influenza pandemics and seasonal influenza up to date.

METHODS/PRINCIPLE FINDINGS

The review will include peer-reviewed original studies published in English, Spanish, Portuguese, Swedish, Danish, and Norwegian. Records will be identified through systematic literature search in eight databases: Embase, MEDLINE, CINAHL, Web of Science, Academic Search Ultimate, SocINDEX, ASSIA, and Google Scholar. Results will be summarized narratively and using meta-analytic strategies.

DISCUSSION

To our knowledge, there is no systematic review combining historical data on the impact of both seasonal and pandemic influenza on Indigenous populations. By summarizing results within and across Indigenous groups, different countries, and historical periods, as well as research in six different languages, we aim to provide information on how strong the risk for influenza is among Indigenous groups and how consistent this risk is across groups, regions, time, and seasonal versus the specific pandemic influenza strains.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021246391.

COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation

Background

Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico.

Methods

We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation.

Results

Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous.

Conclusions

Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.

I belong, therefore I am: The role of economic culture in compliance with COVID-19 preventive measures

Cultural orientations in relation to individualism and collectivism produced by subsistence strategies can lead to a wide array of consequences for perception, cognition, and emotion. We predict that, as a result of different economic patterns, farmers with greater collectivism would show more compliance with COVID-19 precautionary behavior than herders with greater individualism. By adopting a "just minimal difference" approach, we compared Chinese farming and herding communities that share a national identity, ethnicity, and residential area but vary in their degree of individualism-collectivism. Consistent with our hypothesis, Study 1 found that farmers reported higher compliance with prevention initiatives than herders in self-report survey. Study 2 provided a behavioral choice confirmation of the observed relationship. The present research provides the empirical evidence that economic activities can have divergent effects on mitigation strategies in the COVID-19 fight, and these results have meaningful implications for socioecological psychology theory and for pandemic prevention and control.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon request.

Effects of housing layout and perceived behavioral control over social distancing in relation between social isolation and psychological distress during pandemic of COVID-19

Due to the results of the COVID-19 epidemic on health, the positive effect of social distancing has been highlighted. Nevertheless, the effect of housing layouts on resident's perceived behavioral control over social distancing in shared open spaces have been rarely investigated in the context of pandemic. Filling this gap, the current study examines the moderating effect of perceived behavioral control on the relationship between social isolation and psychological distress. Data from 1349 women residing in 9 gated communities during the Iranian national lockdown were collected. The results of ANOVA indicate that there is a significant difference between various housing layouts in terms of residents' perceived behavioral control. Respondent in courtyard blocks layout reported higher perceived behavioral control over social distancing than in linear and freestanding blocks. The findings of structural equation modeling identified perceived behavioral control as a buffer against the effect of social isolation on psychological distress.

World Health Organization myth busters and indigenous perceptions of COVID-19: Quechua and Shipibo communities

When the COVID (SARS-V2) pandemic swept across the world, it impacted Indigenous communities more than others. This is due to a variety of reasons: socioeconomic injustice and racialization, lack of access to equitable healthcare, and linguistic discrimination. As a result, several communities and community types demonstrated this effect when perceptions of inferences or other COVID-related information were measured. This paper reports on a participatory collaborative study with two Indigenous communities in rural Peru-ten Quechua-speaking communities in Southern Cuzco and three Shipibo-speaking communities in Ucayali regions. We investigate the communities' level of preparedness for the crisis by eliciting answers based on the World Health Organization COVID 'MythBusters' in a form of a semi-structured interview. Interviews were transcribed, translated, and analyzed in search of the effect of three variables: gender (male/female), language group (Shipibo/Quechua), and proficiency in the Indigenous language (from 0 to 4). Data reveal that all three variables have some effect on the target comprehension of COVID-related messages. Additionally, we explore other possible explanations.

Indigenous peoples and the COVID-19 pandemic: a systematic scoping review

Past influenza pandemics including the Spanish flu and H1N1 have disproportionately affected Indigenous Peoples. We conducted a systematic scoping review to provide an overview of the state of understanding of the experience of Indigenous peoples during the first 18 months of the COVID-19 pandemic, in doing so we capture the state of knowledge available to governments and decision makers for addressing the needs of Indigenous peoples in these early months of the pandemic. We addressed three questions: (a) How is COVID-19 impacting the health and livelihoods of Indigenous peoples, (b) What system level challenges are Indigenous peoples experiencing, (c) How are Indigenous peoples responding? We searched Web of Science, Scopus, and PubMed databases and UN organization websites for publications about Indigenous peoples and COVID-19. Results were analyzed using descriptive statistics and content analysis. A total of 153 publications were included: 140 peer-reviewed articles and 13 from UN organizations. Editorial/commentaries were the most (43%) frequent type of publication. Analysis identified Indigenous peoples from 19 different countries, although 56% of publications were centered upon those in Brazil, United States, and Canada. The majority (90%) of articles focused upon the general adult population, few (<2%) used a gender lens. A small number of articles documented COVID-19 testing (0.04%), incidence (18%), or mortality (16%). Five themes of system level challenges affecting exposure and livelihoods evolved: ecological, poverty, communication, education and health care services. Responses were formal and informal strategies from governments, Indigenous organizations and communities. A lack of ethnically disaggregated health data and a gender lens are constraining our knowledge, which is clustered around a limited number of Indigenous peoples in mostly high-income countries. Many Indigenous peoples have autonomously implemented their own coping strategies while government responses have been largely reactive and inadequate. To 'build back better' we must address these knowledge gaps.

High SARS-CoV-2 infection rates and viral loads in community-dwelling individuals from rural indigenous and mestizo communities from the Andes during the first wave of the COVID-19 pandemic in Ecuador

Background

Neglected indigenous groups and underserved rural populations in Latin America are highly vulnerable to COVID-19 due to poor health infrastructure and limited access to SARS-CoV-2 diagnosis. The Andean region in Ecuador includes a large number of isolated rural mestizo and indigenous communities living under poverty conditions.

Objective

We herein present a retrospective analysis of the surveillance SARS-CoV-2 testing in community-dwelling populations from four provinces in the Ecuadorian Andes, carried out during the first weeks after the national lockdown was lifted in June 2020.

Results

A total number of 1,021 people were tested for SARS-CoV-2 by RT-qPCR, resulting in an overall high infection rate of 26.2% (268/1,021, 95% CI: 23.6-29%), which was over 50% in several communities. Interestingly, community-dwelling super spreaders with viral loads over 108 copies/mL represented 7.46% (20/268, 95% CI: 4.8-11.1%) of the SARS-CoV-2 infected population.

Conclusion

These results support that COVID-19 community transmission in rural communities from the Andean region was happening at the early stages of the COVID-19 pandemic in Ecuador and point out the weakness of the COVID-19 control program. Community-dwelling individuals in neglected rural and indigenous communities should be considered for a successful control and surveillance program in future pandemics in low- and middle-income countries.

Serum biomarkers for nutritional status as predictors in COVID-19 patients before and after vaccination

The aim of this study was to characterize serum protein biomarkers for nutritional status that may be used as predictors for disease symptomatology in COVID-19 patients before and after vaccination. In pre-vaccine cohorts, proteomics analysis revealed significant differences between groups, with serum proteins alpha-1-acid glycoproteins (AGPs) 1 and 2, C-reactive protein (CRP) and retinol binding protein (RBP) increasing with COVID-19 severity, in contrast with serum albumin, transthyretin (TTR) and serotransferrin (TF) reduction as the symptomatology increased. Immunoassay reproduced and validated proteomics results of serum proteins albumin and RBP. In post-vaccine cohorts, the results showed the same pattern as in pre-vaccine cohorts for serum proteins AGPs, CRP, albumin and TTR. However, TF levels were similar between groups and RBP presented a slight reduction as COVID-19 symptomatology increased. In these cohorts, immunoassay validated proteomics results of serum proteins albumin, TTR and TF. Additionally, immune response to α-Gal in pre-vaccine cohorts varied in predominant immunoglobulin type profile, while post-vaccine groups presented mainly anti-α-Gal protective IgG antibodies. The study identified serum nutritional biomarkers that could potentially predict an accurate prognostic of COVID-19 disease to provide an appropriate nutritional care and guidance in non-vaccinated and vaccinated individuals against SARS-CoV-2. These results highlight the importance of designing personalized nutrition protocols to improve diet along with the application of prebiotics or probiotics for the control of COVID-19 and other infectious diseases.

Governance in mental healthcare policies during the COVID-19 pandemic in Mexico

The COVID-19 pandemic has become the greatest burden of disease worldwide and in Mexico, affecting more vulnerable groups in society, such as people with mental disorders (MD). This research aims to analyze the governance processes in the formulation of healthcare policies for people with MD in the face of the COVID-19 pandemic. An analytical qualitative study, based on semi-structured interviews with key informants in the healthcare system was conducted in 2020. The study followed the theoretical-methodological principles of the Governance Analytical Framework (GAF). The software ATLAS.ti-V.9 was used for inductive thematic analysis, classifying themes and their categories. To ensure the proper interpretation of the data, a process of triangulation among the researchers was carried out. The findings revealed that in Mexico, the federal Secretary of Health issued guidelines for mental healthcare, but there is no defined national policy. Decision-making involved multiple actors, with different strategies and scopes, depending on the type of key-actor and their level of influence. Majority of informants described a problem of implementation in which infection control policies in the psychiatric population were the same as in the general populations which decreased the percentage of access to healthcare during the pandemic, without specific measures to address this vulnerable population. The results suggest that there is a lack of specific policies and measures to address the needs of people with mental disorders during the COVID-19 pandemic in Mexico. It also highlights the importance of considering the role of different actors and their level of influence in the decision-making process.

A year and a half into the pandemic in Mexico: evidence of differences in COVID-19 mortality between Indigenous and non-Indigenous populations continues to accumulate

Among the groups most vulnerable to COVID-19 are Indigenous populations around the world, and in particular, the Mexican Indigenous population. We used public data made available by the General Directorate of Epidemiology of the Mexican Ministry of Health to compare the risk of COVID-19 mortality among the Indigenous and non-Indigenous Mexican population one and a half years into the pandemic. The analytical sample comprises 3,545,952 Mexicans who were diagnosed as infected with severe acute respiratory syndrome coronavirus-2 between March 18, 2020, and September 16, 2021, of which 1.0% (36,195) are Indigenous. Based on parametric survival models, our results show that the risk of death among Indigenous individuals is 52% higher than that of their non-Indigenous counterparts, regardless of age, sex, area of residence, health service, number of chronic diseases, and obesity status. These results suggest that certain structural conditions of the Mexican Indigenous population increase their vulnerability to the pandemic.

Effective medical center finding during COVID-19 pandemic using a spatial DSS centered on ontology engineering

The global spread of the coronavirus has generated one of the most critical circumstances forcing healthcare systems to deal with it everywhere in the world. The complexity of crisis management, particularly in Iran, the unfamiliarity of the disease, and a lack of expertise, provided the foundation for researchers and implementers to propose innovative solutions. One of the most important obstacles in COVID-19 crisis management is the lack of information and the need for immediate and real-time data on the situation and appropriate solutions. Such complex problems fall into the category of semi-structured problems. In this respect, decision support systems use people's mental resources with computer capabilities to improve the quality of decisions. In synergetic situations, for instance, healthcare domains cooperating with spatial solutions, coming to a decision needs logical reasoning and high-level analysis. Therefore, it is necessary to add rich semantics to different classes of involved data, find their relationships, and conceptualize the knowledge domain. For the COVID-19 case in this study, ontologies allow for querying over such established relationships to find related medical solutions based on description logic. Bringing such capabilities to a spatial decision support system (SDSS) can help with better control of the COVID-19 pandemic. Ontology-based SDSS solution has been developed in this study due to the complexity of information related to coronavirus and its geospatial aspect in the city of Tehran. According to the results, ontology can rationalize different classes and properties about the user's clinical information, various medical centers, and users' priority. Then, based on the user's requests in a web-based SDSS, the system focuses on the inference made, advises the users on choosing the most related medical center, and navigates the user on a map. The ontology's capacity for reasoning, overcoming knowledge gaps, and combining geographic and descriptive criteria to choose a medical center all contributed to promising outcomes and the satisfaction of the sample community of evaluators.

Global occurrence of SARS-CoV-2 in environmental aquatic matrices and its implications for sanitation and vulnerabilities in Brazil and developing countries

This paper includes a systematic review of the SARS-CoV-2 occurrence in environmental aquatic matrices and a critical sanitation analysis. We discussed the interconnection of sanitation services (wastewater, water supply, solid waste, and stormwater drainage) functioning as an important network for controlling the spread of SARS-CoV-2 in waters. We collected 98 studies containing data of the SARS-CoV-2 occurrence in aquatic matrices around the world, of which 40% were from developing countries. Alongside a significant number of people infected by the virus, developing countries face socioeconomic deficiencies and insufficient public investment in infrastructure. Therefore, our study focused on highlighting solutions to provide sanitation in developing countries, considering the virus control in waters by disinfection techniques and sanitary measures, including alternatives for the vulnerable communities. The need for multilateral efforts to improve the universal coverage of sanitation services demands urgent attention in a pandemic scenario.

Investigating COVID-19 transmission and mortality differences between indigenous and non-indigenous populations in Mexico

OBJECTIVES

Indigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among indigenous and non-indigenous populations at national and sub-national levels in Mexico.

METHODS

We obtained data from the Ministry of Health, Mexico, on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000 person-weeks, mortality rate ratio (RR) among indigenous vs. non-indigenous groups, and hazard ratio (HR) for COVID-19 deaths across four waves of the pandemic, from February 2020 to March 2022. We also assessed differences in the reproduction number (R_t).

RESULTS

The mortality rate among indigenous populations of Mexico was 68% higher than that of non-indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among indigenous groups (P < 0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the R_t among the two groups was comparable.

CONCLUSION

Indigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks), and COVID-19 vaccination interventions among indigenous and non-indigenous populations in Mexico.

Acceptance and accessibility to the early phase COVID-19 vaccination among the healthcare workers and hill tribe population in Thailand

Coronavirus disease 2019 (COVID-19) is a serious emerging disease and an extreme threat to human life. This study aimed to understand the perceptions of hill tribe people living in the border areas of Thailand-Myanmar and health workers regarding the acceptability and accessibility of the COVID-19 vaccine and health workers’ perceptions of the readiness to implement the vaccination program during the early period of national COVID-19 vaccination. A qualitative method was applied to elicit information from key informants who lived in hill tribe villages and the health professionals who served them. The study was conducted in seven hill tribe villages located along the Thailand-Myanmar borders in Mae Fah Luang District, Chiang Rai Province, Thailand. The participants were hill tribe villagers aged 20 years and over; public health care professionals working in village health centers who had primary roles in implementing disease prevention and control measures; and public health care professionals working in districts and provincial public health offices who had primary roles in policy development and implementation. A total of 63 participants (26 men and 37 women) from seven hill tribe villages provided information. Three acceptance choices regarding receiving the COVID-19 vaccine were found among the hill tribes: definite acceptance, likely acceptance, and no preference. Two factors related to obtaining access to the new COVID-19 vaccine were found: Thai citizenship and the level of literacy related to the vaccine. There was no process or protocol in place for implementing the new vaccine among health professionals working at the district, subdistrict, or community levels, but the national expanded immunization program (EPI) system was clearly demonstrated to extend throughout the health service chain in Thailand. During the early period of national COVID-19 vaccine implantation in Thailand, not all members of the hill tribes accepted the vaccine; participant acceptance depended on several factors, including a participant’s previous experience with vaccination, whether he or she required more information before making a decision, etc. While acceptance of the vaccine depended on the individual’s background, not everyone had an equal opportunity to access the vaccine. The new COVID-19 vaccine should be available at the village level, including in hill tribe villages, to reduce the systemic threat to the country.

Exploring the risk factors of COVID-19 Delta variant in the USA based on Bayesian spatio-temporal analysis

The transmission of coronavirus disease‐2019 (COVID‐19) epidemic is a global emergency, which is worsened by the genetic mutations of SARS‐CoV‐2. However, till date, few statistical studies have researched the COVID‐19 spread patterns in terms of the variant cases. Hence, this paper aims to explore the associated risk factors of Delta variant, the most contagious strain of COVID‐19. The study collected the state‐level COVID‐19 Delta variant cases in the United States during a 12‐week period and included potential environmental, socioeconomic, and public prevention factors as independent variables. Instead of regarding the covariate effects as constant, this paper proposes a flexible Bayesian hierarchical model with spatio‐temporally varying coefficients to account for data heterogeneity. The method enables us to cluster the states into distinctive groups based on the temporal trends of the coefficients and simultaneously identify significant risk factors for each cluster. The findings contribute novel insight into the dynamics of covariate effects on the COVID‐19 Delta variant over space and time, which could help the government develop targeted prevention measures for vulnerable regions based on the selected risk factors.

COVID-19 and risk assessment room for public health in four Colombian crossborder territories

Introduction: Public health risk management in Colombia is led by the Instituto Nacional de Salud. In the face of the COVID-19 emergency, response actions centered on the implementation of risk analysis rooms and the strengthening of surveillance at points of entry into the country. Objective: To analyze the implementation and maintenance phases of the COVID-19 risk analysis rooms in four border departments of Colombia. Materials and methods: We conducted a qualitative study of public health risk analysis rooms for COVID-19. We reviewed the documentation and data generated from March to June, 2020, in the departments of Amazonas, Vichada, Guainía, and Putumayo. We did semi-structured interviews with key actors and analyzed the answers using the NVivo plus version 11 application in three cycles: open coding, identification of emerging categories, and modeling by analyzing the identified strengths and weaknesses. Results: We identified the components of the incident command structure and the relationships between the public health areas. Strengths were evidenced in the integration of the areas: the management of information in real time, the border surveillance and the capabilities of rapid response teams, while weaknesses appeared in planning, community surveillance, and risk communication processes. Conclusions: Risk analysis rooms constitute a joint effort at the national and local levels which has promoted the articulated participation of all actors in the analysis of information and the optimization of an organized response during the COVID-19 pandemic.

An Analysis COVID-19 in Mexico: a Prediction of Severity

BACKGROUND

Coronavirus disease 2019 (COVID-19) causes a mild illness in most cases; forecasting COVID-19-associated mortality and the demand for hospital beds and ventilators are crucial for rationing countries' resources.

OBJECTIVE

To evaluate factors associated with the severity of COVID-19 in Mexico and to develop and validate a score to predict severity in patients with COVID-19 infection in Mexico.

DESIGN

Retrospective cohort.

PARTICIPANTS

We included 1,435,316 patients with COVID-19 included before the first vaccine application in Mexico; 725,289 (50.5%) were men; patient's mean age (standard deviation (SD)) was 43.9 (16.9) years; 21.7% of patients were considered severe COVID-19 because they were hospitalized, died or both.

MAIN MEASURES

We assessed demographic variables, smoking status, pregnancy, and comorbidities. Backward selection of variables was used to derive and validate a model to predict the severity of COVID-19.

KEY RESULTS

We developed a logistic regression model with 14 main variables, splines, and interactions that may predict the probability of COVID-19 severity (area under the curve for the validation cohort = 82.4%).

CONCLUSIONS

We developed a new model able to predict the severity of COVID-19 in Mexican patients. This model could be helpful in epidemiology and medical decisions.

Determinants of internet use by school-age children: The challenges for Mexico during the COVID-19 pandemic

The COVID-19 pandemic has further highlighted the deep digital divide in Mexico and the enormous challenge faced by its education system in continuing to educate the country's students while under confinement. The objective of this article was to examine the determinants of internet access, use and productive uses for school-age children in households of different socioeconomic levels. The Heckman selection model was estimated based on data taken from the Encuesta Nacional sobre Disponibilidad y Uso de Tecnologías de la Información en los Hogares (ENDUTIH or National Survey on the Availability and Use of Information Technologies in the Household) 2018. The results obtained show that the probability of having children internet accessing and usage patterns (homework, courses, and blogs) depends on level of schooling, economic status, digital skills, and place of residence, as well as the presence of electronic devices and infomediaries in the household. These findings suggest the urgent need to redesign current ICT policy with a long-term integrated vision that guarantees access to ICTs and their productive use for students immersed in an ecosystem of educational innovation for the XXI century.

Chemometric analysis of the global pattern of volatile organic compounds in the exhaled breath of patients with COVID-19, post-COVID and healthy subjects. Proof of concept for post-COVID assessment

The objective of this research was to evaluate the application of an electronic nose and chemometric analysis to discriminate volatile organic compounds between patients with COVID-19, post-COVID syndrome and controls in exhaled breath samples. A cross-sectional study was performed on 102 exhaled breath samples, 42 with COVID-19, 30 with the post-COVID syndrome and 30 control subjects. Breath-print analysis was performed by the Cyranose 320 electronic nose with 32 sensors. Group data were evaluated by Principal Component Analysis (PCA), Canonical Discriminant Analysis (CDA), and Support Vector Machine (SVM), and the test's diagnostic power was evaluated through a Receiver Operaring Characteristic curve(ROC curve). The results of the chemometric analysis indicate in the PCA a 97.6% (PC₁ = 95.9%, PC₂ = 1.0%, PC₃ = 0.7%) of explanation of the variability between the groups by means of 3 PCs, the CDA presents a 100% of correct classification of the study groups, SVM a 99.4% of correct classification, finally the PLS-DA indicates an observable separation between the groups and the 12 sensors that were related. The sensitivity, specificity of post-COVID vs. controls value reached 97.6% (87.4%–99.9%) and 100% (88.4%–100%) respectively, according to the ROC curve. As a perspective, we consider that this technology, due to its simplicity, low cost and portability, can support strategies for the identification and follow-up of post-COVID patients. The proposed classification model provides the basis for evaluating post-COVID patients; therefore, further studies are required to enable the implementation of this technology to support clinical management and mitigation of effects.

The link between COVID-19 mortality and PM2.5 emissions in rural and medium-size municipalities considering population density, dust events, and wind speed

One contemporary issue is how environmental pollution and climate can affect the dissemination and severity of COVID-19 in humans. We documented the first case of association between particulate matter ≤2.5 μm (PM_2.5) and COVID-19 mortality rates that involved rural and medium-sized municipalities in northwestern Mexico, where direct air quality monitoring is absent. Alternatively, anthropogenic PM_2.5 emissions were used to estimate the PM_2.5 exposure in each municipality using two scenarios: 1) considering the fraction derived from combustion of vehicle fuel; and 2) the one derived from modeled anthropogenic sources. This study provides insights to better understand and face future pandemics by examining the relation between PM_2.5 pollution and COVID-19 mortality considering the population density and the wind speed. The main findings are: (i) municipalities with high PM_2.5 emissions and high population density have a higher COVID-19 mortality rate; (ii) the exceptionally high COVID-19 mortality rates of the rural municipalities could be associated to dust events, which are common in these regions where soils without vegetation are dominant; and (iii) the influence of wind speed on COVID-19 mortality rate was evidenced only in municipalities with <100 inhabitants per km². These results confirm the suggestion that high levels of air pollutants associated with high population density and an elevated frequency of dust events may promote an extended prevalence and severity of viral particles in the polluted air of urban, suburban, and rural communities. This supports an additional means of dissemination of the coronavirus SARS-CoV-2, in addition to the direct human-to-human transmission.

Impacts of COVID-19 pandemic on national security issues: Indonesia as a case study

The national security issues in particular non-traditional security issues such as law enforcement, health, food, supply chain management, industry etc. are severely impacted by the COVID-19 outbreak in all countries of the world. As such, the developing country like Indonesia has largely been suffering from this epidemic. In this context, this paper attempts to analyse some national security issues that are affecting Indonesia, which is currently struggling with the COVID-19 pandemic. Proposed here are policy measures to combat both present and future challenges. The study uses secondary data collected from different sources concerning COVID-19 pandemic and security issues of Indonesia. The study analyses the data based on descriptive statistics, highlighting the impact of the COVID-19 pandemic on Indonesian law enforcement issues, and security of health, food, supply chain management, industrial and other economic sectors. The study argues that if the vulnerability continues in these security-related issues due to pandemic, the country will face a harsh reality to manage the state-affairs. Therefore, the policy options are mainly concerned with the COVID-19 issue. Indonesia’s government should identify what measures to take by conducting rapid diagnostics and polymerase chain reaction tests in the laboratory, respectively. Moreover, the government and relevant stakeholders need to develop strategies that break the stranglehold of COVID-19 transmission in order to resolve Indonesian national security concern.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Risk factors associated with hospitalization owing to COVID-19: a cross-sectional study in Palestine

OBJECTIVES

We aimed to identify the risk factors for coronavirus disease 2019 (COVID-19)-associated hospitalization to provide evidence for improved clinical care of patients with COVID-19 infection.

METHODS

We conducted a cross-sectional study among 300 participants. The collected data comprised sociodemographic data, lifestyle habits, physical activity, medical history, anthropometric measurements, COVID-19-related symptoms, dietary habits prior to and after COVID-19 infection, and psychological status.

RESULTS

Fifty-nine participants were hospitalized. Fever, dry cough, joint pain, chills, diarrhea, and shortness of breath were significantly associated with hospitalization owing to COVID-19. Adults with obesity, diabetes mellitus, hypertension, respiratory diseases, and cardiovascular diseases had higher rates of hospitalization. The findings also showed that residential area and age were related to COVID-19 hospitalization. Furthermore, our analysis revealed that certain dietary habits were associated with hospitalization rates.

CONCLUSION

Our study confirmed that older age, urban residence, illiteracy, obesity, hypertension, diabetes mellitus, respiratory diseases, cardiovascular diseases, and symptoms of loss of smell and sneezing elevated the risk of hospitalization among patients with COVID-19 infection. Patients with a higher risk of hospitalization may benefit from targeted therapeutic and preventive interventions.

Asthma is not a Risk Factor for Severity of SARS-CoV-2 Infection in the Mexican Population

Objective. This study aims to assess the association between asthma and severity of COVID-19 in the Mexican population.Methods. The data from a national database of confirmed patients diagnosed with COVID-19, who attended from February to June 2020, were analyzed in a retrospective cohort study. Patients with and without asthma were compared concerning hospitalization, pneumonia, endotracheal intubation, and death related to COVID-19. Other covariates (age, sex, indigenous group, and comorbidity) were included in various logistic regression models.Results. Asthma was associated with a lower risk of hospitalization (OR =0.71, 95% CI 0.66 to 0.76), lower risk of pneumonia (OR =0.75, 95% CI 0.69 to 0.81), and lower risk of endotracheal intubation (OR =0.79, 95% CI 0.63 to 0.98). In addition, asthma decreased the risk of death from COVID-19 (OR =0.73, 95% CI 0.65 to 0.82). In a subgroup analysis, the same association was observed in patients who required hospitalization (OR =0.79, 95% CI 0.69 to 0.90), while in non-hospitalized patients, associations were inconsistent according to the covariates introduced in the models. There was no association between asthma and death in patients admitted to the intensive care unit (ICU), however, asthma significantly reduced the risk of death in the hospitalized patients who did not require ICU.Conclusion. Our results suggest that patients with asthma are less likely to require hospitalization, develop pneumonia, need tracheal intubation or die from COVID-19 as compared to patients without asthma.

Clinical characteristics of COVID-19 patients with complications: implications for management

Background:

A novel coronavirus disease 2019 (COVID-19) has caused outbreaks worldwide, and the number of cases is rapidly increasing through human-to-human transmission. Because of the greater transmission capacity and possible subsequent multi-organ damage caused by the virus, it is crucial to understand precisely and manage COVID-19 patients. However, the underlying differences in the clinical features of COVID-19 with and without comorbidities are not fully understood.

Aim:

The objective of this study was to identify the clinical features of COVID-19 patients with and without complications to guide treatment and predict the prognosis.

Method:

We collected the clinical characteristics of COVID-19 patients with and without different complications, including hypertension, cardiovascular disease and diabetes. Next, we performed a baseline comparison of each index and traced the dynamic changes in these factors during hospitalization to explore the potential associations.

Result:

A clinical index of differential expression was used for the regression to select top-ranking factors. The top-ranking clinical characteristics varied in each subgroup, such as indices of liver function, renal function and inflammatory markers. Among them, the indices of renal function were highly ranked in all subgroups and displayed significant differences during hospitalization.

Conclusion:

Organ functions of COVID-19 patients, particularly renal function, should be cautiously taken care of during management and might be a crucial factor for a poor prognosis of these patients with complications.

Panorámica de la COVID-19 en tres municipios de Guerrero, México, durante 2020

Objetivo Estimar la magnitud de daños a la salud por la pandemia de COVID-19 y su dinámica en Ometepec, Xochistlahuaca y Tlacoachistlahuaca, en Guerrero, México, durante 2020. Métodos Estudio retrospectivo hecho mediante un análisis secundario de la base de datos de COVID-19 de la Secretaría de Salud de México. Con análisis bivariado y regresión logística binaria, se desarrollaron estimaciones de series de tiempo y de magnitud del daño a la salud por COVID-19. Resultados Durante las semanas epidemiológicas 12 a 40 de 2020, se confirmaron 325 casos y 28 defunciones por COVID-19. De los casos confirmados, solo 16% fueron indígenas. Dos de cada tres defunciones ocurrieron en las primeras 48 horas del ingreso hospitalario. Las variables predictoras que mejor se ajustaron al modelo de regresión, asociadas a la letalidad hospitalaria, fueron diabetes, neumonía asociada a COVID-19 y edad de 50 años o mayor. Conclusiones Es importante enfatizar los datos de alarma de la COVID-19 a la población indígena (en particular, la dificultad respiratoria) y factores asociados a complicaciones por COVID-19 como diabetes y edad avanzada, para incrementar el uso oportuno de los servicios de salud.

Innovation as recovery strategy for SMEs in emerging economies during the COVID-19 pandemic

The quarantine and disruption of non-essential activities as measure to contain the COVID-19 pandemic has negatively affected all economies around the World. This has had a deeper impact on small and medium enterprises (SMEs) in emerging economies because they have very limited resources and vulnerable supply chain and business-to-business/business-to-clients relationships. In this context, it is expected that after the pandemic many of these enterprises will disappear as the "new normality" will require changes in business and infrastructure management. To reduce this risk, innovation is identified as a key aspect of business recovery in the ongoing and post-COVID-19 pandemic period. This work presents a multidisciplinary methodological approach to guide these enterprises to innovate their products for new markets and making a better use of their limited available resources. As an example of this approach, the research-supported development of a new product for a family-owned SME was performed in a zone with high COVID-19 risk. The results provide insight regarding innovation as a survival tool for SMEs during and after the COVID-19 contingency, and the use of digital resources is identified as the main facilitator for networking and research-based design of innovative products within the "social distance" context.

Evaluation of hydroxylated metabolites of polycyclic aromatic hydrocarbons and biomarkers of early kidney damage in indigenous children from Ticul, Yucatán, Mexico

Polycyclic aromatic hydrocarbons (PAHs) are environmental persistent chemicals, produced by the incomplete combustion of solid fuels, found in smoke. PAHs are considered carcinogenic, teratogenic, and genotoxic. Children are susceptible to environmental pollutants, particularly those living in high-exposure settings. Therefore, the main objective of this study was to evaluate the exposure to PAHs through hydroxylated metabolites of PAHs (OH-PAHs), 1-hydroxynaphtalene (1-OH-NAP), and 2-hydroxynaphtalene (2-OH-NAP); 2-,3-, and 9-hydroxyfluorene (2-OH-FLU, 3-OH-FLU, 9-OH-FLU); 1-,2-,3-, and 4-hydroxyphenanthrene (1-OH-PHE, 2-OH-PHE, 3-OH-PHE, 4-OH-PHE); and 1-hydroxypyrene (1-OH-PYR), as well as kidney health through biomarkers of early kidney damage (osteopontin (OPN), neutrophil gelatinase-associated lipocalin (NGAL), α1-microglobulin (α1-MG), and cystatin C (Cys-C)) in children from an indigenous community dedicated to footwear manufacturing and pottery in Ticul, Yucatán, Mexico. The results show a high exposure to PAHs from the found concentrations of OH-PAHs in urine in 80.5% of the children in median concentrations of 18.4 (5.1-71.0) μg/L of total OH-PAHs, as well as concentrations of kidney damage proteins in 100% of the study population in concentrations of 4.8 (3-12.2) and 7.9 (6.5-13.7) μg/g creatinine of NGAL and Cys-C respectively, and 97.5% of the population with concentrations of OPN and α1-MG at mean concentrations of 207.3 (119.8-399.8) and 92.2 (68.5-165.5) μg/g creatinine. The information provided should be considered and addressed by the health authorities to establish continuous biomonitoring and programs to reduce para-occupational exposure in the vulnerable population, particularly children, based on their fundamental human right to health.

COVID-19 Vaccine Intention among Rural Residents in Mexico: Validation of a Questionnaire

The COVID-19 pandemic forced the scientific community and the pharmaceutical industry to develop new vaccines, in an attempt to reach herd immunity and stop the SARS-CoV-2 from spreading. However, to ensure vaccination among the general population, COVID-19 vaccine intention must be measured. So far, no studies have focused on rural residents in Latin America, which represent approximately 20% of the population of this geographical region. In this study, we present the validation of a self-developed questionnaire, which was validated in a pilot study with 40 Spanish-speaking Mexican rural residents in the state of Guerrero, Mexico. In this study, we describe the chronological validation of the questionnaire, including the assessment of its internal consistency and temporal reliability, which we measured with the Cronbach’s alpha and Spearman’s rank correlation coefficient, respectively. After the psychometrical analysis, we were able to validate a 20-item questionnaire, which intends to assess vaccine intention among the rural population. Aiming to develop a comprehensive policy and vaccination strategies, we hope this instrument provides valuable insight regarding COVID-19 vaccination willingness across rural communities in Mexico and Latin America. Finally, if we want to reach worldwide herd immunity, it is important to understand rural residents’ position towards COVID-19 vaccination.

Risk perceptions of COVID-19 and its impact on precautionary behavior: A qualitative study

OBJECTIVE

The controlling of the COVID-19 pandemic is influenced by the precautionary behavior of the community, and such behavior is frequently related to individuals' risk perception. The current study aimed to explore risk perceptions and precautionary behavior in response to COVID-19.

METHOD

Qualitative in-depth interviews by telephone were undertaken with 26 participants from three affected cities in an initial stage of the disease outbreak, from May 3 to June 5, 2020. The method of analyzing data was inductive. The results were analyzed using interpretation, categorizing, and thematic analysis.

RESULTS

The perception of risk is influenced by numerous individual, community, and cultural factors; these perceptions act as triggers for precautionary behavior, with a tendency to deny risks or react with exaggeration in terms of the precautionary reactions related to COVID-19. The thematic analysis produced two major categories: 1) risk perception and 2) precautionary behavior. The analysis provides essential insight into risk perception and precautionary behavior.

CONCLUSION

The risk perceptions and patterns of precautionary behavior could be unreliable, unhealthy, and culturally affected, which would influence the effectiveness of pandemic control measures. Further investigations with more data and including risk perception and precautionary behavior in the national response plan for emergency and crisis are highly recommended.

PRACTICE IMPLICATIONS

A greater understanding and ongoing assessment of COVID-19 risk perception could inform policymakers and health professionals who seek to promote precautionary behavior. This could also facilitate early interventions during pandemics.

A Systematic Map of Non-Clinical Evidence Syntheses Published Globally on COVID-19

STUDY OBJECTIVE

Evidence syntheses perform rigorous investigations of the primary literature and they have played a vital role in generating evidence-based recommendations for governments worldwide during the Covid-19 pandemic. However, there has not yet been an attempt to organize them by topic and other characteristics. This study performed a systematic mapping exercise of non-clinical evidence syntheses pertaining to Covid-19.

METHODS

This study conducted a systematic search on December 5, 2020 across 10 databases and servers: CINAHL (EBSCO Information Services, Ipswich, Massachusetts, United States), Embase (Elsevier, Aalborg, Denmark), Global Health (EBSCO Information Services, Ipswich, Massachusetts, United States), Healthstar (NICHSR and AHA, Bethesda, United States), MEDLINE (NLM, Bethesda, United States), PsychINFO (APA, Washington, DC, United States), Web of Science (Clarivate Analytics, London, UK), Research Square (Research Square, Durham, North Carolina), MEDRxiv (Cold Spring Harbor Laboratory, New York, United States), and PROSPERO (NIHR, York, United Kingdom). Only full evidence syntheses published in a peer-reviewed journal or preprint server were included.

RESULTS

This study classified all evidence syntheses in the following topics: health service delivery (n = 280), prevention and behavior (n = 201), mental health (n = 140), social epidemiology (n = 31), economy (n = 22), and environment (n = 19). This study provides a comprehensive resource of all evidence syntheses categorized according to topic.

CONCLUSIONS

This study proposes the following research priorities: governance, the impact of Covid-19 on different populations, the effectiveness of prevention and control methods across contexts, mental health, and vaccine hesitancy.

Evaluating the Immediate Response of Country-Wide Health Systems to the Covid-19 Pandemic: Applying the Gray Incidence Analysis Model

The purpose of the study is to evaluate county-wide health systems using the data set of the first wave of the COVID-19 pandemic. The overall design of study comprises a literature review, secondary data, and a mathematical analysis. It is a cross-sectional quantitative study following a deductive approach. It uses the data of the first wave of the COVID-19 pandemic taken from the website of Worldometer as of April 8, 2020. The study uses a gray incidence analysis model (commonly known as Gray Relational Analysis, i.e., GRA) as its research methodology. On the basis of the results of GRA, a classification has been made under a predetermined scheme of ensigns: much better, better, somewhat better, fair, poor, somewhat worse, and worse health systems. There are a total 211 countries that have been divided into the seven aforementioned categories. Findings of the study show that Southern Africa Development Community (SADC) countries fall predominantly under the much better ensign, whereas Organization for Economic Co-operation and Development (OECD), Schengen Area (SA), and/or European Union (EU) countries fall under the worse ensign. Pakistan falls under the ensign of poor. It is an original attempt to evaluate the response of health systems based on real data using a scientific methodology. The study provides valuable information about the health systems of the countries for forming an informed opinion about the health systems herein. The study provides useful new information for stakeholders and a new framework for future research.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review

BACKGROUND

The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs.

METHODS

We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available.

RESULTS

A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or "low-tech" care must also remain available.

CONCLUSIONS

The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

Assessment of variations of air pollutant concentrations during the COVID-19 lockdown and impact on urban air quality in South Asia

Quantifying the variations of atmospheric aerosols and trace gas concentrations with the impact of lockdown due to the Coronavirus disease of 2019 (COVID-19) pandemic is crucial in understanding urban air quality. For this purpose, we utilized the multi-instrumental approach of satellite remote sensing and reanalysis model data to examine the spatial and temporal patterns of major air pollutants during December 2019-June 2020 in South Asia. The lockdown has to lead to a considerable decrease in aerosol optical thickness (AOT) over South China (-18.92%) and Indo-Gangetic Plain (IGP; -24.29%) compared to its ordinary level for a couple of weeks. Noticeable reductions in tropospheric NO2 are observed over the Pearl River Delta (PRD; -0.3/cm2) followed by Central China (CC) with -0.21/cm2and IGP (-0.085/cm2), and the lowest (-0.0008/cm2) in the Tibetan Plateau (TP) region. The changes observed in PM2.5 and SO2 levels (from -58.56% to - 63.64%) are attributed to the decrease in anthropogenic emissions, vehicular exhaust, and industrial activities. However, the BC concentrations are reduced by approximately halved of its ordinary levels in the IGP (-2.28 μg/m3) followed by YRD (-1.56 μg/m3), CC (-1.5 μg/m3), NCP (-1.29 μg/m3), and PRD (-0.78 μg/m3) regions. The total column O3 predominantly increased from 262.68 to 285.53DU, 323.00 to 343.00DU, and 245.00 to 265.00DU in the YRD, NCP, and IGP areas. This is mainly associated with solar radiation, meteorological factors, and an unprecedented reduction in NOx during the lockdown period.

Not far enough: Public health policies to combat COVID-19 in Mexico's states

BACKGROUND

Mexican state governments' actions are essential to control the COVID-19 pandemic within the country. However, the type, rigor and pace of implementation of public policies have varied considerably between states. Little is known about the subnational (state) variation policy response to the COVID-19 pandemic in Mexico.

MATERIAL AND METHODS

We collected daily information on public policies designed to inform the public, as well as to promote distancing, and mask use. The policies analyzed were: School Closure, Workplace Closure, Cancellation of Public Events, Restrictions on Gatherings, Stay at Home Order, Public Transit Suspensions, Information Campaigns, Internal Travel Controls, International Travel Controls, Use of Face Masks We use these data to create a composite index to evaluate the adoption of these policies in the 32 states. We then assess the timeliness and rigor of the policies across the country, from the date of the first case, February 27, 2020.

RESULTS

The national average in the index during the 143 days of the pandemic was 41.1 out of a possible 100 points on our index. Nuevo León achieved the highest performance (50.4); San Luis Potosí the lowest (34.1). The differential between the highest versus the lowest performance was 47.4%.

CONCLUSIONS

The study identifies variability and heterogeneity in how and when Mexican states implemented policies to contain COVID-19. We demonstrate the absence of a uniform national response and widely varying stringency of state responses. We also show how these responses are not based on testing and do not reflect the local burden of disease. National health system stewardship and a coordinated, timely, rigorous response to the pandemic did not occur in Mexico but is desirable to contain COVID-19.

Afforestation, reforestation and new challenges from COVID-19: Thirty-three recommendations to support civil society organizations (CSOs)

Afforestation/reforestation (A/R) programs spearheaded by Civil Society Organizations (CSOs) play a significant role in reaching global climate policy targets and helping low-income nations meet the United Nations (UN) Sustainable Development Goals (SDGs). However, these organizations face unprecedented challenges due to the COVID-19 pandemic. Consequently, these challenges affect their ability to address issues associated with deforestation and forest degradation in a timely manner. We discuss the influence COVID-19 can have on previous, present and future A/R initiatives, in particular, the ones led by International Non-governmental Organizations (INGOs). We provide thirty-three recommendations for exploring underlying deforestation patterns and optimizing forest policy reforms to support forest cover expansion during the pandemic. The recommendations are classified into four groups - i) curbing deforestation and improving A/R, ii) protecting the environment and mitigating climate change, iii) enhancing socio-economic conditions, and iv) amending policy and law enforcement practices.

Demystifying media sources of information and levels of knowledge about COVID-19: a rapid mini-review of cross-sectional studies in Africa

COVID-19 control is highly affected by knowledge levels which are also affected by receipt of information on the disease. Therefore, this review examined knowledge levels and media sources of information findings of the studies on knowledge, attitudes, perceptions, and practices towards COVID-19 done in low- and middle-income countries in Africa to shed light on the interplay of the use of different media platforms and populations’ knowledge about the COVID-19 pandemic and identify shorter- and longer-term priorities for COVID-19 research to improve the continent’s capacity to not only deal with COVID-19 but also future pandemics. Searches were conducted in PubMed and CINAHL databases/sites with major terms being “knowledge”, “attitudes”, “perceptions”, “practices”, “COVID-19 “, and “Africa”. 319 were where identified and subjected to the exclusion and inclusion criteria retaining only 10 free, full-text research articles related to knowledge, attitudes, perceptions, and practices towards COVID-19. This review summarized the levels of knowledge and media information sources among African populations. The review indicated a largely higher level of knowledge towards COVID-19 among populations who received information through various media platforms and alluded to the different media platforms that could be appropriate to spread COVID-19 related information to African populations.

Analysis of urinary metabolites of polycyclic aromatic hydrocarbons in precarious workers of highly exposed occupational scenarios in Mexico

Exposure to polycyclic aromatic hydrocarbons (PAHs) is a risk factor for human health. Workers are a vulnerable group due to their high exposure and therefore require special attention to mitigation measurements; however, some groups of workers are especially vulnerable, precarious workers. The objective of this research was to evaluate mixtures of hydroxylated PAHs (OH-PAHs) in precarious workers in Mexico. The following activities were evaluated: (i) brickmakers (TER), stonemasons (ESC), indigenous workers (TOC) and mercury miners (CAM). Ten OH-PAHS were analyzed: 1-hydroxynaphtalene and 2-hydroxynaphtalene; 2-,3- and 9-hydroxyfluorene; 1-,2-,3- and 4-hydroxyphenanthrene; and 1-hydroxypyrene in urine by GC-MS, chemical fingerprints of the sites were established by multivariate analysis. One hundred forty-nine precarious workers participated in the study. The populations presented total OH-PAHs concentrations of 9.20 (6.65-97.57), 14.8 (9.32-18.85), 15.7 (6.92-195.0), and 101.2 (8.02-134.4) μg/L for CAM, ESC, TER, and TOC, respectively (median (IQR)). The results of the multivariate analysis indicate that the indigenous population presented a different fingerprint compared to the three scenarios. The chemical fingerprints among the brickmakers and mercury mining population were similar. The results of the concentrations were similar and in some metabolites higher than workers in occupations classified as carcinogenic by the IARC; therefore, the control of exposure in these occupations acquires great importance and surveillance through biological monitoring of OH-PAHs should be applied to better estimate exposure in these working populations.

COVID-19 Risk Assessment: Contributing to Maintaining Urban Public Health Security and Achieving Sustainable Urban Development

As the most infectious disease in 2020, COVID-19 is an enormous shock to urban public health security and to urban sustainable development. Although the epidemic in China has been brought into control at present, the prevention and control of it is still the top priority of maintaining public health security. Therefore, the accurate assessment of epidemic risk is of great importance to the prevention and control even to overcoming of COVID-19. Using the fused data obtained from fusing multi-source big data such as POI (Point of Interest) data and Tencent-Yichuxing data, this study assesses and analyzes the epidemic risk and main factors that affect the distribution of COVID-19 on the basis of combining with logistic regression model and geodetector model. What’s more, the following main conclusions are obtained: the high-risk areas of the epidemic are mainly concentrated in the areas with relatively dense permanent population and floating population, which means that the permanent population and floating population are the main factors affecting the risk level of the epidemic. In other words, the reasonable control of population density is greatly conducive to reducing the risk level of the epidemic. Therefore, the control of regional population density remains the key to epidemic prevention and control, and home isolation is also the best means of prevention and control. The precise assessment and analysis of the epidemic conducts by this study is of great significance to maintain urban public health security and achieve the sustainable urban development.