"The Art of War" in the Era of Coronavirus Disease 2019 (COVID-19)

Qualitative perspectives of isolation experiences due to COVID-19 from a group of bioethicists in training performing interdisciplinary healthcare activities. Medellin, Colombia. September 2020

Introduction

In Colombia, there is still little information on how health care personnel have lived and coped with isolation due to COVID-19.

Objectives

To explore the experiences related to the isolation of health professionals performing interdisciplinary care activities from March to September 2020, in Medellín, Colombia.

Methods

Qualitative, exploratory, with a group of bioethicists in training. Data collected through the focus group, after obtaining the consent and approval of the Institutional Ethics Committee. Open and axial coding was performed. Texts are presented in prose, information was triangulated, and results were validated with the participants.

Results

Work increased and staff decreased, with high staff turnover, redistribution and reassignment of loads and roles, facilitating physical and emotional overload. Study participants considered that teleworking facilitated their work, although more work was done. They lived in double isolation, had losses, and took work and family overloads. For fear of infecting and being infected, they separated from their loved ones, "this is an absolutely lonely disease, if people does not die from COVID, sadness and loneliness kills them." It affected "the recovery process, specifically, of psychiatric patients was prolonged, worsening their condition." They live in the present, and prioritize what is most important, because "being healthy and having those you love is the best wealth".

Conclusion

Isolation increased workload, with reassignment of roles, affecting health care. For fear of becoming infected and infecting, study participants lived a double isolation, with anguish and uncertainty, which is why now they prioritize the most important health and love.

The Impact of COVID-19 on Members of the Saudi Community: Perceptions and Expectations From the Pandemic

Background and purpose Community individuals and sectors worldwide, including health, security, economy, education, and occupation, are being challenged to confront the coronavirus disease 2019 (COVID-19) pandemic. The deadly virus originated in Wuhan city in China and spread globally to other countries on account of its rapid mode of transmission. Solidarity and cooperation were vital elements in mitigating the COVID-19 pandemic all around the globe. Actions of solidarity among countries included gathering the world's leading experts to discuss the latest research and innovation while working to promote knowledge and empowerment across the communities. The purpose of this study was to explore the influence of the COVID-19 pandemic on different aspects of the Saudi community, including health, education, finance, lifestyle, and others. We also wanted to identify the perceptions of the general Saudi population regarding the impact of the pandemic and its long-term effects. Methodology This cross-sectional study was conducted from March 2020 to February 2021 among individuals across the Kingdom of Saudi Arabia. The online self-developed survey was disseminated to thousands of individuals in the Saudi community and yielded 920 responses. Results Roughly 49% of the studied participants postponed their dental and cosmetic center appointments, and 31% reported delayed periodic health appointments in hospitals and primary healthcare centers. Around 64% reported missing hearing "Tarawih/Qiyam" Islamic prayers. Furthermore, 38% of the study respondents reported being anxious and stressed, 23% reported having sleeping disorders, and 16% wanted to be isolated from the community. On the other hand, the COVID-19 pandemic helped approximately 65% of the studied participants to abstain from ordering from restaurants and cafes. Additionally, 63% of them reported gaining new skills or behaviors during the pandemic. Many participants (54%) thought that after the curfew recession, they will face financial challenges while 44% assumed that life will not return to what it used to be. Conclusion The COVID-19 pandemic has had a multidimensional impact on Saudi society, which has affected both individuals and the community as a whole. Some of the short-term perceived impacts involved interruption in the provision of health care, poor mental well-being, financial hardship, challenges related to homeschooling and working from home, and the inability to fulfill spiritual needs. On the bright side, community individuals demonstrated the ability to learn and develop during the pandemic by striving to acquire knowledge and new skills.

Bibliometric, network, and thematic mapping analyses of metaphor and discourse in COVID-19 publications from 2020 to 2022

The research contributions of metaphor as part of (critical) discourse studies have flourished during COVID-19; hence, it is necessary to consider their progress and foresee their future growth. To obtain a comprehensive understanding of COVID metaphor research in discourse and to identify the most recent research foci, bibliometric, network, thematic mapping and word cloud analyses were conducted in this study. The results showed that (1) research on COVID metaphors is largely shaped by Critical Discourse Analysis research approaches and methodologies; (2) the research production has investigated traditional genres such as news and emerging genres, including social media and multimodal data; and (3) research highlights the role played by metaphors in persuasion in public discourse. The findings of this study can assist future research in this or related fields by providing an overview of metaphor research in crisis communication.

Metaphors we Lie by: our 'War' against COVID-19

In this paper we discuss the influence of war as a metaphor in the context of the COVID-19 pandemic. After an introduction on the traditional analysis of the war metaphor, we address the social consequences of using this metaphor, a topic that has been widely debated with regard to public communication in the context of COVID-19. We pay particular attention to a theory that many intellectuals have raised: the possibility that the use of the metaphor in this context is harmful to a democratic society because it may lead citizens to accept limited civil liberties and authoritarian policies. After presenting the extensive literature on the use of the war metaphor before and during the COVID-19 pandemic, in the final section of the paper, we analyse experimental evidence of the effects of this metaphor. In the conclusion, we hint at open questions and suggest that the current evidence does not support claims of direct liberticidal influence.

The Impact of the First Wave of the COVID-19 Pandemic on Healthcare Workers: An Italian Retrospective Study

Healthcare workers (HCWs) played an essential role in managing the COVID-19 pandemic. The Italian Workers’ Compensation Authority (INAIL) and the Italian National Institute of Health (ISS) developed a retrospective study to analyze and understand trends and characteristics of infections among HCWs during the first wave of the pandemic. Between May and September 2020, Italian Regions retrospectively collected anonymous data regarding HCWs infected from the beginning of the pandemic until 30 April 2020 from their administrative sources through a questionnaire asking for socio-demographic and occupational information about the characteristics of contagion and disease outcome. Almost 16,000 valid questionnaires were received. Logistic regression was performed to ascertain the effect of age, gender, geographical macro area, profession, and pre-existing health conditions on the likelihood of HCWs developing more severe forms of COVID-19 (at least hospitalization with mild symptoms). All predictor variables were statistically significant. HCWs at higher risk of developing a more severe disease were males (OR: 1.90; 95% CI: 1.44–2.51), older than 60 years of age (OR: 6.00; 95% CI: 3.30–10.91), doctors (OR: 4.22; 95% CI: 2.22–9.02), working in Lombardy (OR: 55.24; 95% CI: 34.96–87.29) and with pre-existing health conditions (OR: 1.90; 95% CI: 1.43–2.51). This study analyses the main reasons for the overload put on the National Health Service by the first wave of the pandemic and the risk of infection for HCWs by age, gender, occupational profile and pre-existing health conditions. Improved knowledge, availability of personal protective equipment (PPE) and a tight vaccination campaign for HCWs strongly changed the trend of infections among HCWs, with substantial elimination of serious and fatal cases.

Effect of virtual reality simulation training on the response capability of public health emergency reserve nurses in China: a quasiexperimental study

OBJECTIVE

To develop a virtual reality simulation training programme, and further verify the effect of the programme on improving the response capacity of emergency reserve nurses confronting public health emergencies.

DESIGN

A prospective quasiexperimental design with a control group.

PARTICIPANTS

A total of 120 nurses were recruited and randomly divided into the control group and the intervention group.

INTERVENTION

Participants underwent a 3-month training. The control group received the conventional training of emergency response (eg, theoretical lectures, technical skills and psychological training), while the intervention group underwent the virtual reality simulation training in combination with skills training. The COVID-19 cases were incorporated into the intervention group training, and the psychological training was identical to both groups. At the end of the training, each group conducted emergency drills twice. Before and after the intervention, the two groups were assessed for the knowledge and technical skills regarding responses to fulminate respiratory infectious diseases, as well as the capacity of emergency care. Furthermore, their pandemic preparedness was assessed with a disaster preparedness questionnaire.

RESULTS

After the intervention, the scores of the relevant knowledge, the capacity of emergency care and disaster preparedness in the intervention group significantly increased (p<0.01). The score of technical skills in the control group increased more significantly than that of the intervention group (p<0.01). No significant difference was identified in the scores of postdisaster management in two groups (p>0.05).

CONCLUSION

The virtual reality simulation training in combination with technical skills training can improve the response capacity of emergency reserve nurses as compared with the conventional training. The findings of the study provide some evidence for the emergency training of reserve nurses in better response to public health emergencies and suggest this methodology is worthy of further research and popularisation.

The Interactive Management of the SARS-CoV-2 Virus: The Social Cohesion Index, a Methodological-Operational Proposal

This contribution places itself within the emergency context of the COVID-19 spread. Until medical research identifies a cure acting at an organic level, it is necessary to manage what the emergency generates among the members of the Community in interactive terms in a scientific and methodologically well-founded way. This is in order to promote, among the members of the Community, the pursuit of the common aim of reducing the spread of infection, with a view to community health as a whole. In addition, being at the level of interactions enables us to move towards a change of these interactions in response to the COVID-19 emergency, in order to manage what will happen in the future, in terms of changes in the interactive arrangements after the emergency itself. This becomes possible by shifting away from the use of deterministic-causal references to the use of the uncertainty of interaction as an epistemological foundation principle. Managing the interactive (and non-organic) fallout of the emergency in the Community is made possible by the formalisation of the interactive modalities (the Discursive Repertories) offered by Dialogical Science. To place oneself within this scientific panorama enables interaction measurements: so, the interaction measurement indexes offers a range of generative possibilities of realities built by the speeches of the Community members. Moreover, the Social Cohesion measurement index, in the area of Dialogical Science, makes available to public policies the shared measure of how and by how much the Community is moving towards the common purpose of reducing the contagion spread, rather than moving towards other personal and not shared goals (for instance, having a walk in spite of the lockdown). In this index, the interaction between the Discursive Repertories and the “cohesion weight” associated with them offers a Cohesion output: the data allow to manage operationally what happens in the Community in a shared way and in anticipation, without leaving the interactions between its members to chance. In this way, they can be directed towards the common purpose through appropriate interventions relevant to the interactive set-up described in the data. The Cohesion measure makes it possible to operate effectively and efficiently, thanks to the possibility of monitoring the progress of the interventions implemented and evaluating their effectiveness. In addition, the use of predictive Machine Learning models, applied to interactive cohesion data, allows for immediate and efficient availability of the measure itself, optimising time and resources.

Assessing social support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China

Following the 2019 coronavirus disease (COVID-19) outbreak in China, undergraduate students may experience psychological changes. During emergency circumstances, social support is an important factor influencing the mental health condition among undergraduate students in Shaanxi province. This study aims to find the factors associated with mental health symptoms of depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic in China. A cross-sectional study was conducted from Feb 23 to Mar 7, 2020. A total of 1278 undergraduate students from the universities located in Shaanxi province participated in this study. The mental health symptoms were measured by 12-item Perceived Social Support Scale (PSSS) and Depression Anxiety Stress Scale (DASS-21) instruments. This survey showed that females receive more social support compared to males (t = -5.046, P<0.001); males have higher-level depression symptoms (t = 5.624, P<0.001); males have higher-level anxiety symptoms (t = 6.332, P<0.001), males have higher-level stress symptoms (t = 5.58, P<0.001). This study also found participants who have low social support was negatively correlated with mental health symptoms. In Conclusion, Males and low social support were associated with having the higher level of depression, anxiety, and stress symptoms among undergraduate students in Shaanxi province during the COVID-19 pandemic in China. Therefore, it is suggested that people should supply more social support for undergraduate students in Shaanxi province during COVID-19 pandemic.

Government responses and COVID-19 deaths: Global evidence across multiple pandemic waves

We provide an assessment of the impact of government closure and containment measures on deaths from COVID-19 across sequential waves of the COVID-19 pandemic globally. Daily data was collected on a range of containment and closure policies for 186 countries from January 1, 2020 until March 11th, 2021. These data were combined into an aggregate stringency index (SI) score for each country on each day (range: 0-100). Countries were divided into successive waves via a mathematical algorithm to identify peaks and troughs of disease. Within our period of analysis, 63 countries experienced at least one wave, 40 countries experienced two waves, and 10 countries saw three waves, as defined by our approach. Within each wave, regression was used to assess the relationship between the strength of government stringency and subsequent deaths related to COVID-19 with a number of controls for time and country-specific demographic, health system, and economic characteristics. Across the full period of our analysis and 113 countries, an increase of 10 points on the SI was linked to 6 percentage points (P < 0.001, 95% CI = [5%, 7%]) lower average daily deaths. In the first wave, in countries that ultimately experiences 3 waves of the pandemic to date, ten additional points on the SI resulted in lower average daily deaths by 21 percentage points (P < .001, 95% CI = [8%, 16%]). This effect was sustained in the third wave with reductions in deaths of 28 percentage points (P < .001, 95% CI = [13%, 21%]). Moreover, interaction effects show that government policies were effective in reducing deaths in all waves in all groups of countries. These findings highlight the enduring importance of non-pharmaceutical responses to COVID-19 over time.

Training and education of healthcare workers during viral epidemics: a systematic review

BACKGROUND

It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes.

OBJECTIVE

To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW.

DATA SOURCES

Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics.

STUDY ELIGIBILITY CRITERIA

All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020.

PARTICIPANTS

Healthcare workers.

INTERVENTIONS

Educational or training interventions.

STUDY APPRAISAL AND SYNTHESIS METHODS

Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist.

RESULTS

A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes.

CONCLUSIONS AND IMPLICATIONS OF FINDINGS

The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.

Training non-intensivist doctors to work with COVID-19 patients in intensive care units

Background

Due to an expected surge of COVID‐19 patients in need of mechanical ventilation, the intensive care capacity was doubled at Rigshospitalet, Copenhagen, in March 2020. This resulted in an urgent need for doctors with competence in working with critically ill COVID‐19 patients. A training course and a theoretical test for non‐intensivist doctors were developed. The aims of this study were to gather validity evidence for the theoretical test and explore the effects of the course.

Methods

The 1‐day course was comprised of theoretical sessions and hands‐on training in ventilator use, hemodynamic monitoring, vascular access, and use of personal protective equipment. Validity evidence was gathered for the test by comparing answers from novices and experts in intensive care. Doctors who participated in the course completed the test before (pretest), after (posttest), and again within 8 weeks following the course (retention test).

Results

Fifty‐four non‐intensivist doctors from 15 different specialties with a wide range in clinical experience level completed the course. The test consisted of 23 questions and demonstrated a credible pass–fail standard at 16 points. Mean pretest score was 11.9 (SD 3.0), mean posttest score 20.6 (1.8), and mean retention test score 17.4 (2.2). All doctors passed the posttest.

Conclusion

Non‐intensivist doctors, irrespective of experience level, can acquire relevant knowledge for working in the ICU through a focused 1‐day evidence‐based course. This knowledge was largely retained as shown by a multiple‐choice test supported by validity evidence. The test is available in appendix and online.

Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: A systematic review

Considering the importance of evidence on interventions to tackle mental health problems in healthcare workers (HCWs) during pandemics, we conducted a systematic review, aiming to identify and summarize the implemented interventions to deal with mental health issues of HCWs during infectious disease outbreaks and report their effectiveness. Web of Science, PubMed, Cochrane, Scopus, CINAHL and PsycInfo electronic databases were searched until October 2nd, 2020. Primary-data articles, describing any implemented interventions and their effectiveness were considered pertinent. Studies were screened according to the inclusion/exclusion criteria and subsequently data extraction was performed. Twenty-four articles, referring to SARS, Ebola, Influenza AH1N1 and COVID-19 were included. Interventions addressing mental health issues in HCWs during pandemics/epidemics were grouped into four categories: 1) informational support (training, guidelines, prevention programs), 2) instrumental support (personal protective equipment, protection protocols); 3) organizational support (manpower allocation, working hours, re-organization of facilities/structures, provision of rest areas); 4) emotional and psychological support (psychoeducation and training, mental health support team, peer-support and counselling, therapy, digital platforms and tele-support). These results might be helpful for researchers, stakeholders, and policymakers to develop evidence-based sustainable interventions and guidelines, aiming to prevent or reduce the immediate and long-term effect of pandemics on mental health status of HCWs.

Community health worker knowledge, attitudes and practices towards COVID-19: Learnings from an online cross-sectional survey using a digital health platform, UpSCALE, in Mozambique

Healthcare workers (HCWs) are at the frontline of the Coronavirus Disease 2019 (COVID-19) pandemic response, yet there is a paucity of literature on their knowledge, attitudes and practices (KAP) in relation to the pandemic. Community Health Workers (CHWs) in Mozambique are known locally as agentes polivalentes elementares (APEs). While technical guidance surrounding COVID-19 is available to support APEs, communicating this information has been challenging due to restrictions on travel, face-to-face group meetings and training, imposed from May to August 2020. A digital health platform, upSCALE, that already supports 1,213 APEs and 299 supervisors across three provinces, is being used to support APEs on effective COVID-19 management by delivering COVID-19 sensitive SMS messages, training modules and a COVID-19 KAP survey. The KAP survey, conducted from June 2020 to August 2020, consisted of 10 questions. Of 1,065 active upSCALE APEs, 28% completed the survey. Results indicate that only a small proportion of APEs listed the correct COVID-19 symptoms, transmission routes and appropriate prevention measures (n = (25%), n = (16%) and n = (39%), respectively) specifically included in national health education materials. Misconceptions were mainly related to transmission routes, high risk individuals and asymptomatic patients. 84% said they followed all government prevention guidelines. The results from the KAP survey were used to support the rapid development and deployment of targeted COVID-19 awareness and education materials for the APEs. A follow-up KAP survey is planned for November 2020. Adapting the existing upSCALE platform enabled a better understanding, in real time, of the KAP of APEs around COVID-19 management. Subsequently, supporting delivery of tailored messages and education, vital for ensuring a successful COVID-19 response.

Implementation challenges of COVID-19 safety measures at construction sites in South Africa

Purpose

The COVID-19 pandemic drastically changed safety measures in every industry, including the construction industry. Thus, the construction companies have instituted safety measures at the construction sites to curve the disease’s spread among the workforce. This paper aims to examine the challenges encountered by construction firms in implementing COVID-19 safety measures at construction sites.

Design/methodology/approach

A qualitative research approach was adopted for this study using open-ended interview questions to solicit data from 19 construction professionals currently working on a construction project in South Africa. Content analysis with the assistance of an Excel spreadsheet was used to analyse the data collected.

Findings

The findings indicate that there are numerous challenges such as ignorance of COVID-19, the supply of poor personal protective equipment (PPEs) by contractors, lack of compliance, sanitising construction materials, difficulty in sharing tools and equipment, public transport usage by workers, superstition (COVID-19 is for a particular group of people), complying with social distancing rules, among others in the implementation of the COVID-19 safety measure at the construction site to curb the spread of the disease among the workers. These challenges have, therefore, hampered their effort to strictly adhere to the safety measures in accordance with the COVID-19 safety protocol at the project sites currently under construction.

Research limitations/implications

The interviewees were construction professionals working in the South African construction industry during the COVID-19 period.

Practical implications

The implication is that, due to the challenges faced in implementing the COVID-19 safety measures, workers on the construction site are not adequately protected from contracting COVID-19. The workers may thus contract the disease at the project sites and transmit it to their families and vice versa, which may have further implications on the spread of the disease within the communities and society.

Originality/value

The study has identified implementation challenges of the COVID-19 safety measures at construction sites of which the construction stakeholders must institute measures to overcome since COVID-19 has become part of our daily life. The study also recommends some preventive measures to the owners of construction companies to help overcome or minimise these COVID-19 safety implementation hurdles to minimise the spread of the disease among the construction site workers.

Listening to Hospital Personnel's Narratives during the COVID-19 Outbreak

Healthcare workers (HCWs) facing the COVID-19 pandemic are required to deal with unexpectedly traumatic situations, concern about contamination, and mounting patient deaths. As a means to address the changing needs of our hospital’s HCWs, we conducted a narrative analysis study in the early stages of the covid-19 outbreak. A focus group of medical experts, conducted as the initial step, recommended that a bottom-up research tool be used for exploring HCWs’ traumatic experiences and needs. We therefore conducted 450 semi-structured in-depth interviews with hospital personnel. The interviews were based on Maslow’s Pyramid of Needs model, and the narratives were analyzed by applying the Listening Guide methodology. The interviewees expressed a need for physical and psychological security in the battle against Covid-19, in addition to the need for attachment and meaning. Importantly, we also found that the interview itself may serve as a therapeutic tool. In light of our findings, we recommended changes in hospital practices, which were subsequently implemented. Further research on HCWs’ traumatic experiences and needs will provide evidence-based knowledge and may enable novel approaches in the battle against Covid-19. To conclude, the knowledge generated by listening to HCWs’ narratives may provide suitable support programs for professionals.

Monitoring approaches for health-care workers during the COVID-19 pandemic

Health-care workers are crucial to any health-care system. During the ongoing COVID-19 pandemic, health-care workers are at a substantially increased risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and could come to considerable harm as a result. Depending on the phase of the pandemic, patients with COVID-19 might not be the main source of SARS-CoV-2 infection and health-care workers could be exposed to atypical patients, infected family members, contacts, and colleagues, or live in communities of active transmission. Clear strategies to support and appropriately manage exposed and infected health-care workers are essential to ensure effective staff management and to engender trust in the workplace. These management strategies should focus on risk stratification, suitable clinical monitoring, low-threshold access to diagnostics, and decision making about removal from and return to work. Policy makers need to support health-care facilities in interpreting guidance during a pandemic that will probably be characterised by fluctuating local incidence of SARS-CoV-2 to mitigate the impact of this pandemic on their workforce.

COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice

The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.

Optimizing Anti-Viral Vaccine Responses: Input from a Non-Specialist

Recently, the research community has had a real-world look at reasons for improving vaccine responses to emerging RNA viruses. Here, a vaccine non-specialist suggests how this might be done. I propose two alternative options and compare the primary alternative option with current practice. The basis of comparison is feasibility in achieving what we need: a safe, mass-produced, emerging virus-targeted vaccine on 2–4 week notice. The primary option is the following. (1) Start with a platform based on live viruses that infect bacteria, but not humans (bacteriophages, or phages). (2) Isolate phages (to be called pathogen homologs) that resemble and provide antigenic context for membrane-covered, pathogenic RNA viruses; coronavirus-phage homologs will probably be found if the search is correctly done. (3) Upon isolating a viral pathogen, evolve its phage homolog to bind antibodies neutralizing for the viral pathogen. Vaccinate with the evolved phage homolog by generating a local, non-hazardous infection with the phage host and then curing the infection by propagating the phage in the artificially infecting bacterial host. I discuss how this alternative option has the potential to provide what is needed after appropriate platforms are built.

"I feel like death on legs": COVID-19 isolation and mental health

This study investigates the personal and collective responses to COVID-19, as it is described in British personal stories and newspaper reports from Britain and Sri Lanka and examines the social and economic impact of the pandemic on different societies. Although some studies have been done on the impact of COVID-19, none of these studies have focused specifically on the impact the coronavirus has had on different societies because of the global lockdown and restrictions on people’s movements. This study attempts to address this gap in the literature by focusing on how the language used in a corpus of personal stories and newspaper reports collected over a span of one month, reveal the impact of COVID-19 on two societies by investigating how self-isolation and lockdown is leading to mental health breakdown in individuals and affecting wider social and economic collapse. The data was analysed using corpus linguistics methodology such as keyword analysis using AntConc (Anthony, 2019) and Linguistic Inquiry and Word Count (LIWC) (Pennebaker Conglomerates, 2015). The findings from LIWC shows that the enforced self-isolation is leading to mental health breakdown. The analysis of the news reports show that Britain’s priorities are centred on the economy whereas Sri Lankan newspapers focus on educating people about the severity of COVID-19.