Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan

Healthcare policies, precautionary measures and outcomes of mass gathering events in the era of COVID-19 pandemic: Expedited review

With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.

From Archipelago to Pandemic Battleground: Unveiling Indonesia's COVID-19 Crisis

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to countries worldwide, including Indonesia. With its unique archipelagic geography consisting of more than 17,000 thousand islands, Indonesia faces unique complexities in managing the spread of the virus. Based on existing literature, this review article elaborates on key issues that have shaped Indonesia's COVID-19 response. The article begins by examining the early stages of the COVID-19 pandemic in Indonesia, along with the implementation of various preventive measures and the impact of the virus on public health. This article examines how Indonesia's socio-economic factors have generally influenced its healthcare system and further delves into the COVID-19 response strategies implemented by the Indonesian government and public health authorities as well as overall crisis preparedness. It discusses the actions taken to control the spread of the virus, including testing strategies and vaccination efforts. The difficulties encountered in implementing these measures are presented. In conclusion, this review article provides a comprehensive understanding of the COVID-19 crisis in Indonesia, covering facts on multiple dimensions ranging from the timeline of the pandemic to vaccination efforts, epidemiology, socio-economic implications, testing strategies, mobility patterns, public holidays, the impact of working from home, and the utilization of complementary and alternative medicine in addition to the standard of care for COVID-19. The insights gained from this article can complement future strategies for pandemic management and response in Indonesia and other countries facing similar challenges.

Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan

BACKGROUND

We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started.

METHODS

Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation.

RESULTS

Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging.

CONCLUSIONS

During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection.

Super-spreaders of novel coronaviruses that cause SARS, MERS and COVID-19: A systematic review

PURPOSE

Most index cases with novel coronavirus infections transmit disease to just one or two other individuals, but some individuals "super-spread"-they infect many secondary cases. Understanding common factors that super-spreaders may share could inform outbreak models, and be used to guide contact tracing during outbreaks.

METHODS

We searched in MEDLINE, Scopus, and preprints to identify studies about people documented as transmitting pathogens that cause SARS, MERS, or COVID-19 to at least nine other people. We extracted data to describe them by age, sex, location, occupation, activities, symptom severity, any underlying conditions, disease outcome and undertook quality assessment for outbreaks published by June 2021.

RESULTS

The most typical super-spreader was a male age 40+. Most SARS or MERS super-spreaders were very symptomatic, the super-spreading occurred in hospital settings and frequently the individual died. In contrast, COVID-19 super-spreaders often had very mild disease and most COVID-19 super-spreading happened in community settings.

CONCLUSIONS

SARS and MERS super-spreaders were often symptomatic, middle- or older-age adults who had a high mortality rate. In contrast, COVID-19 super-spreaders tended to have mild disease and were any adult age. More outbreak reports should be published with anonymized but useful demographic information to improve understanding of super-spreading, super-spreaders, and the settings in which super-spreading happens.

Evaluating Research Impact Based on Semantic Scholar Highly Influential Citations, Total Citations, and Altmetric Attention Scores: The Quest for Refined Measures Remains Illusive

Background: The evaluation of scholarly articles’ impact has been heavily based on the citation metrics despite the limitations of this approach. Therefore, the quest for meticulous and refined measures to evaluate publications’ impact is warranted. Semantic Scholar (SS) is an artificial intelligence-based database that allegedly identifies influential citations defined as “Highly Influential Citations” (HICs). Citations are considered highly influential according to SS when the cited publication has a significant impact on the citing publication (i.e., the citer uses or extends the cited work). Altmetrics are measures of online attention to research mined from activity in online tools and environments. Aims: The current study aimed to explore whether SS HICs provide an added value when it comes to measuring research impact compared to total citation counts and Altmetric Attention Score (AAS). Methods: Dimensions was used to generate the dataset for this study, which included COVID-19-related scholarly articles published by researchers affiliated to Jordanian institutions. Altmetric Explorer was selected as an altmetrics harvesting tool, while Semantic Scholar was used to extract details related to HICs. A total of 618 publications comprised the final dataset. Results: Only 4.57% (413/9029) of the total SS citations compiled in this study were classified as SS HICs. Based on SS categories of citations intent, 2626 were background citations (29.08%, providing historical context, justification of importance, and/or additional information related to the cited paper), 358 were result citations (3.97%, that extend on findings from research that was previously conducted), and 263 were method citations (2.91%, that use the previously established procedures or experiments to determine whether the results are consistent with findings in related studies). No correlation was found between HICs and AAS (r = 0.094). Manual inspection of the results revealed substantial contradictions, flaws, and inconsistencies in the SS HICs tool. Conclusions: The use of SS HICs in gauging research impact is significantly limited due to the enigmatic method of its calculation and total dependence on artificial intelligence. Along with the already documented drawbacks of total citation counts and AASs, continuous evaluation of the existing tools and the conception of novel approaches are highly recommended to improve the reliability of publication impact assessment.

The battle against COVID-19 in Jordan: A cross-sectional study assessing the experience of Jordanians who have been infected with COVID-19

Background

Patients infected with coronavirus have new experiences and hence needs from the healthcare sector. Pharmacists can play vital roles in adopting innovative strategies to meet such needs.

Objectives

To assess the experience of people who have been infected with coronavirus, and to assess the roles played by pharmacists to meet their new needs.

Methods

This descriptive cross-sectional online survey was developed based on previous literature, validated, and conducted in Jordan (3-13 May 2021).

Results

The mean age of the study participants (n=470) was 34.31 years (SD=11.75). About three-quarters were females. Out of the study participants, 24.0% reported to having been infected with the coronavirus previously, and 48.9% of them were infected after contacting an infected family member/friend. Only 36.0% ranked their commitment to the preventative measures as "very committed" before getting infected. The most reported symptom was fatigue (77.1%). The most used medicine/supplement was vitamin C (85.3%), followed by pain relievers (77.7%), and zinc tablets (75.3%). More than half of the participants (66.4%) documented that their anxiety and stress levels increased during their infection. More than half of the participants (53.7%) strongly agreed/agreed that pharmacists had an important and effective role during their infection.

Conclusion

The experience of individuals who contracted the coronavirus indicated that few were very committed to preventative measures before getting infected. Fatigue was the main experienced symptom, while vitamin C was the supplement used the most. About half of the participants believed that pharmacists have an important role in managing their needs during their COVID-19 infection.

Religion, Islam, and Compliance with COVID-19 Best Practices

While many have implemented best practices intended to help stem the spread of COVID-19, there are also a substantial number of citizens, both domestically and abroad, who have resisted these practices. We argue that public health authorities, as well as scientific researchers and funders, should help address this resistance by putting greater effort into ascertaining how existing religious practices and beliefs align with COVID-19 guidelines. In particular, we contend that Euro-American scholars-who have often tended to implicitly favor secular and Christian worldviews-should put added focus on how Islamic commitments may (or may not) support COVID-19 best practices, including practices that extend beyond the domain of support for mental health.

Sources of SARS-CoV-2 transmission in Jordan: Self-reported approach

Background

Understanding the dynamics of virus transmission is essential for controlling the COVID-19 pandemic. Demographic factors could influence transmission of the virus in different communities. Herein, the sources of COVID-19 infection in Jordan were explored. In addition, the effects of demographic factors and the adherence to preventive measures on household transmission were investigated.

Methods

The study recruited Jordanian adults who recovered from COVID-19 from March to July 2021. Using a questionnaire, information about participants’ demographics, level of adherence to personal protective measures, and their perceived source of COVID-19 infection were collected. Crosstabs were used to test for differences in household transmission ratios between different demographic variables. Logistic regression analysis was used to predict risk factors for household transmission.

Results

The study recruited a total of 2313 participants. Household transmission was the most frequently reported source of infection (44.9%). Other sources of transmission were work/education related (16.0%), friends (8.6%), healthcare facilities (4.8%), social/event gathering (3.1%), shopping activities (2.2%), and public transport (1.6%). Significantly higher ratios of household transmission were reported by older adults (>60 years), college/university students, and female participants. No significant difference in household transmission was found between low-income and medium-high income groups. A significant increase in household transmission ratios was found with increased adherence to mask-wearing and social distancing. This could be a reflection of the reduced risk of community transmission with increased adherence to these preventive measures, coupled with the difficulty in adhering to these measures within the household setting. In multivariate logistic regression, females, young adults (18–30 years), older adults (>60 years), and those who adhere to mask-wearing most of the time were associated with an increased risk of infection in the household setting.

Conclusion

The results reported in the current study provided an insight into the transmission dynamics of the virus in Jordan, as an example of the MENA region. These findings could be invaluable for the future design of public health policies to control COVID-19 and possibly future pandemics.

A post-occupancy study of ventilation effectiveness from high-resolution CO2 monitoring at live theatre events to mitigate airborne transmission of SARS-CoV-2

Mass-gathering events were closed around the world in 2020 to minimise the spread of the SARS-CoV-2 virus. Emerging research on the transmission of SARS-CoV-2 emphasised the importance of sufficient ventilation. This paper presents the results of an indoor air quality (IAQ) monitoring study over 82 events in seven mechanically ventilated auditoria to support the UK government Events Research Programme. Indoor carbon dioxide concentration was measured at high resolution before, during, and after occupancy to allow for assessment of the ventilation systems. Generally, good indoor air quality was measured in all auditoria, with average IAQ found to be excellent or very good for 70% of spaces. In some auditoria, spatial variation in IAQ was identified, indicating poor mixing of the air. In addition, surface and air samples were taken and analysed for the presence of bacteria by culture and SARS-CoV-2 using RT-qPCR in one venue. SARS-CoV-2 RNA was detected on a small number of surfaces at very low copy numbers, which are unlikely to pose an infection risk. Under the ventilation strategies and occupancy levels investigated, it is likely that most theatres pose a low risk of long-range transmission of COVID-19.

Travel in the Time of COVID: A Review of International Travel Health in a Global Pandemic

Purpose of Review

This review critically considers the impact of the COVID-19 pandemic on global travel and the practice of travel medicine, highlights key innovations that have facilitated the resumption of travel, and anticipates how travel medicine providers should prepare for the future of international travel.

Recent Findings

Since asymptomatic transmission of the virus was first recognized in March 2020, extensive efforts have been made to characterize the pattern and dynamics of SARS-CoV-2 transmission aboard commercial aircraft, cruise ships, rail and bus transport, and in mass gatherings and quarantine facilities. Despite the negative impact of further waves of COVID-19 driven by the more transmissible Omicron variant, rapid increases of international tourist arrivals are occurring and modeling anticipates further growth. Mitigation of spread requires an integrated approach that combines masking, physical distancing, improving ventilation, testing, and quarantine. Vaccines and therapeutics have played a significant role in reopening society and accelerating the resumption of travel and further therapeutic innovation is likely.

Summary

COVID-19 is likely to persist as an endemic infection, and surveillance will assume an even more important role. The pandemic has provided an impetus to advance technology for telemedicine, to adopt mobile devices and GPS in contact tracing, and to apply digital applications in research. The future of travel medicine should continue to harness these novel platforms in the clinical, research, and educational arenas.

Effect of COVID-19 pandemic on presentation and referral patterns of newly diagnosed children with type 1 diabetes in a developing country

OBJECTIVES

The global spread of coronavirus disease 2019 (COVID-19), had a great impact on patients worldwide, including those with chronic diseases. We aim to study the effect of COVID-19 pandemic on presentation patterns of patients with type 1 diabetes (T1D) in Jordan, as an example a developing country with limited resources.

METHODS

Medical charts were reviewed for patients presented with new-onset T1D to Jordan University hospital during the first year of pandemic and the preceding year. Categorical data were compared using Pearson Chi-Square and Fisher's exact test. Continuous data were compared using the Independent Sample t-Test.

RESULTS

A total of 137 children were diagnosed with T1D during the study period, with 60.6% of those children were diagnosed in the pre-pandemic year compared to 39.4% during the first year of pandemic, p-value=0.013. Percentage of patients diagnosed with DKA as first presentation of T1D during the pre-pandemic year was 34.9% compared to 51.9% during the pandemic year, p-value=0.049. Significant differences in family monthly income (p-value=0.006) and paternal education level (p-value=0.036) were found between children with DKA and those without DKA in the pre-pandemic year, but they were not significant during the pandemic year.

CONCLUSIONS

The unprecedented COVID-19 pandemic had affected presentation pattern of newly diagnosed T1D patients, manifested by lower number of children diagnosed with T1D and higher percentage of DKA as first presentation compared to the preceding year. Health care services should be at utmost preparedness for possible future waves and other pandemics.

Consensus, convergence, and COVID-19: The ethical role of religious reasons in leaders' response to COVID-19

Focusing on current efforts to persuade the public to comply with COVID-19 best practices, this essay examines what role appeals to religious reasons should (or should not) play in leaders' attempts to secure followers' acceptance of group policies in contexts of religious and moral pluralism. While appeals to followers' religious commitments can be helpful in promoting desirable public health outcomes, they also raise moral concerns when made in the contexts of secular institutions with religiously diverse participants. In these contexts, leaders who appeal to religious reasons as bases of justification for imposing COVID policies may seem to fail to show respect for the autonomy of those who lack the relevant religious commitments, and-especially when a leader herself rejects the religious commitments she makes reference to to persuade others-her appeals to religious reasons may seem to constitute ethically problematic exercises of manipulation. This essay draws on the resources of contemporary political philosophy to analyze and respond to these concerns and concludes that they are not sufficiently well-founded. To the contrary, it contends that there are good moral grounds for leaders to appeal to religious reasons as (partial) bases of justification for why followers should accept COVID policies. In the course of the argument, this essay also highlights how contemporary political theory can enrich discussions about the distinctions between coercion, manipulation, and leadership. It thereby give insight not only into the ethics of leadership but also-at least by the lights of central theories of leadership like that of James MacGregor Burns (1978)-into whether and how appeals to religious reasons can figure into genuine exercises of leadership, in contrast with mere instances of the wielding of social power.

SARS-CoV-2 Transmission and Prevention in the Era of the Delta Variant

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant transmits much more rapidly than prior SARS-CoV-2 viruses. The primary mode of transmission is via short range aerosols that are emitted from the respiratory tract of an index case. There is marked heterogeneity in the spread of this virus, with 10% to 20% of index cases contributing to 80% of secondary cases, while most index cases have no subsequent transmissions. Vaccination, ventilation, masking, eye protection, and rapid case identification with contact tracing and isolation can all decrease the transmission of this virus.

Preventing the Growing Transmission of COVID Clusters: An Integration of the Maslow's Hierarchy of Needs in the Risk Chain

PURPOSE

China's success in containing the coronavirus is an ongoing process of identifying loopholes and refining the management in the COVID-19 risk chain. This article discusses the role of personal needs in epidemic control and linked psychological needs with management measures to propose intervention advice on curbing viral transmission in a systematic way.

METHODS

Based on case studies, we showed the integration of the Maslow's Hierarchy of Needs in the COVID-19 risk chain. The analysis combined the micro-view from individual needs and macro influences from governmental measures. The proposed chain of vulnerabilities could help identify critical links of COVID-19 crisis management in case that cascading effects such as super-spread can be intercepted in time.

RESULTS

The article mainly focused on curbing the viral transmission timely whenever cluster of cases resurge. Considering the triggered activities from personal needs may facilitate the spread, minimizing the impact scale while managing the crisis could start with protecting vulnerable population, well governing potential hotspots, and necessary restrictions on group activities. Besides, "individual" protections combined with "institutional" solutions are strongly advocated. The worst scenario would be the governance link slackened or made mistakes, together with delayed identification, plus unprotected way of living and gathering. In order to cut the transmission in time, besides virus-blocking strategies and vaccination approach, screening measures in combination with the satisfaction of personal needs would help identify confirmed cases earlier. Publicizing the model citizen of being responsible could show needs' satisfaction can live with the virus elimination. At the emergency response stage, it is also crucial to secure fewer loopholes in the health system and strengthen the self-protection barrier by all means.

CONCLUSION

China's experience offers a reference for the balance between the resurgence of clustered cases and sustained recovery. As long as the global pandemic continues, its impact on personal activities will not stop, and vice versa. The chain of vulnerabilities integrating psychological needs into the COVID-19 risk management can provide clear clues for cutting further transmission in an efficient and more socially acceptable way.

A Review of Infectious Diseases Associated with Religious and Nonreligious Rituals

Rituals are an integral part of human life but a wide range of rituals (both religious and non-religious), from self-flagellation to blood brotherhood to ritual sprinkling of holy water, have been associated with transmission of infections. These infections include angiostrongyliasis, anthrax, brucellosis, cholera, COVID-19, cutaneous larva migrans, Ebola, hepatitis viruses, herpes simplex virus, HIV, human T-cell leukemia virus (HTLV), kuru, Mycobacterium bovis, Naegleria fowleri meningoencephalitis, orf, rift valley fever, and sporotrichosis. Education and community engagement are important cornerstones in mitigating infectious risks associated with rituals.

Secondary attack rate of COVID-19 among contacts and risk factors, Tamil Nadu, March-May 2020: a retrospective cohort study

OBJECTIVE

To describe the characteristics of contacts of patients with COVID-19 case in terms of time, place and person, to calculate the secondary attack rate (SAR) and factors associated with COVID-19 infection among contacts.

DESIGN

A retrospective cohort study SETTING AND PARTICIPANTS: Contacts of cases identified by the health department from 14 March 2020to 30 May 2020, in 9 of 38 administrative districts of Tamil Nadu. Significant proportion of cases attended a religious congregation.

OUTCOME MEASURE

Attack rate among the contacts and factors associated with COVID-19 positivity.

RESULTS

We listed 15 702 contacts of 931 primary cases. Of the contacts, 89% (n: 14 002) were tested for COVID-19. The overall SAR was 4% (599/14 002), with higher among the household contacts (13%) than the community contacts (1%). SAR among the contacts of primary cases with congregation exposure were 5 times higher than the contacts of non-congregation primary cases (10% vs 2%). Being a household contact of a primary case with congregation exposure had a fourfold increased risk of getting COVID-19 (relative risk (RR): 16.4; 95% CI: 13 to 20) than contact of primary case without congregation exposure. Among the symptomatic primary cases, household contacts of congregation primaries had higher RR than household contacts of other cases ((RR: 25.3; 95% CI: 10.2 to 63) vs (RR: 14.6; 95% CI: 5.7 to 37.7)). Among asymptomatic primary case, RR was increased among household contacts (RR: 16.5; 95% CI: 13.2 to 20.7) of congregation primaries compared with others.

CONCLUSION

Our study showed an increase in disease transmission among household contacts than community contacts. Also, symptomatic primary cases and primary cases with exposure to the congregation had more secondary cases than others.

"Mass gathering events and COVID-19 transmission in Borriana (Spain): A retrospective cohort study"

OBJECTIVE

Mass gathering events (MGEs) are associated with the transmission of COVID-19. Between 6 and 10 March 2020, several MGEs related to the Falles festival took place in Borriana, a municipality in the province of Castellon (Spain). The aim of this study was to estimate the incidence of COVID-19 and its association with these MGEs, and to quantify the potential risk factors of its occurrence.

METHODS

During May and June 2020, a population-based retrospective cohort study was carried out by the Public Health Center of Castelló and the Hospital de la Plana in Vila-real. Participants were obtained from a representative sample of 1663 people with potential exposure at six MGEs. A questionnaire survey was carried out to obtain information about attendance at MGEs and COVID-19 disease. In addition, a serologic survey of antibodies against SARS-Cov-2 was implemented. Inverse probability weighted regression was used in the statistical analysis.

RESULTS

A total of 1338 subjects participated in the questionnaire survey (80.5%), 997 of whom undertook the serologic survey. Five hundred and seventy cases were observed with an attack rate (AR) of 42.6%; average age was 36 years, 62.3% were female, 536 cases were confirmed by laboratory tests, and 514 cases were found with SARS-CoV-2 total antibodies. Considering MGE exposure, AR was 39.2% (496/1264). A dose-response relationship was found between MGE attendance and the disease, (adjusted relative risk [aRR] = 4.11 95% confidence interval [CI]3.25-5.19). Two MGEs with a dinner and dance in the same building had higher risks. Associated risk factors with the incidence were older age, obesity, and upper and middle class versus lower class; current smoking was protective.

CONCLUSIONS

The study suggests the significance of MGEs in the COVID-19 transmission that could explain the subsequent outbreak in Borriana.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Setting-specific Transmission Rates: A Systematic Review and Meta-analysis

BACKGROUND

Understanding the drivers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is crucial for control policies, but evidence of transmission rates in different settings remains limited.

METHODS

We conducted a systematic review to estimate secondary attack rates (SARs) and observed reproduction numbers (Robs) in different settings exploring differences by age, symptom status, and duration of exposure. To account for additional study heterogeneity, we employed a beta-binomial model to pool SARs across studies and a negative-binomial model to estimate Robs.

RESULTS

Households showed the highest transmission rates, with a pooled SAR of 21.1% (95% confidence interval [CI]:17.4-24.8). SARs were significantly higher where the duration of household exposure exceeded 5 days compared with exposure of ≤5 days. SARs related to contacts at social events with family and friends were higher than those for low-risk casual contacts (5.9% vs 1.2%). Estimates of SARs and Robs for asymptomatic index cases were approximately one-seventh, and for presymptomatic two-thirds of those for symptomatic index cases. We found some evidence for reduced transmission potential both from and to individuals younger than 20 years of age in the household context, which is more limited when examining all settings.

CONCLUSIONS

Our results suggest that exposure in settings with familiar contacts increases SARS-CoV-2 transmission potential. Additionally, the differences observed in transmissibility by index case symptom status and duration of exposure have important implications for control strategies, such as contact tracing, testing, and rapid isolation of cases. There were limited data to explore transmission patterns in workplaces, schools, and care homes, highlighting the need for further research in such settings.

Family medicine practice challenges during Covid-19 outbreak, curfew and phased re-opening, lessons to be learned from jordanian experience

Background

Rapid outbreak of Novel Corona Virus Disease (Covid-19) had a significant disrupts and challenges to many of well-established, traditional structure of medical Care, The family medicine practice in Jordan as many other countries has been challenged and severely strained due to the pandemic as well as the strict lockdowns and curfew that implanted in order to control the spread of the disease, in which major if not all family medicine outpatient's clinics were temporary suspended which negatively impact proper health care delivery to many patients.

Objective

This is to report the challenges we have been faced in Family medicine practice during Corona virus pandemic and it is related strict lockdowns periods, on both patient's care and education levels.

Methods

A Retrospective review of the family medicine out patient's visits at Jordan University of science and technology medical center before the pandemic, during the Pandemic lockdown and curfew, and after the phased opening and resuming the practice under new safety precautions and measures, results we compared.

•

SARS-CoV-2 is considered a highly contagious virus mainly due to its S spiking protein.

•

Rapid outbreak of Novel Corona Virus Disease (Covid-19) had a significant disrupts and challenges to many of well-established, traditional structure of medical Care.

•

Clear strategies and polices are needed to deal with the known long- and short-term effects of lockdowns on people's health and well-being when planning for the next pandemics in the future.

A Coronavirus Outbreak Linked to a Funeral Among a Romani Community in Central Italy

Background: The epidemic dynamics of COVID-19 in the Molise region, central Italy, has dramatically changed from the beginning of May 2020, which was when infections were reported amongst Romani people. The aims of this study were to describe the characteristics of an outbreak that occurred in the Romani community and the interventions implemented for control.

Methods: A retrospective analysis of outbreak data was performed to describe the SARS-CoV-2 transmission dynamics.

Results: A young Romani woman was the first case reported and epidemiological investigation established a possible link with the funeral of a deceased member of this community. In total, 150 close contacts within 34 family groups in two cities were traced, and 109 (72.7%) Romani individuals were found to be infected by COVID-19. The patient's median age was 31 years, 58% were female, and the highest (20.2%) incidence occurred in the 0–9 years age group. A total of 26 (23.8%) patients developed typical SARS-CoV-2 symptoms, 15 (57.8%) were hospitalized, and 21 (22.1%) had comorbidities [most commonly hypertension (28.6%) and/or coronary heart diseases (23.8%)]. The outbreak was effectively controlled through compulsory quarantine and enhanced active surveillance.

Conclusions: This is the first study providing insight into COVID-19 transmission dynamics among a Romani population living in Italy. These findings support general conclusions about the role of crowded social gatherings in SARS-CoV-2 spread, the high communicability among close contacts and household settings, and the impact of asymptomatic carriers. These features are of relevance to certain Romani customs where family gatherings are a fundamental pillar of their lives. Although difficulties emerged in interacting with Romani people related to cultural drivers, beliefs, and lifestyle, the outbreak management was effective and should be considered as a valuable model applicable to similar incidents occurring in minority populations.

Early warning of vulnerable counties in a pandemic using socio-economic variables

In the U.S. in early 2020, heterogenous and incomplete county-scale data on COVID-19 hindered effective interventions in the pandemic. While numbers of deaths can be used to estimate actual number of infections after a time lag, counties with low death counts early on have considerable uncertainty about true numbers of cases in the future. Here we show that supplementing county-scale mortality statistics with socioeconomic data helps estimate true numbers of COVID-19 infections in low-data counties, and hence provide an early warning of future concern. We fit a LASSO negative binomial regression to select a parsimonious set of five predictive variables from thirty-one county-level covariates. Of these, population density, public transportation use, voting patterns and % African-American population are most predictive of higher COVID-19 death rates. To test the model, we show that counties identified as under-estimating COVID-19 on an early date (April 17) have relatively higher deaths later (July 1) in the pandemic.

Knowledge and attitudes regarding Covid-19 among syrian refugee women in Jordan

OBJECTIVES

To explore knowledge and attitude about Covid-19, among Syrian refugee mothers in the Governorate of Irbid, where the first outbreak of Covid-19 in Jordan took place.

METHODS

This is a cross-section study among Syrian refugee mothers, who were pregnant or having had children. Data was collected through an online questionnaire. The survey link was distributed in April 2020, through the social network's messaging services Facebook and WhatsApp. Contact information was obtained from local community centres and non-governmental organisations in the town of Irbid, the north of Jordan.

RESULTS

In total, 389 Syrian refugee mothers participated in the study. It showed that 66% of mother's access information regarding Covid-19. The main sources of information were Facebook 87%, WhatsApp 69%, television 53%, while 21% indicated that they access professional databases or government websites. In general, Syrian refugee mothers were knowledgeable about Covid-19 transmission and prevention. However, they lacked adequate knowledge about transmission of Covid-19 between the mother and the child, and smoking risks associated with Covid-19.

CONCLUSIONS

There are gaps in the knowledge and attitude of Syrian refugee mothers in the Governorate of Irbid in relation to the Covid-19 pandemic. There is a need for further health education measures.

Superspreading events suggest aerosol transmission of SARS-CoV-2 by accumulation in enclosed spaces

Viral transmission pathways have profound implications for public safety; it is thus imperative to establish a complete understanding of viable infectious avenues. Mounting evidence suggests SARS-CoV-2 can be transmitted via the air; however, this has not yet been demonstrated. Here we quantitatively analyze virion accumulation by accounting for aerosolized virion emission and destabilization. Reported superspreading events analyzed within this framework point towards aerosol mediated transmission of SARS-CoV-2. Virion exposure calculated for these events is found to trace out a single value, suggesting a universal minimum infective dose (MID) via aerosol that is comparable to the MIDs measured for other respiratory viruses; thus, the consistent infectious exposure levels and their commensurability to known aerosol-MIDs establishes the plausibility of aerosol transmission of SARS-CoV-2. Using filtration at a rate exceeding the destabilization rate of aerosolized SARS-CoV-2 can reduce exposure below this infective dose.

The Grand Magal of Touba was spared by the COVID-19 pandemic

In the context of the coronavirus disease-2019 (COVID-19) pandemic, all mass gathering (MG) events have been cancelled. The Grand Magal took place on October 6, 2020, in Touba, Senegal, which was the only MG event organized in 2020. This Muslim pilgrimage gathers about four million Muslim Mourides from Senegal and beyond. No significant increase in COVID-19 cases was therefore observed at the national level in the weeks following the Grand Magal. This successful strategy is an invitation to better promote community commitments by public authorities in their various strategies.

COVID-19 simulation study-the effect of strict non-pharmaceutical interventions (NPIs) on controlling the spread of COVID-19

BACKGROUND

From the beginning of 2020, COVID-19 infection has changed our lives in many aspects and introduced limitations in the way people interact and communicate. In this paper, we are evaluating the effect of non-pharmaceutical interventions (NPI) in limiting the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 pandemic during a wedding ceremony from Irbid, Northern Jordan. Agent-based modeling was used in a real wedding event that occurred at the beginning of the spread of the pandemic in Jordan. Two infected nationals of Jordan, who arrived in Jordan about a week before the event, initiated the spread of the pandemic within the contact community.

METHODS

In this work, a strict national NPI that the government implemented is developed by using an abstract model with certain characteristics similar to the Jordanian community. Thus, the Jordanian community is represented in terms of ages, occupations, and population movements. After that, the extent of the impact of the NPI measures on the local community is measured.

RESULTS

We observed the deterioration of the state of society while the epidemic is spreading among individuals in the absence of preventive measures. Also, the results show that the herd immunity case was an epidemic, with a high level of spread among the community with 918 cases during a short interval of time. On the other hand, the preventive measures scenario shows a totally controlled spread with only 74 cases applied on the same interval of time. Furthermore, a convergence in the actual results of the real system with the hypothetical system were detected in the case of applying the strict NPI measures. Finally, strict NPI at the community level following social gatherings seem to be effective measures to control the spread of the COVID- 19 pandemic.

Cultural values predict national COVID-19 death rates

National responses to a pandemic require populations to comply through personal behaviors that occur in a cultural context. Here we show that aggregated cultural values of nations, derived from World Values Survey data, have been at least as important as top-down government actions in predicting the impact of COVID-19. At the population level, the cultural factor of cosmopolitanism, together with obesity, predict higher numbers of deaths in the first two months of COVID-19 on the scale of nations. At the state level, the complementary variables of government efficiency and public trust in institutions predict lower death numbers. The difference in effect between individual beliefs and behaviors, versus state-level actions, suggests that open cosmopolitan societies may face greater challenges in limiting a future pandemic or other event requiring a coordinated national response among the population. More generally, mass cultural values should be considered in crisis preparations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43545-021-00080-2.

Viral Clearance Course of COVID-19 Outbreaks

Background

Coronavirus disease 2019 (COVID-19) viral course and behavior remain unpredictable. This study describes incubation time and viral clearance of COVID-19 hospitalized cases in Northern Jordan.

Methods

All COVID-19 confirmed cases hospitalized from March 15 to June 09, 2020, were included. Nasopharyngeal swabs were collected, and COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) was performed every two days in all cases. The viral cure was defined when two negative RT-PCR tests were obtained ≥ 24 hours apart. Viral clearance time (VCT) reflects the time from the first positive nasopharyngeal swab to the first of two consecutive negative tests.

Results

In this cohort, a total of 157 patients were included. Most cases resulted from two major outbreaks. The median incubation period was 6 days (IQR, 3-10) and ranged from 1 to 17 days. The median VCT was 13 days (IQR, 7-2) and ranged from 1 to 40 days. Symptomatic presentation and abnormal chest radiograph were predictors for a prolonged VCT (p=0.015 and p=0.014, respectively). The median time of resolution of symptoms was 7 days (IQR, 3-10 days). Most symptomatic cases (91.7%) remained RT-PCR positive for up to 20 days after symptoms resolution, with a median of 13.5 days. VCT significantly correlated with the incubation period (p=0.013).

Conclusion

Viral cure lagged for as long as 20 days after resolution of symptoms. Continuing with social-distancing, frequent hand hygiene, and wearing facial mask remains essential and is recommended even after clinical resolution of symptoms.

COVID-19 presenting as intussusception in infants: A case report with literature review

The novel Corona virus disease 2019 (COVID-19) first presented in Wuhan, China. The virus was able to spread throughout the world, causing a global health crisis. The virus spread widely in Jordan after a wedding party held in northern Jordan. In most cases of COVID-19 infection, respiratory symptoms are predominant. However, in rare cases the disease may present with non-respiratory symptoms. The presentation of COVID-19 as a case of intussusception in children is a strange and rare phenomenon. We present here a case of a two-and-a-half month old male baby who was brought to hospital due to fever, frequent vomiting, dehydration and blood in stool. He was diagnosed as intussusception. The child was tested for corona due to the large societal spread of the virus and because he was near his mother, who was suffering from symptoms similar to corona or seasonal flu (she did not conduct a corona test). Patient was treated without surgery and recovered quickly. The COVID-19 infection was without respiratory symptoms, and there was no need for the child to remain in hospital after treatment of intussusception. The relationship between viruses, mesenteric lymphoid hyperplasia, and intussusception is a confirmed relation. ACE2 is the key receptor required for SARA-COV-2 to enter the host cells. ACE2 has been also found in the brush border of the intestinal mucosa, as well as it is a key inflammatory regulator in the intestine. This may suggest that SARSA-COV-2 could invade the respiratory tract as well as gastrointestinal tract or both. Few case reports documented the presentation of COVID-19 as intussusception in children. In the light of the wide-spread of corona virus, performing COVID-19 tests for children with intussusception can help linking the two entities. Development of gastrointestinal symptoms in COVID-19 positive children should raise concern about the development of intussusception.

The impact of COVID-19 outbreak on otolaryngology practice, jordanian experience: A qualitative study

BACKGROUND

In response to the rapid spread of coronavirus disease 2019 (COVID-19) caused by "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2), many countries including Jordan have implemented strict lockdowns. These lockdowns were associated with temporary suspension of all outpatient clinics and all elective (Non emergent, non-oncologic) surgical procedures.

OBJECTIVE

We aimed to report the impact of COVID-19 outbreak on otolaryngology practice in Jordan.

METHODS

Retrospectively we reviewed all admissions to the otolaryngology wards of King Abdullah University Hospital during the lockdown and for the same dates for the year 2019, results were compared.Additionally, an online questionnaire was sent to a sample of Jordanian otolaryngologists in June 2020. The questionnaire was comprised of a series of multiple choice questions regarding each physician's participation in the treatment or screening of COVID-19 patients, the number of consultations during the lockdown, the numbers of elective and emergency surgical procedures performed during the lockdown and the effects the lockdown had on their practices, their patients conditions and teaching and training processes.The study was done in line with the criteria set by the Standards for Reporting Qualitative Research (O'Brien et al., September 2014) [12].

STRENGTHS AND WEAKNESSES

In our study, we aimed to include the experience of all otolaryngology practitioners in Jordan, providing a comprehensive view of the lockdown effects on practice in the region. The data found is likely representative of lockdown effects on all departments, not just otolaryngological practice, and may be beneficial in providing a pathway to minimize any negative impact on patient care.However, our data may be limited due to its dependence on responses through a Whatsapp questionnaire, with no guarantee that the answers provided are fully accurate. It also may have a certain degree of sampling bias, as while the questionnaire was sent to all ENT practitioners in Jordan, answering it was totally optional, and so people who did not respond to the survey were not accounted for.

RESULTS

During the lockdown period in Jordan all outpatient clinics were closed, and all elective surgical procedures (non-emergency and non-oncologic procedures) were suspended. During the lockdown it was observed that there was a reduction in the number of admissions related to post-operative complications, head and neck abscesses & infections and foreign bodies related admission when compared to the same period of 2019.A total of 144 otolaryngologists have participated in the questionnaire part of the study. More than half of the participants (n = 80, 55.6%) reported providing 10 or less consultations during the lockdown, more than half of the them have not performed any emergency surgical procedures during the lockdown, and a total of 110 (76.4%) of the 144 participants reported having at least 1 patient whose condition worsened during the lockdown due to lack or delay in medical care.

CONCLUSION

The COVID-19 pandemic, and the resultant lockdown period in Jordan has caused a significant shift in otolaryngological practice throughout the country, with a complete cessation of all outpatient clinics and elective surgical procedures and admissions, with activity being limited to oncological and emergency procedures only. These changes have already impacted the dynamics of patient care and might lead to a risk of diagnostic delays which will have severe impacts on patient's health.

Undetected infectives in the Covid-19 pandemic

Objectives

Epidemiological investigations and mathematical models have revealed that the rapid diffusion of Covid-19 can mostly be attributed to undetected infective individuals who continue to circulate and spread the disease: finding their number would be of great importance in the control of the epidemic.

Methods

The dynamics of an infection can be described by the SIR model, which divides the population into susceptible (S), infective I, and removed R subjects. In particular, we exploited the Kermack-McKendrick epidemic model, which can be applied when the population is much larger than the fraction of infected subjects.

Results

We proved that the fraction of undetected infectives, compared to the total number of infected subjects, is given by 1−1R0, where R0 is the basic reproduction number. The mean value R0=2.10 2.09-2.11 for the Covid-19 epidemic in three Italian regions yielded a percentage of undetected infectives of 52.4% (52.2%–52.6%) compared to the total number of infectives.

Conclusions

Our results, straightforwardly obtained from the SIR model, highlight the role of undetected carriers in the transmission and spread of the SARS-CoV-2 infection. Such evidence strongly recommends careful monitoring of the infective population and ongoing adjustment of preventive measures for disease control until a vaccine becomes available for most of the population.

Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), has spread globally in a few short months. Substantial evidence now supports preliminary conclusions about transmission that can inform rational, evidence-based policies and reduce misinformation on this critical topic. This article presents a comprehensive review of the evidence on transmission of this virus. Although several experimental studies have cultured live virus from aerosols and surfaces hours after inoculation, the real-world studies that detect viral RNA in the environment report very low levels, and few have isolated viable virus. Strong evidence from case and cluster reports indicates that respiratory transmission is dominant, with proximity and ventilation being key determinants of transmission risk. In the few cases where direct contact or fomite transmission is presumed, respiratory transmission has not been completely excluded. Infectiousness peaks around a day before symptom onset and declines within a week of symptom onset, and no late linked transmissions (after a patient has had symptoms for about a week) have been documented. The virus has heterogeneous transmission dynamics: Most persons do not transmit virus, whereas some cause many secondary cases in transmission clusters called "superspreading events." Evidence-based policies and practices should incorporate the accumulating knowledge about transmission of SARS-CoV-2 to help educate the public and slow the spread of this virus.

Impact of COVID-19 lockdown on children with asthma in Jordan: a parental questionnaire

OBJECTIVE

To evaluate the impact of a 10-week lockdown on children with asthma aged 4-17 years in terms of presentations to the emergency department (ED), frequency of admissions, compliance with medications and changes in pulmonary function testing results.

DESIGN AND SETTING

A questionnaire-based cross-sectional study using Google Forms to collect parents' and caregivers' responses after they consented to participation.

RESULTS

A total of 374 parents/caregivers were contacted and 297 (79%) responded. The majority of the children were male (188 or 63%) and 49.8% were aged 7-12 years. More than half of the participants (194 or 65%) reported improved compliance with medications and spacer use. There was a significant reduction in the number of presentations to the ED from 137 to 80 and admissions to hospital from 56 to 24 during the 10-week lockdown period compared with the same time period in the previous year (p≤0.0001). Around 25% of the participants used telemedicine by phone and social media applications for communication with their treating physician and 59 (80%) described it as easy and smooth.

CONCLUSION

The national lockdown in Jordan due to the COVID-19 pandemic was associated with a fall in emergency presentations and hospital admissions for acute asthma exacerbations. Parental responses indicate that fears focused around COVID-19 were associated with enhanced compliance with use preventer medications during the lockdown.

Clinical characteristics and predictors of the duration of hospital stay in COVID-19 patients in Jordan

Background: On March 11th, 2020, the World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19) as a global pandemic. Healthcare systems in low- and middle-income countries may face serious limitations during a pandemic, for which understanding the predictors of prolonged hospital stay are crucial in decreasing the mortality rate. The aim of this study was to investigate the predictors of increased length of hospitalization among COVID-19 patients. Methods: In this prospective study, we investigated the effect of presenting symptoms and laboratory investigations on the duration of hospitalization of 131 COVID-19 patients at a tertiary hospital in Jordan from March 17th to April 9th, 2020. Results: Patients median age was 24 years [interquartile range (IQR): 8-39], of which 67 (51.15%) were males and 64 (48.85%) were females. Smokers had shorter in-hospital stay (OR: -3.52; 95% CI: -6.73 to -0.32; P=0.03). Taste loss (OR: 5.1; 95% CI: 1.95 to 8.25; P<0.01) and chills or rigors (OR: 4.08; 95% CI: 0.73 to 7.43; P=0.02) were the symptoms significantly associated with increased in-hospital stay, while those who had malaise (OR: -4.98; 95% CI: -8.42 to -1.59; P<0.01) and high white blood cell (WBC) count (OR: -0.74; 95% CI: -1.31 to -0.17; P=0.01) had faster recovery. Conclusions: Our study found that the most common presenting symptoms of COVID-19 are cough, malaise, and headache. Smoking, presenting with malaise or elevated WBCs were associated with shorter hospital stay, while loss of taste and chills or rigors at presentation were associated with a longer in-hospital stay.

Bat-Borne Coronaviruses in Jordan and Saudi Arabia: A Threat to Public Health?

Emerging infectious diseases are of great concern to public health, as highlighted by the ongoing coronavirus disease 2019 (COVID-19) pandemic. Such diseases are of particular danger during mass gathering and mass influx events, as large crowds of people in close proximity to each other creates optimal opportunities for disease transmission. The Hashemite Kingdom of Jordan and the Kingdom of Saudi Arabia are two countries that have witnessed mass gatherings due to the arrival of Syrian refugees and the annual Hajj season. The mass migration of people not only brings exotic diseases to these regions but also brings new diseases back to their own countries, e.g., the outbreak of MERS in South Korea. Many emerging pathogens originate in bats, and more than 30 bat species have been identified in these two countries. Some of those bat species are known to carry viruses that cause deadly diseases in other parts of the world, such as the rabies virus and coronaviruses. However, little is known about bats and the pathogens they carry in Jordan and Saudi Arabia. Here, the importance of enhanced surveillance of bat-borne infections in Jordan and Saudi Arabia is emphasized, promoting the awareness of bat-borne diseases among the general public and building up infrastructure and capability to fill the gaps in public health preparedness to prevent future pandemics.

SARS-CoV-2 outbreak investigation in a German meat processing plant

We describe a multifactorial investigation of a SARS-CoV-2 outbreak in a large meat processing complex in Germany. Infection event timing, spatial, climate and ventilation conditions in the processing plant, sharing of living quarters and transport, and viral genome sequences were analyzed. Our results suggest that a single index case transmitted SARS-CoV-2 to co-workers over distances of more than 8 m, within a confined work area in which air is constantly recirculated and cooled. Viral genome sequencing shows that all cases share a set of mutations representing a novel sub-branch in the SARS-CoV-2 C20 clade. We identified the same set of mutations in samples collected in the time period between this initial infection cluster and a subsequent outbreak within the same factory, with the largest number of confirmed SARS-CoV-2 cases in a German meat processing facility reported so far. Our results indicate climate conditions, fresh air exchange rates, and airflow as factors that can promote efficient spread of SARS-CoV-2 via long distances and provide insights into possible requirements for pandemic mitigation strategies in industrial workplace settings.

SARS-CoV-2 outbreak investigation in a German meat processing plant

We describe a multifactorial investigation of a SARS-CoV-2 outbreak in a large meat processing complex in Germany. Infection event timing, spatial, climate and ventilation conditions in the processing plant, sharing of living quarters and transport, and viral genome sequences were analyzed. Our results suggest that a single index case transmitted SARS-CoV-2 to co-workers over distances of more than 8 m, within a confined work area in which air is constantly recirculated and cooled. Viral genome sequencing shows that all cases share a set of mutations representing a novel sub-branch in the SARS-CoV-2 C20 clade. We identified the same set of mutations in samples collected in the time period between this initial infection cluster and a subsequent outbreak within the same factory, with the largest number of confirmed SARS-CoV-2 cases in a German meat processing facility reported so far. Our results indicate climate conditions, fresh air exchange rates, and airflow as factors that can promote efficient spread of SARS-CoV-2 via long distances and provide insights into possible requirements for pandemic mitigation strategies in industrial workplace settings.

Hajj and Umrah Mass Gatherings and COVID-19 Infection

Purpose of Review

We discuss the risk of COVID-19 in religious mass gathering events including Hajj and Umrah pilgrimages.

Recent Findings

The risk of transmission of respiratory viruses including COVID-19 is particularly high due to the overcrowding conditions at the Hajj and Umrah. The profile of the Hajj pilgrims who tend to be older and with multiple comorbidities corresponds to that of individuals at risk for severe COVID-19. In order to avoid a COVID-19 outbreak with potential spreading to many countries through returning pilgrims, Saudi Arabia suspended the Umrah, and access to the 2020 Hajj was very limited.

Summary

A clear relation between early suspension of religious mass gatherings and lower occurrence of COVID-19 transmission in countries that took such measures promptly was noticed. There are lessons to national and international health organizations for other mass gatherings in the context of the pandemic.

Epidemiologic and Clinical Characteristics of COVID-19 Patients from a Quarantine Center in a Developing Community: A Retrospective Study

Purpose

Coronavirus disease 2019 (COVID-19) is an ongoing infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) agent, and is generally known as novel coronavirus. The impact of the disease has had apparent effects on health, social, and economic levels. This study aimed to investigate the epidemiologic features, clinical presentations, laboratory examination, and outcomes of COVID-19 patients in Jordan.

Patients and Methods

This retrospective study included all COVID-19 patients admitted to the quarantine center at King Abdullah University Hospital in Jordan between March 16 and May 21, 2020. Patient information was abstracted from hospital electronic records and included patient demographics, symptoms, comorbidities, laboratory tests, infection period, and outcome.

Results

Approximately 42% of the quarantined individuals were asymptomatic. The majority of symptomatic patients had mild to moderate symptoms of the disease. Only ten patients (9.3%) had severe symptoms, with one of them progressed to a critical stage and died 15 days after admission. Erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), and D-dimer levels were significantly elevated in many patients. More than two-thirds (69.8%) of the symptomatic patients were females. Elevated ESR and LDH levels, along with longer periods of infection, were significantly associated with symptomatic patients.

Conclusion

A large proportion of Jordanian patients were asymptomatic carriers of the virus. This finding emphasizes the importance of a continuous surveillance process to discover these contagious carriers to control the disease spread. Additionally, we suggest that future analyses should investigate for sexual variation in the inflammatory response to this viral infection since most of our symptomatic patients were females. Finally, the role of ESR and LDH biomarkers should be investigated further for the possibility of earlier identification of patients with greater risk.

The psychosocial and clinical concerns of physicians treating patients with COVID-19

Objectives

This study aims to assess the psychosocial and clinical issues affecting physicians who have been directly involved in treating patients with novel coronavirus (COVID-19).

Methods

We recruited physicians from four hospitals in Jordan. A structured 20-item, self-administered survey was used to gather data. Descriptive statistics were employed to represent the numbers and percentages of the participants' responses to the survey items. Multivariate logistic regression was used to examine the relationship between the participants’ traits and items related to the level of fear, the quality of care provided to patients, and social distancing among family members.

Results

A total of 135 physicians participated; 65.9% were men. More than half reported moderate to high levels of fear (55.5%). The majority (71.1%) were moderately to highly concerned about becoming infected with COVID-19 from the patients they treated. Most physicians practiced adequate social distancing. While most of them thought that COVID-19 patients received a high quality of care, they generally perceived a shortage of specialised physicians and personal protective equipment (PPE). The ratings for the quality of care and social distancing practices were significantly associated with the presence or absence of training related to COVID-19.

Conclusions

The degree of fear and concerns about COVID-19's impact on physicians and their families was high. There were also concerns about the long-term consequences of COVID-19 on medical services.

What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors

INTRODUCTION

Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case.

METHODS

We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test.

RESULTS

43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%).

DISCUSSION

While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.

What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors

INTRODUCTION

Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case.

METHODS

We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test.

RESULTS

43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%).

DISCUSSION

While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.

Caring for a child with type 1 diabetes during COVID-19 lockdown in a developing country: Challenges and parents' perspectives on the use of telemedicine

BACKGROUND AND AIM

Jordan implemented abrupt and extreme lockdown measures to prevent the spread of COVID-19. This study aims to evaluate the effect of these measures on paediatric patients with type 1 diabetes in terms of acute metabolic complications and shortages in insulin and glucose measuring supplies. It also evaluates the caregivers' perceptions of the use of telemedicine during the lockdown.

METHODS

This is a questionnaire-based cross-sectional study. It was completed using Google forms and patients/caregivers were asked to consent if they agreed to answer.

RESULTS

235 patients/families participated in the study. The mean age of the patients was 10.8 years ± 3.9 years (N = 229). Twenty-four children (10.2%) needed to visit the emergency department during the lockdown period which lasted for 10 weeks. Of these, eight (3.4%) were hospitalized due to acute metabolic complications. Families (58.3%) faced insulin shortages and 14% had to ration insulin, i.e., decrease the dose, during the lockdown. Glucose monitoring strips were rationed by 43.4% of families leading to more frequent low/high glucose readings in 75.5% of children of these families. Telemedicine using phones and social media applications was utilized for communication with healthcare professionals and continuing medical care. Most of the participants (85.5%) described it as a smooth and positive experience.

CONCLUSIONS

The extreme lockdown due to COVID-19 pandemic caused insulin and glucose measuring equipment shortages in children with diabetes in Jordan. However, the use of telemedicine for providing guidance and support was perceived positively by the families.

COVID-19 outbreak in Jordan: Epidemiological features, clinical characteristics, and laboratory findings

BACKGROUND

In March 2020, an outbreak of coronavirus 19 (COVID-19) was detected in the North of Jordan. This retrospective study is the first from Jordan to report the epidemiologic, clinical, laboratory, and radiologic characteristics of COVID-19 infected patients.

METHODS

All patients with laboratory-confirmed COVID-19 infection by RT-PCR in the North of Jordan admitted between March 15 and April 2, 2020 were included. The clinical features, radiological, and laboratory findings were reviewed.

RESULTS

Of 81 patients affected, 79 (97.5%) shared a common exposure to four recent travelers from endemic areas. The mean age was 40 years. Although about half (44 [54.3%]) were females, symptomatic patients were mostly females (75%). The most common presenting symptoms were nasal congestion, sore throat and dry cough. Less than one-third (31%) had chronic diseases. Although 84% of patients reported receiving Bacille Calmette-Guérin (BCG) vaccination, more asymptomatic patients had BCG than symptomatic (p = 0.017). Almost all patients (97.5%) had an elevated D-dimer level. Erythrocyte sedimentation rate (ESR) and c-reactive protein were elevated in 50% and 42.7% of patients, respectively. High ESR found to be the predictor of abnormal chest radiograph observed in 13 (16%) patients with OR of 14.26 (95% CI 1.37-147.97, p = 0.026).

CONCLUSIONS

An outbreak of COVID-19 infection in northern Jordan affected more females and relatively young individuals and caused mainly mild illnesses. The strict outbreak response measures applied at early stages probably contributed to the lenient nature of this outbreak, but the contribution of other factors to such variability in COVID-19 presentation is yet to be explained.