The Rise and Impact of COVID-19 in India

The impact of COVID-19 pandemic on fertility behaviour in Indian states: Evidence from the National Family Health Survey (2019/21)

BACKGROUND

The COVID-19 pandemic affected a broad spectrum of people's lives very quickly. Although the pandemic could influence people's fertility behaviours in several ways, there is little knowledge about such influence in diverse socioeconomic and cultural settings. This study investigated the impact of the COVID-19 pandemic on fertility behaviours and desires among women in a lower-middle-income country, India.

DATA AND METHODS

Our study analyzed cross-sectional data from 13 states and union territories (UTs) in India that were surveyed in pre- and post-lockdown periods by the 2019/21 National Family Health Survey (NFHS). The data were analysed using the descriptive analysis technique and the multilevel logit model. All these analyses were performed using the technique developed for complex sample design.

RESULTS

The poverty-stricken states of Uttar Pradesh and Jharkhand and the Odisha state with moderate socioeconomic status experienced a significant decrease in contraceptive use and non-significant changes in the desire for birth and sexual activities after the lockdown. Contraceptive use significantly increased after the lockdown in the rich states of Punjab, Delhi, and Tamil Nadu, as well as in the Arunachal Pradesh state with moderate socioeconomic status. The changes in fertility behaviours in Uttar Pradesh, Jharkhand, and Odisha may influence fertility positively, while those changes in Punjab, Delhi, Tamil Nadu, and Arunachal Pradesh may influence fertility negatively.

CONCLUSION

At the aggregate level, there was a significant increase in desire for another child and a decrease in contraceptive use after the lockdown, which may influence fertility positively but can be compensated by reduced sexual activities. The influence of the fertility trends in the states with pro-natalist changes on India's recent fertility trend could be greater than those with anti-natalist changes, which can be better understood by analyzing reliable data from a couple of years following the 2019/21 NFHS.

Prevalence of anti-HLA antibodies in COVID-19 convalescent plasma donors: an Indian experience

BACKGROUND

COVID-19 convalescent plasma is one of the experimental therapies used widely in moderately sick COVID-19 patients. However, there are a few risks involved in plasma transfusion; notably, transfusion-related acute lung injury (TRALI) caused by antibodies against human leukocyte antigens (HLA). This study was designed to assess the prevalence of anti-HLA antibodies in convalescent plasma donors using the single antigen bead method.

STUDY DESIGN AND METHODS

This was a hospital-based observational study of consecutive plasma donors. A total of 252 samples were screened for anti-HLA Class I and Class II antibodies using the microbead assay with the identification of anti-HLA Ab in positive samples being performed using a single antigen bead assay. Luminex-based normalized background cutoff ratios of 10.8 for Class I and 6.9 for Class II and mean fluorescence intensity cutoffs of 2500 for Class I and 1500 for Class II were used for screening and the single bead assay, respectively.

RESULTS

Of 252 screened samples, 28 (11.1 %) were positive for Class I, Class II or both Class I and Class II anti-HLA antibodies in donors with no history of a previous immunizing event. Moreover, 20/252 (7.9%) donors without any history of prior immunization had specific anti-HLA antibodies of Class I or Class II or both by the single bead assay.

CONCLUSIONS

The high prevalence of anti-HLA antibodies in our cohort of donors raises an urgent and immediate need for anti-HLA antibody screening in all convalescent plasma donors for safe therapy of COVID-19 patients.

Disease X and COVID-19: turning lessons from India and the world into policy recommendations

Disease X is caused by pathogen X, an unknown infectious agent that can potentially trigger an epidemic or pandemic. Pathogen X might be any pathogen, including bacteria, viruses, parasites, fungi, and prions. WHO uses the term 'Disease X' for any new emerging disease caused by an unknown pathogen X. Disease X stands for any possible future pandemic in WHO's shortlist of high-priority diseases. This review looks at the manifestations of the recent COVID-19 epidemic as the first Disease X to evaluate what has happened and to learn from what went wrong in India and worldwide. To this end, a summary is presented of response measures by governments, often lacking flows of information, discrepancies in the views of experts and decisions of policymakers, and undesirable variations in individual and collective behavior and their consequences. The elements of combating Disease X in a world with considerable inequalities in relevant knowledge, expertise, information, quality of governance, and financial possibilities are discussed. Based on this, recommendations are given for an innovative global pandemic preparedness system.

UDHAVI Community Support During India's Second COVID-19 Wave: A Descriptive Study on a Tertiary Care Center's Pandemic Response Helpline

BACKGROUND

In April 2021, during the peak of the second wave of the COVID-19 pandemic in India, hospitals overflowed with COVID-19 patients, and people hesitated to seek necessary care due to fear of contracting the disease. The UDHAVI helpline was set up by a tertiary care hospital in Vellore with the help of district administration, nongovernmental organizations, and various supporting agencies to provide general information, medical advice, counseling, and logistics support to the community.

METHODS

This is a retrospective study of all the phone calls made to the UDHAVI helpline between mid-May and mid-June 2021 during the second wave of the COVID-19 pandemic. The calls were electronically captured as part of the process, and the information was subsequently retrieved and analyzed.

RESULTS

In all, 677 calls were received. The lines for general information, medical advice, counseling, and logistics support received 168 (25%), 377 (56%), 15 (2%), and 117 (17%) calls, respectively. Home care kits, oxygen concentrators, and food were delivered by volunteers from local nongovernmental organizations and hospitals.

CONCLUSION

We believe the details of our experience would be useful in the preparedness and mobilization of resources in the event of any public health emergency. As a result of this initiative, we propose an integrated partnership model for emergency response to any pandemic situation.

Developing a Deep Neural Network model for COVID-19 diagnosis based on CT scan images

COVID-19 is most commonly diagnosed using a testing kit but chest X-rays and computed tomography (CT) scan images have a potential role in COVID-19 diagnosis. Currently, CT diagnosis systems based on Artificial intelligence (AI) models have been used in some countries. Previous research studies used complex neural networks, which led to difficulty in network training and high computation rates. Hence, in this study, we developed the 6-layer Deep Neural Network (DNN) model for COVID-19 diagnosis based on CT scan images. The proposed DNN model is generated to improve accurate diagnostics for classifying sick and healthy persons. Also, other classification models, such as decision trees, random forests and standard neural networks, have been investigated. One of the main contributions of this study is the use of the global feature extractor operator for feature extraction from the images. Furthermore, the 10-fold cross-validation technique is utilized for partitioning the data into training, testing and validation. During the DNN training, the model is generated without dropping out of neurons in the layers. The experimental results of the lightweight DNN model demonstrated that this model has the best accuracy of 96.71% compared to the previous classification models for COVID-19 diagnosis.

Genomic evolution of the SARS-CoV-2 Variants of Concern: COVID-19 pandemic waves in India

SARS-CoV-2 has mutated rapidly since its first case report in Wuhan, China, leading to the emergence of an indefinite number of variants. India has witnessed three waves of the COVID-19 pandemic. The country saw its first wave of SARS-CoV-2 illness from late January 2020 to February 2021. With a peak surge of cases in mid-September 2020, India recorded more than 11 million cases and a death toll of more than 0.165 million at this time. India faced a brutal second wave driven by the emergence of highly infectious SARS-CoV-2 variants B.1.617.2 (Delta variant) and the third wave with the leading cause of BA.2 (Omicron variant), which has led to an unprecedented rise in COVID-19 cases in the country. On September 14, 2022, India recorded a cumulative 44.51 million cases of COVID-19 with more than 0.528 million deaths. The discovery of common circulating mutants is facilitated by genome sequencing. The changes in the Spike surface glycoprotein recombinant binding domains served as the critical alterations, resulting in enhanced infectivity and transmissibility, with severe clinical effects. Further, the predominant mutation in the SARS-CoV-2 spike protein; the D614G strains served as a model for vaccine development. The mutation of the Wuhan strain to the Variant of Concern led to a significant increase in SARS-CoV-2 infections. In addition, there was a shift in the age group affected by SARS-CoV-2 variant infection. The current review summarized the COVID-19 pandemic's Variant of Concern and the advent of SARS-CoV-2 in India.

Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population

Introduction

The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG).

Methods

This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods.

Results

The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods.

Discussion

We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

Spatial variability of trace gases (NO2, O3 and CO) over Indian region during 2020 and 2021 COVID-19 lockdowns

COVID-19 lockdown has given us an opportunity to investigate the pollutant concentrations in response to the restricted anthropogenic activities. The atmospheric concentration levels of nitrogen dioxide (NO₂), carbon monoxide (CO) and ozone (O₃) have been analysed for the periods during the first wave of COVID-19 lockdown in 2020 (25th March-31st May 2020) and during the partial lockdowns due to second wave in 2021 (25th March-15th June 2021) across India. The trace gas measurements from Ozone Monitoring Instrument (OMI) and Atmosphere InfraRed Sounder (AIRS) satellites have been used. An overall decrease in the concentration of O₃ (5-10%) and NO₂ (20-40%) have been observed during the 2020 lockdown when compared with business as usual (BAU) period in 2019, 2018 and 2017. However, the CO concentration increased up to 10-25% especially in the central-west region. O₃ and NO₂ slightly increased or had no change in 2021 lockdown when compared with the BAU period, but CO showed a mixed variation prominently influenced by the biomass burning/forest fire activities. The changes in trace gas levels during 2020 lockdown have been predominantly due to the reduction in the anthropogenic activities, whereas in 2021, the changes have been mostly due to natural factors like meteorology and long-range transport, as the emission levels have been similar to that of BAU. Later phases of 2021 lockdown saw the dominant effect of rainfall events resulting in washout of pollutants. This study reveals that partial or local lockdowns have very less impact on reducing pollution levels on a regional scale as natural factors like atmospheric long-range transport and meteorology play deciding roles on their concentration levels.

Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India

Background

Maternal and child health (MCH) care is one of the essential routine healthcare services, which got affected during the coronavirus disease 2019 (COVID-19) pandemic. Modeled projections had anticipated an 8.3%-38.6% rise in maternal mortality from different countries globally. In view of limited studies pertaining to issues related to accessing MCH services in the event of a pandemic, this study was carried out on pregnant and postnatal mothers in Odisha, India.

Methods

An explorative qualitative study through 36 in-depth interviews (IDIs) was conducted among 16 (44.4%) antenatal and 20 (55.5%) postnatal mothers in six of thirty districts of Odisha, India, from February to April 2021. The districts and blocks were randomly selected for better representativeness. The IDIs were conducted using a predesigned and pretested guide among mothers who had undergone delivery or availed of antenatal, postnatal, or child health services from October 2020 to April 2021. The IDIs were conducted till data saturation. The data were analyzed using MAXQDA software.

Results

The average age of mothers was 27.6 (+/- 2.2) years. Among the participants, 16 (44.4%) were antenatal and 20 (55.6%) were postnatal mothers; 19 (52.8%) were primipara and 17 (47.2%) were multipara. The majority explained that they received enormous support including door-to-door services from the community health workers (CHWs) even during the difficult times of the pandemic. Reduced transportation facility and fear of contracting the infection were reasons behind the unwillingness to visit health facilities and preference for home delivery. Furthermore, the pandemic had physical, mental, social, and financial impacts among pregnant and postnatal women.

Conclusion

The unprecedented COVID-19 pandemic has affected access to MCH services by antenatal and postnatal mothers. Health system preparedness and appropriate strategies including better community engagement and participation could avert such challenges in the future.

A Review of the Machine Learning Algorithms for Covid-19 Case Analysis

The purpose of this article is to see how machine learning (ML) algorithms and applications are used in the COVID-19 inquiry and for other purposes. The available traditional methods for COVID-19 international epidemic prediction, researchers and authorities have given more attention to simple statistical and epidemiological methodologies. The inadequacy and absence of medical testing for diagnosing and identifying a solution is one of the key challenges in preventing the spread of COVID-19. A few statistical-based improvements are being strengthened to answer this challenge, resulting in a partial resolution up to a certain level. ML have advocated a wide range of intelligence-based approaches, frameworks, and equipment to cope with the issues of the medical industry. The application of inventive structure, such as ML and other in handling COVID-19 relevant outbreak difficulties, has been investigated in this article. The major goal of this article is to 1) Examining the impact of the data type and data nature, as well as obstacles in data processing for COVID-19. 2) Better grasp the importance of intelligent approaches like ML for the COVID-19 pandemic. 3) The development of improved ML algorithms and types of ML for COVID-19 prognosis. 4) Examining the effectiveness and influence of various strategies in COVID-19 pandemic. 5) To target on certain potential issues in COVID-19 diagnosis in order to motivate academics to innovate and expand their knowledge and research into additional COVID-19-affected industries.

Picture fuzzy set-based decision-making approach using Dempster-Shafer theory of evidence and grey relation analysis and its application in COVID-19 medicine selection

To offer better treatment for a COVID-19 patient, preferable medicine selection has become a challenging task for most of the medical practitioners as there is no such proven information regarding it. This article proposes a decision-making approach for preferable medicine selection using picture fuzzy set (PFS), Dempster-Shafer (D-S) theory of evidence and grey relational analysis (GRA). PFS is an extended version of the intuitionistic fuzzy set, where in addition to membership and non-membership grade, neutral and refusal membership grades are used to solve uncertain real-life problems more efficiently. Hence, we attempt to use it in this article to solve the mentioned problem. Previously, researchers considered the neutral membership grade of the PFS similar to the other two membership values (positive and negative) as applied to the decision-making method. In this study, we explore that neutral membership grade can be associated with probabilistic uncertainty which is measured using D-S theory of evidence and FUSH operation is applied for the aggregation purpose. Then GRA is used to measure the performance among the set of parameters which are in conflict and contradiction with each other. In this process, we propose an alternative group decision-making approach by the evidence of the neutral membership grade which is measured by the D-S theory and the conflict and contradiction among the criteria are managed by GRA. Finally, the proposed approach is demonstrated to solve the COVID-19 medicine selection problem.

Challenges faced by frontline health managers during the implementation of COVID-19 related policies in India: A qualitative analysis

Background & objectives

The COVID-19 pandemic exposed the strengths and weaknesses of the healthcare systems across the world. Many directives, guidelines and policies for pandemic control were laid down centrally for its implementation; however, its translation at the periphery needs to be analyzed for future planning and implementation of public health activities. Hence, the objectives of this study were to identify the challenges faced by frontline health managers in selected States in India during the pandemic with regard to implementation of the COVID-19-related policies at the district level and also to assess the challenges faced by the them in adapting the centrally laid down COVID-19 guidelines as per the local needs of the district.

Methods

A qualitative study using the grounded theory approach was conducted among frontline district-level managers from eight different States belonging to the north, south, east and west zones of India. The districts across the country were selected based on their vulnerability index, and in-depth interviews were conducted among the frontline managers to assess the challenges faced by them in carrying out COVID-19 related activities. Recorded data were transcribed verbatim, manually coded and thematically analyzed.

Results

Challenges faced in implementing quarantine rules were numerous, and it was also compounded by stigma attached with the disease. The need for adapting the guidelines as per local considerations, inclusion of components of financial management at local level, management of tribal and vulnerable populations and migrants in COVID context were strongly suggested. The need to increase human resource in general and specifically data managers and operators was quoted as definite requirement.

Interpretation & conclusions

The COVID-19 guidelines provided by the Centre were found to be useful at district levels. However, there was a need to make some operational and administrative modifications in order to implement these guidelines locally and to ensure their acceptability.

An empirical investigation of investor sentiment and volatility of realty sector market in India: an application of the DCC-GARCH model

Understanding how an irrational investors' sentiment affects the realty market returns, especially during the pandemic, is imperative to take any financial decisions. The effect of investor sentiment on the movement of the realty market leading to market volatility is dynamically represented in a numerical form. The study incorporates daily market data and their implicit indices to construct a sector-specific investor sentiment index by using the principal component analysis method. To analyse the relationship between the variables, a quantitative approach is used by incorporating an econometric model-dynamic conditional correlation-generalized autoregressive conditional heteroskedasticity (DCC-GARCH). The directionality of the relationship between the variables is assessed by the Diebold-Yilmaz method. This study is done to investigate the return deviation in the realty sector due to sentiment impact during the pandemic in the Indian context. The findings indicate the existence of an asymmetric impact of the sentiment, leading to extreme volatility and returns in the realty sector. The results confirmed the presence of bi-directional relationship between asset returns and investor sentiment and quantified the relationship numerically. This study focused on the development, applicability, and validity of a sentiment index pertaining to the Indian realty sector. This study highlights the impact of a qualitative non-fundamental factor like sentiment as a measurable factor in determining the volatility on market returns.

Examining the role of saving and safety on the buying behavior: lessons from the Indian consumer's in COVID-19 crisis

Purpose

The COVID-19 pandemic has transformed consumer buying behavior across the world. COVID-19 crisis brought a behavioral change in consumers' attitudes toward health, financial and social well-being. The current research work highlights the factors influencing consumer buying behavior during the COVID-19 pandemic considering saving and safety perspectives.

Design/methodology/approach

This study attempts to understand the gap in buying behavior with reference to saving and safety. Survey-based study was conducted during the second phase of COVID-19, and the respondents were those who lived in highly affected COVID cities in India. Exploratory factor analysis and multiple regression analysis were carried out for testing the hypotheses.

Findings

Seven factors became the prominent factors in consumer buying patterns during the pandemic. Consumers in the times of COVID-19 pandemic spend only on essential items as compared to nice-to-have and non-essential items.

Research limitations/implications

Respondents considered in the research were millennials aged 25–40. The current research is limited to specific geographic location.

Practical implications

The study assessed how savings and safety influence consumer buying behavior. The 2S framework model for consumer buying behavior during pandemic has been developed. The findings of the study provides a road map to the companies, policy makers, managers and consumers in understanding the consumer buying behavior during pandemic.

Originality/value

The current research work observe the changes in the behavioral patterns of consumers in the context of 2S framework, i.e. saving and safety. This study offer novel contribution as there is no available literature that examined the saving and safety aspects together for consumer buying behavior during crisis.

COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has brought fundamental changes to our problems and priorities, especially those related to the healthcare sector. India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.

AIM

To understand the challenges faced by the healthcare system during a pandemic.

METHODS

The literature search for this review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. We also used Reference Citation Analysis (RCA) to search and improve the results. We focused on the published scientific articles concerned with two major vital areas: (1) The Indian healthcare system; and (2) COVID-19 pandemic effects on the Indian healthcare system.

RESULTS

The Indian healthcare system was suffering even before the pandemic. The pandemic has further stretched the healthcare services in India. The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases. Besides the pandemic measures, there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations. The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.

CONCLUSION

Severely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic. Re-establishment of primary healthcare services, maternal and child health services, noncommunicable diseases programs, National Tuberculosis Elimination Program, etc. are important to prevent serious long-term consequences of this pandemic.

Health status of persons with dementia and caregivers' burden during the second wave of COVID-19 pandemic: an Indian study

Due to the disruption of normal flow of treatment during the restrictions related to the coronavirus disease 2019 (COVID-19) pandemic, the health status of persons with dementia (PwD) and their caregivers' burden might worsen.

Objective

The article aims to find out the health status of PwD and caregivers' burden during the peak of second wave of COVID-19 and make a comparison with the preceding trough phase.

Methods

The study was conducted with 53 PwD and their caregivers in two phases. On their visit to the hospital during the unlock phase (phase 1), data were collected for CDR from PwD, and NPI-Q and ZBI from their caregivers. During the peak of second wave (phase 2), data were collected for NPI-Q, ZBI, and DASS-21 through telephonic communication, and statistical analyses were performed on the collected data.

Results

Significantly higher caregiver burden (p=0.001) and neuropsychiatric symptoms (NPSs) [both in severity (p=0.019) and distress (p=0.013)] were observed among the respondents during the peak of second wave of the pandemic as compared to the preceding trough phase. Positive correlations were observed between the caregiver burden and depression, anxiety, and stress of the caregivers (p<0.001) and between the severity of dementia in PwD and caregiver burden (p<0.001) for both the first and second phases. Positive correlation was also observed between the severity of dementia in PwD and depression (p=0.042) and stress (p=0.023) of caregivers.

Conclusions

Significant increase in the burden and distress was observed among caregivers due to increased NPSs of PwD during the second wave of COVID-19 pandemic.

Perception of Global Participants of ITEC Nations on Country's Preparedness and Response to COVID-19 Pandemic

Background

The Coronavirus disease 2019 (COVID-19) pandemic has exposed the public health preparedness and response system across the world. The current study was conducted to gauge the perception of public health professionals of Indian Technical and Economic Cooperation (ITEC) countries regarding the preparedness and responses of their countries in mitigating the COVID-19 pandemic.

Methodology

Three capacity-building programs, namely “Managing COVID-19 Pandemic–Experience and Best practices of India” were conducted by PGIMER, Chandigarh, for public health professionals from ITEC countries from April to May 2021 in which 97 participants from 13 countries have participated. The tools used in the study were adapted from WHO's COVID-19 Strategic Preparedness and Response (SPRP), Monitoring and Evaluation Framework, interim guidelines for Critical preparedness, readiness and response actions for COVID-19, and a strategic framework for emergency preparedness, and finalized using Delphi technique. The overall preparedness of managing COVID-19 was rated using five-point Likert scale, whereas the overall score for the country in combating the COVID-19 pandemic was assessed using 10 point scale.

Results

We found that the perception of public health professionals to government response regarding COVID-19 for fostering improvement on COVID-19 situation was “moderate” with respect to transmission and surveillance mechanism, uniform reporting mechanism, and availability of adequate personal protective equipment (PPE) for health workers. However, the participants rated government response as “poor” in the availability of multisectoral national operational plan, human resource capacity, availability of trained rapid response team (RRT), preparedness in prevention and clinical management, training of healthcare workers, communication and community engagement strategies, facilities to test samples of patients, and transparent governance and administration.

Conclusion

A poor level of preparedness of countries in diverse domains of managing the COVID-19 pandemic was observed. As the global threat of COVID-19 is still looming, great efforts on building a robust preparedness and response system for COVID-19 and similar pandemics are urgently required.

Optimal control design incorporating vaccination and treatment on six compartment pandemic dynamical system

In this paper, a mathematical model of the COVID-19 pandemic with lockdown that provides a more accurate representation of the infection rate has been analyzed. In this model, the total population is divided into six compartments: the susceptible class, lockdown class, exposed class, asymptomatic infected class, symptomatic infected class, and recovered class. The basic reproduction number (R0) is calculated using the next-generation matrix method and presented graphically based on different progression rates and effective contact rates of infective individuals. The COVID-19 epidemic model exhibits the disease-free equilibrium and endemic equilibrium. The local and global stability analysis has been done at the disease-free and endemic equilibrium based on R0. The stability analysis of the model shows that the disease-free equilibrium is both locally and globally stable when R0<1, and the endemic equilibrium is locally and globally stable when R0>1 under some conditions. A control strategy including vaccination and treatment has been studied on this pandemic model with an objective functional to minimize. Finally, numerical simulation of the COVID-19 outbreak in India is carried out using MATLAB, highlighting the usefulness of the COVID-19 pandemic model and its mathematical analysis.

Modeling COVID-19 Impact on Consumption and Mobility in Europe: A Legacy Toward Sustainable Business Performance

This article has explored the impact of coronavirus disease 2019 (COVID-19)-induced decline in consumer durables and mobility on nitrogen dioxide (NO2) emission in Europe by providing empirical and graphical justifications based on consumer price index (CPI) and gross domestic product (GDP) deflator indexes. The empirical estimations show that carbon dioxide (CO2) and NOx emission along with other greenhouse gases drastically decreased in the wake of COVID-19-induced lockdowns and decrease in the demand of consumer goods in Europe. This means that COVID-19 improved environment in the European region. However, high cost (e.g., unemployment, loss of life, and social segregation) makes COVID-19 an unstable solution to environmental woes where positive impact of COVID-19 on environment achieved in short run cannot be guaranteed in the long run. Besides environment, COVID-19 drastically curtailed economic activities and exposed them to the risk of economic crisis particularly in case of Europe.

Altered Ocular Surface Health Status and Tear Film Immune Profile Due to Prolonged Daily Mask Wear in Health Care Workers

Prolonged daily face mask wearing over several months might affect health of the ocular surface and is reported to be associated with complaints of discomfort and dry-eye-like symptoms. We studied the ocular surface clinical parameters, tear soluble factors and immune cell proportions in ophthalmologists practicing within similar environmental conditions (n = 17) at two time points: pre-face-mask period (Pre-FM; end of 2019) and post-face-mask-wearing period (Post-FM; during 2020 COVID-19 pandemic), with continuous (~8 h/day) mask wear. A significant increase in ocular surface disease index (OSDI) scores without changes in tear breakup time (TBUT), Schirmer’s test 1 (ST1) and objective scatter index (OSI) was observed Post-FM. Tear soluble factors (increased—IL-1β, IL-33, IFNβ, NGF, BDNF, LIF and TSLP; decreased—IL-12, IL-13, HGF and VEGF-A) and mucins (MUC5AC) were significantly altered Post-FM. Ex vivo, human donor and corneoscleral explant cultures under elevated CO₂ stress revealed that the molecular profile, particularly mucin expression, was similar to the Post-FM tear molecular profile, suggesting hypercapnia is a potential contributor to ocular surface discomfort. Among the immune cell subsets determined from ocular surface wash samples, significantly higher proportions of leukocytes and natural killer T cells were observed in Post-FM compared to Pre-FM. Therefore, it is important to note that the clinical parameters, tear film quality, tear molecular factors and immune cells profile observed in prolonged mask-wear-associated ocular surface discomfort were distinct from dry eye disease or other common ocular surface conditions. These observations are important for differential diagnosis as well as selection of appropriate ocular surface treatment in such subjects.

A cross-sectional study of COVID-19 outbreak in Indian population

Background

Presently India is the second most populous country in the world with an estimated population of 1.4 billion people and has recently been affected by COVID-19 pandemic and subsequent mutant viral outbreak. To date, India has administered its population with over 1.30 billion cumulative doses of COVID-19 vaccine. The consequences of COVID-19 vaccination on the outbreak in India has not been reported until now. Therefore, we probed to assess the impact of COVID-19 outbreak in India from December 2019 to December 2021.

Methods

Indian COVID-19 related data were extracted from "ourworldindata.org" and "cowin.gov.in" databases. The incidence rate of COVID-19 per million people was calculated and other parameters such as new cases, positive rate, reproduction rate, new death and stringency index values were extracted from the database for statistical analysis.

Results

Data indicate that the COVID-19 positive rate declined as the number of vaccinations rose over time. The Pearson correlation values between new cases and the cumulative percentage of vaccination or the percentage of fully vaccinated population showed no correlation (P < 0.01). COVID-19 vaccination has significantly decreased the R-value and positive rate of SARS-CoV-2 in India (P < 0.01). Furthermore, containment measures showed no correlation with the incidence rate of SARS-CoV-2 in India which may be in contradictory to the global trends.

Conclusion

Vaccination against COVID-19 was efficacious in the control of the SARS-CoV-2 outbreak and the decrease in the positive rate. Further, the containment measures had no effect on the spread of COVID-19 infection in India, thus far.

Intestinal viral infections of nSARS-CoV2 in the Indian community: Risk of virus spread in India

In December 2019, novel severe acute respiratory syndrome coronavirus 2 (nSARS-CoV-2) virus outbreaks emerged from Wuhan, China, and spread all over the world, including India. Molecular diagnosis of Coronavirus Disease 2019 (COVID) 19 for densely and highly populated countries like India is time-consuming. A few reports have described the successful diagnosis of nSARS-CoV-2 virus from sewage and wastewater samples contaminated with fecal matter, suggesting the diagnosis of COVID 19 from the same to raise an alarm about the community transmission of virus for implementation of evacuation and lockdown strategies. So far, the association between the detection of virus and its concentration in stool samples with severity of the disease and the presence or absence of gastrointestinal symptoms have been rarely reported. We led the search utilizing multiple databases, specifically PubMed (Medline), EMBASE, and Google Scholar. We conducted a literature survey on gastrointestinal infection and the spread of this virus through fecal-oral transmission. Reports suggested that the existence and persistence of nSARS-CoV-2 in anal/rectal swabs and stool specimens for a longer period of time than in nasopharyngeal swabs provides a strong tenable outcome of gastrointestinal contamination and dissemination of this infection via potential fecal-oral transmission. This review may be helpful to conduct further studies to address the enteric involvement and excretion of nSARS-CoV-2 RNA in feces and control the community spread in both COVID-19 patients ahead of the onset of symptoms and in asymptomatic individuals through wastewater and sewage surveillance as an early indication of infection. The existence of the viral genome and active viral particle actively participate in genomic variations. Hence, we comprehended the enteric spread of different viruses amongst communities with special reference to nSARS-CoV-2.

Analyzing the factors affecting the attitude of public toward lockdown, institutional trust, and civic engagement activities

The early 2020 witnessed Coronavirus disease 2019 (COVID-19) pandemic followed by a nationwide lockdown in the whole history for the first time. The entire world had to go for nationwide lockdown to curb the spread of such contagious and deadly disease. In short, the coronavirus outbreak and the subsequent lockdown had created a storm in the world giving rise to change in public with respect to parameters like trust in the government institutions, civic engagement, and so on. In this raising dilemma, multiple countries have acknowledged the significance of trusting institutions, especially during lockdown. It is also widely accepted that lives of individuals had been undergoing change ever since the spread of COVID-19. Likewise, public's trust in the institutions is directly related to the civic engagement. Civic engagement is commonly understood as a phenomenon that develops a difference in an individual's civic life by combining values, skills, motivation, as well as knowledge. Different forms of civic engagement include national service, volunteering, societal services, and so forth. The main focus of this article is to examine the influence of COVID-19 outbreak on general attitude of the citizens of Malaysia and India, their trust on the governing institutions, and the civic engagement. In other words, this study tries to assess the impact of the pandemic on variables such as attitude toward the lockdown, trust in institutions, and civic engagement. For this, the study adopted cross-sectional community questionnaire survey in two countries-Malaysia and India. The respondents selected for the study was 1437. The respondent's demographics, attitude toward lockdown, trust in institutions, and civic engagement during the lockdown were collected by means of convenience sampling technique. Later the collected data were measured in terms of descriptive statistics and regression analysis. Findings of the study stated that public's trust in the institution can be increased by enhancing the civic activities and implementing policies that govern and build the society.

The COVID-19 pandemic impact on clinical load of plastic and reconstructive surgery in a tertiary care hospital of north India: A retrospective comparative analysis

BACKGROUND

The objective of the study was to analyze and determine statistically significant impact of the COVID-19 on clinical load of plastic and reconstructive surgery practices.

MATERIALS AND METHODS

The retrospective analysis and comparison of the number of patients visiting to outpatient clinic, number of patients admitted, number of patients operated in the plastic and reconstructive surgery department during the COVID-19 pandemic months of January 2020-June 2020 with the same months of preceding non-COVID-19 year was done. The data obtained were tabulated in Microsoft Excel spread sheet and the statistical analysis done using MedCalc statistical software.

RESULTS

The mean ± standard deviation of patients attended in outpatient department (OPD), admitted in inpatient department (IPD), emergency surgeries performed, and elective surgeries performed during -COVID-19 versus COVID-19 pandemic period is (651.167 ± 310.42 vs. 212.5 ± 307.591), (83.5 ± 16.263 vs. 34.333 ± 53.74), (5.167 ± 4.243 vs. 3.333 ± 4.95), and (74.333 ± 28.284 vs. 40.833 ± 60.811), respectively. The difference in means is highly significant statistically in the number of patients attended in OPD, admitted in IPD, and elective surgeries performed during pre-COVID versus COVID period; however, the difference in the means is not statistically significant in the number of emergency surgeries performed during pre-COVID versus COVID period.

CONCLUSION

The COVID-19 pandemic has significantly reduced the number of patients attended in OPD, admitted in IPD, and elective surgeries performed in the department of plastic surgery. However, there is a reduction in number of emergency surgeries but statistically insignificant. The strategy is to use telemedicine portal e-Sanjeevani services for OPD, encourage admission of patients with reverse transcription polymerase chain reaction negative for COVID-19, and perform reconstructive and esthetic plastic surgery operative procedures using COVID-19 appropriate precautions.

Understanding the activating mechanism of the immune system against COVID-19 by Traditional Indian Medicine: Network pharmacology approach

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmissions are occurring rapidly; it is raising the alarm around the globe. Though vaccines are currently available, the evolution and mutations in the SARS-CoV-2 threaten available vaccines' significance. The drugs are still undergoing clinical trials, and certain medications are approved for “emergency use” or as an “off-label” drug during the pandemic. These drugs have been effective yet accommodating side effects, which also can be lethal. Complementary and alternative medicine is highly demanded since it embraces a holistic approach. Since ancient times, natural products have been used as drugs to treat various diseases in the medical field and are still widely practiced. Medicinal plants contain many active compounds that serve as the key to an effective drug design. The Kabasura kudineer and Nilavembu kudineer are the two most widely approved formulations to treat COVID-19. However, the mechanism of these formulations is not well known. The proposed study used a network pharmacology approach to understand the immune-boosting mechanism by the Kabasura kudineer, Nilavembu kudineer, and JACOM in treating COVID-19. The plants and phytochemical chemical compounds in the Kabasura kudineer, Nilavembu kudineer, and JACOM were obtained from the literature. The Swiss target prediction algorithm was used to predict the targets for these phytochemical compounds. The common genes for the COVID-19 infection and the drug targets were identified. The gene–gene interaction network was constructed to understand the interactions between these common genes and enrichment analyses to determine the biological process, molecular functions, cellular functions, pathways involved, etc. Finally, virtual screening and molecular docking studies were performed to identify the most potential targets and significant phytochemical compounds to treat the COVID-19. The present study identified potential targets as ACE, Cathepsin L, Cathepsin B, Cathepsin K, DPP4, EGFR, HDAC2, IL6, RIPK1, and VEGFA. Similarly, betulinic acid, 5″-(2⁗-Hydroxybenzyl) uvarinol, antofine, (S)-1′-methyloctyl caffeate, (Z)-3-phenyl-2-propenal, 7-oxo-10α-cucurbitadienol, and PLX-4720 collectively to be potential treatment agents for COVID-19.

The burden & contributing factors of psychological distress across India during the COVID pandemic

The unprecedented COVID-19 pandemic spread rapidly and engulfing the entire world, forcing people to stay home, muting the hustle and bustle of modern world with tide of fear for contracting disease and death. This brutal disease has infected millions of people worldwide, many lost their job, world economies have ravaged and many more uncountable consequences.

OBJECTIVE

To assess the psychological distress due to COVID-19 outbreak and to determine contributing factors towards psychological distress.

METHOD

A cross-sectional survey was conducted between 12th May to 20th June 2020 & 1537 valid responses were received. Modified K10 scale was used to assess psychological distress. Binary logistic regression analysis was used to determine extent of relationship between the contributing factors and psychological distress scale by estimating the odds of having significant stress with P ≤ 0.05.

RESULT

A total of 1537 valid responses were obtained. The overall psychological distress score was 19.79 ± .75 which implies mild psychological distress. Analysis of degree of psychological distress revealed 815 (53.0%) with no psychological distress, 385 (25.0%) mild, 194 (12.6%) moderate and 143 respondents (9.3%) had severe degree of psychological distress. Females psychological distress was 1.448 times as compared to male (CI 0.191-10.986). The odds of having significant psychological distress for above 60 years as compared to 16-30 years. Shop owner & business man had more stress in compared to professionals (OR 1.176, CI 0.058-2.362). As compared to married, the psychological distress was 13.203 times higher among divorcee/separated (0.786-221.787) and 3.629 times higher among unmarried (0.376-35.054).

CONCLUSION

This study showed 39.2% of the subject had psychological distress which is quite high. So, government and other policy makers have to develop strategy to relieve psychological distress among Indian population.

Association between the HLA genotype and the severity of COVID-19 infection among South Asians

Regional variations are found in the incidence and severity of the COVID-19 infection. Human leukocyte antigen (HLA) polymorphism is one of the genetic factors that might have an impact on the outcome of the disease. This study explored the association between the HLA genotype and the severity of COVID-19 among patients from South Asia. Blood samples from 95 Asians (Bangladeshis, Indians, and Pakistanis) with COVID-19 were collected. The patients were divided according to the severity of their infection: mild (N = 64), severe (N = 31), and fatal (N = 20). DNA was extracted from all samples, and HLA genotyping was performed for both class I (A, B, and C) and class II (DRB1, DQA1, and DQB1) using the PCR-rSSO (polymerase chain reaction-reverse sequence-specific oligonucleotide) molecular method. The frequency of HLA-B*51 was significantly higher among patients in the fatal group than among those in the mild infection group (15% vs. 4.7%, p = 0.027). Additionally, the frequency of HLA-B*35 was significantly higher in the mild infection group than in the fatal group (21.1% vs. 7.5%, p = 0.050 [a borderline p-value]). In terms of HLA class II, DRB1*13 was significantly observed in the fatal group than in the mild infection group (17.5% vs. 11.3%, p = 0.049). However, the p-value for all alleles became insignificant after a statistical correction for the p-values (pc  = 0.216, pc  = 0.4, and pc  = 0.49, respectively). Compared with all published data, this study highlights that the association between the HLA system and the COVID-19 outcome might be ethnic-dependent. Genetic variation between populations must be examined on a wider scale to assess infection prognosis and vaccine effectiveness.

Evaluation of knowledge, attitude and practice of guidelines towards the novel covid 19 among eye care professionals of a government medical college in north India

The novel COVID-19 pandemic, caused by the SARS CoV- 2 virus, has led to widespread public health concerns across the globe. Ophthalmology professionals may be susceptible to infection due to close patient proximity during slit lamp examination and the potential contamination of instruments. The knowledge, attitude, practice (KAP)study can provide an insight of ECPs’(eye care practitioners) knowledge, methods of practice and attitude during this pandemic. This helps to reduce their risk, and that of their family, of contracting the virus, reduce morbidity and mortality associated with being infected.Data and results obtained from this study can also be used to make emergency policies and implement them to stop the spread and impact of a similar outbreak in future.

A cross-sectional study was conducted to evaluate the knowledge, attitude and practice of guidelines amongst the Eye care professionals towards the novel Covid-19. The demographic characteristics and infection rate of Covid-19 among the professionals during practice was also recorded and analyzed.

In this hospital based cross-sectional study, total 67 eye care professionals including nurses, optometrist participated in the study with their due consent. Among total 67 participants, 60 (89.5%) were doctors, 4 (5.97%) were nurses and 3 (4.477) were optometrists All the participants including doctors, nurses and optometrists achieved a mean of 97.8% in the knowledge section of questionnaire.100% of the participants wear mask and maintain social distancing while all of them have received training regarding practice and management of patients during Covid19 and all the participants have a positive attitude towards the measure taken to combat Covid-19 pandemic.

The eye care professionals participated in this study shows a good knowledge, positive attitude and practice of guidelines by the government of India are followed for the pandemic of Covid-19.

Asian-Origin Approved COVID-19 Vaccines and Current Status of COVID-19 Vaccination Program in Asia: A Critical Analysis

COVID-19 vaccination has started throughout the globe. The vaccination program has also begun in most Asian countries. This paper analyzed the Asian-origin COVID-19 vaccines and vaccination program status in Asia till March 2021 under three sections. In the first section, we mapped the approved vaccines that originated from Asia, their technological platforms, collaborations during vaccine development, and regulatory approval from other countries. We found that a total of eight Asian COVID-19 vaccines originated and got approval from three countries: China, India, and Russia. In the second section, we critically evaluated the recent progress of COVID-19 vaccination programs. We analyzed the overall vaccination status across the Asian region. We also calculated the cumulative COVID-19 vaccine doses administered in different Asian countries, vaccine rolling in 7-day average in various Asian countries, and COVID-19 vaccine per day doses administrated in several Asian countries. We found that China and India vaccinated the maximum number of people. Finally, we evaluated the factors affecting the COVID-19 vaccination program in Asia, such as vaccine hesitancy, basic reproduction numbers (R0) and vaccination campaigns, and the cost of the vaccines. Our analysis will assist the implementation of the COVID-19 vaccination program successfully in Asia.

Yoga and Naturopathy intervention for reducing anxiety and depression of Covid-19 patients - A pilot study

Background

Coronavirus disease 2019 (Covid-19) infection has caused a prominent psychological and mental havoc among the patients. Till now, there is paucity in literature for the management of psychological problems among patients with Covid-19. So we aimed in our study to assess the effect of Yoga and Naturopathy intervention on anxiety and depression of Covid-19 patients.

Methods

This quasi experimental study was conducted among 130 Covid-19 positive patients admitted in a tertiary care hospital. Yoga and Naturopathic intervention was given for 60 min a day for two weeks. Hospital anxiety depression scale (HADS) and Corona anxiety scale (CAS) was used to assess the generalized anxiety and depression among the patients.

Results

Average age of the patients participated was 44 with the range from 36 to 53 years. Among them 85 were male and 45 were female. Of all 130 patients, 33% had symptoms of borderline depression, 9.2% had severe depression, 40% had borderline anxiety and 12.3% had severe anxiety. In CAS, 59 patients (45.38%) reported Covid-19 related dysfunctional anxiety. All the patients showed a significant reduction in the HADS- anxiety (P < 0.01), HADS-depression (p < 0.01) and CAS (p < 0.01) score after the intervention.

Conclusion

The present study showed significant reduction of anxiety and depression level among the Covid-19 patients. These interventions can be added to the conventional care for better mental and physical wellbeing of the patients after validating the findings with justified study design.

Psychological assessment and lived experiences of recovered COVID-19 patients who presented for convalescent plasma donation

Background

Increasingly, it has been seen that patients recovering from COVID-19 may face a second battle of coping with its mental health ramifications. These psychological issues can even be experienced by patients who were asymptomatic or had mild to moderate symptoms, potentially impacting their quality of life.

Methodology

This was a prospective observational study to analyse the psychological impact of COVID-19 in recovered patients who presented as prospective convalescent plasma (CP) donors. An interview for the psychological assessment of the prospective donors was carried out. Depression and anxiety in the participants were assessed by HAM-A, and HAM-D scores and Quality of Life were assessed using the WHOQOL-BREF scale.

Results

A total of 51 prospective donors were assessed, with a mean age of 34.37 (±9.08) years, with the majority being males (46). No clinically significant depression and anxiety were found on the basis of HAM-D and HAM-A scores. The worst affected quality of life parameter, based on the WHOQOL-BREF scale, was physical quality of life followed by environmental, psychological, and social relationships. Moreover, due to infection, social stigma was experienced by 49.02% of the donors, while 21.97% had anxiety related to convalescent plasma donation as a common livid experience.

Conclusion

Poor quality of life and social stigma during the recovery phase is prevalent in COVID-19 recovered patients, for which formulation of holistic support strategies are the need of the hour.

A review of novel coronavirus disease (COVID-19): based on genomic structure, phylogeny, current shreds of evidence, candidate vaccines, and drug repurposing

Coronavirus disease (COVID-19) pandemic is instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of March 13, 2021, more than 118.9 million cases were infected with COVID-19 worldwide. SARS-CoV-2 is a positive-sense single-stranded RNA beta-CoV. Most COVID-19 infected individuals recover within 1-3 weeks. Nevertheless, approximately 5% of patients develop acute respiratory distress syndrome and other systemic complications, leading to death. Structural genetic analyses of SARS-CoV-2 have shown genomic resemblances but a low evolutionary correlation to SARS-CoV-1 responsible for the 2002-2004 outbreak. The S glycoprotein is critical for cell adhesion and the entrance of the virus into the host. The process of cell entry uses the cellular receptor named angiotensin-converting enzyme 2. Recent evidence proposed that the CD147 as a SARS-CoV-2's potential receptor. The viral genome is mainly held by two non-structural proteins (NSPs), ORF1a and ORF1ab, along with structural proteins. Although NSPs are conserved among the βCoVs, mutations in NSP2 and NSP3 may play critical roles in transmitting the virus and cell tropism. To date, no specific/targeted anti-viral treatments exist. Notably, more than 50 COVID-19 candidate vaccines in clinical trials, and a few being administered. Preventive precautions are the primary strategy to limit the viral load transmission and spread, emphasizing the urgent need for developing significant drug targets and vaccines against COVID-19. This review provides a cumulative overview of the genomic structure, transmission, phylogeny of SARS-CoV-2 from Indian clusters, treatment options, updated discoveries, and future standpoints for COVID-19.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13205-021-02749-0.

Post-lockdown challenges for ophthalmologists during COVID-19 pandemic in India: A survey-based analysis

Purpose

The purpose of this study is to evaluate the post-lockdown challenges during Coronavirus disease 2019 (COVID-19) pandemic amongst the ophthalmologists in India.

Methods

An online survey was sent to the practicing ophthalmologists across India. Data were collected from the responding ophthalmologists and analysed using Medcalc 16.4 software.

Results

A total of 794 responses were obtained. Most respondents (51%) were in the age group 30-50 years and were in independent practice (40.05%). Almost three-fourth of ophthalmologists resumed their surgical services after a gap of more than a month post-lockdown. Almost a third of the respondents had significant reduction in their surgical workload during this period. Significant fear of contracting COVID-19 infection in the operation theatres was reported while moderate difficulty was found in procuring protective gear during immediate post-national lockdown period.

Conclusion

The pandemic has changed the ophthalmic practice significantly, with patient and staff safety becoming areas of major concern. Both financial and psychological concerns affecting healthcare workers need addressing for continued patient care.

Performance evaluation of selected decision tree algorithms for COVID-19 diagnosis using routine clinical data

Background: The novel 2019 Coronavirus disease (COVID-19) poses a great threat to global public health and the economy. The earlier detection of COVID-19 is the key to its treatment and mitigating the transmission of the virus. Given that Machine Learning (ML) could be potentially useful in COVID-19 identification, we compared 7 decision tree (DT) algorithms to select the best clinical diagnostic model. Methods: A hospital-based retrospective dataset was used to train the selected DT algorithms. The performance of DT models was measured using performance criteria, such as accuracy, sensitivity, specificity, receiver operating characteristic (ROC), and precision-recall curves (PRC). Finally, the best decision model was obtained based on comparing the mentioned performance criteria. Results: Based on the Gini Index (GI) scoring model, 13 diagnostic criteria, including the lung lesion existence (GI= 0217), fever (GI= 0.205), history of contact with suspected people (GI= 0.188), O2 saturation rate in the blood (GI= 0.181), rhinorrhea (GI= 0.177), dyspnea (GI = 0.177), cough (GI = 0.159), history of taking the immunosuppressive drug (GI= 0.145), history of respiratory failure (ARDS) (GI= 0.141), lung lesion situation (GI= 0.133) and appearance (GI= 0.126), diarrhea (GI= 0.112), and nausea and vomiting (GI = 0.092) have been obtained as the most important criteria in diagnosing COVID-19. The results indicated that the J-48, with the accuracy= 0.85, F-Score= 0.85, ROC= 0.926, and PRC= 0.93, had the best performance for diagnosing COVID-19. Conclusion: According to the empirical results, it is promising to implement J-48 in health care settings to increase the accuracy and speed of COVID-19 diagnosis.

Repercussions of COVID‐19 on small restaurant entrepreneurs: The Indian context

In the pre‐COVID period, the restaurant industry had significantly grown in India in the past decade due to rapid urbanization and modernization. In the post‐COVID period, the small restaurant entrepreneurs are fighting for their survival due to the lack of funds, a shift in the consumers' behaviour and perception, and negative cash flows. It has led to the closure of restaurants, loss of employment, and adversely affected the allied industries. The small restaurant entrepreneurs are exploring some new opportunities amid the crisis and adopting innovative approaches, technological and digital interventions to meet the consumers' need for a contact‐less dining experience. However, a joint effort on the part of entrepreneurs and government bodies will facilitate and fuel the restaurant industry's growth again.

The current situation of COVID-19 in India

The COVID-19 pandemic has now risen to a global health crisis across the globe. This novel virus outbreak has challenged India's economic, medical and public health infrastructure. Health care professionals and researchers around the world are looking for an effective treatment regime for COVID-19. The number of people infected by COVID-19 in India crossed 9.74 million; nearly eleven - months after the country reported its first case. The Ministry of Health and Family Welfare of India (MOHFW) has taken numerous measures to raise awareness on COVID-19 and the necessary actions to control the spread of the virus. The central and state governments are formulating several wartime protocols to achieve this goal. The MOHFW has implemented the new clinical management protocol to treat COVID-19. Besides, the Ministry of AYUSH has also provided guidelines to use conventional preventive and treatment strategies to enhance immunity. The national recovery rate has increased to 94.66% and the reported fatality rate is down to 1.45, due to "test, track and treat". MOHFW and Ministry of AYUSH are the two pillars of health care to prevent and manage the current pandemic outbreak in India. Since, there is no specific drug or vaccine effective against COVID-19 infection, exploring every possible option for prevention and treatment is of great importance.

Care of inflammatory bowel disease patients during coronavirus disease-19 pandemic using digital health-care technology

Background and Aim

Although telemedicine is an option for the care of inflammatory bowel disease (IBD) patients during the Coronavirus Disease (COVID)‐19 pandemic, its feasibility and acceptability data are scant. Data on the frequency of COVID‐19 among patients with IBD, quality of life (QOL), access to health care, psychological stress, and anxiety during the COVID‐19 pandemic are scant.

Methods

Video/audio consultation for IBD patients was undertaken after a web‐based appointment, and data on acceptability, IBD control, Hospital Anxiety Depression Scale (HADS), and World Health Organization Quality of Life questionnaire (WHOQOL‐Bref) were obtained electronically. IBD patients were assessed for COVID‐19 symptoms or contact history and tested using reverse transcriptase polymerase chain reaction (RT‐PCR) on naso‐ oro‐pharyngeal swabs, and data were compared with 16,317 non‐IBD controls.

Results

Teleconsultation was feasible and acceptable. IBD patients had COVID‐19 as frequently as non‐IBD controls despite immunosuppressive therapy, possibly due to their awareness and preventive practices. Although the physical, psychological, and social QOL scores during the COVID‐19 pandemic were comparable to the prepandemic period, the environmental scores were worse. Psychological tension and interference with work due to pain were lower during the pandemic, which might be influenced by the control of the disease.

Conclusions

Teleconsultation is a feasible and acceptable alternative for IBD patients. They had COVID‐19 as frequently as non‐IBD controls despite a high frequency of immunosuppressive treatment, possibly due to their awareness of the disease and preventive practices. The QOL scores (except the environmental domains) and psychological issues were quite comparable or even better during the COVID‐19 pandemic than earlier.

Clade GR and clade GH isolates of SARS-CoV-2 in Asia show highest amount of SNPs

Clades are monophyletic groups composed of a common ancestor and all its lineal descendants. As the propensity of virulence of a disease depends upon the type of clade the virus belongs to and it causes different fatality rates of disease in different countries, so the clade-wise analysis of SARS-CoV-2 isolates collected from different countries can illuminate the actual evolutionary relationships between them. In this study, 1566 SARS-CoV-2 genome sequences across ten Asian countries are collected, clustered, and characterized based on the clade they belong to. The isolates are compared to the Wuhan reference sequence” hCoV-19/Wuhan/WIV04/19″ to identify the mutations that occurred at different protein regions. Structural changes in amino acids due to mutations lead to functional instability of the proteins. Detailed clade-wise functional assessments are carried out to quantify the stability and vulnerability of the mutations occurring in SARS-CoV-2 genomes which can shade light on personalized prevention and treatment of the disease and encourage towards the invention of clade-specific vaccines.

Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications

Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future.

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Knowledge, Attitudes, and Practices toward COVID-19 among Indian Residents during the Verge of Lockdown Restrictions: A Quick Online Cross-Sectional Survey

Introduction Prodigious restrictions and safety measures have been adopted by the government to control the spread of wildfire coronavirus disease 2019 (COVID-19) pandemic in India. However, the effective implementation of these measures depends upon the knowledge, attitudes, and practices (KAP) of the people. In this context, a cross-sectional online survey of a sample of Indian residents for assessing their KAP toward COVID-19 has been taken up during the verge of lockdown restrictions.

Methods A self-developed online KAP questionnaire consisted of 21 questions related to clinical treatment and prevention aspects of COVID-19 including the safety measures completed by the participants. Assessments on their attitudes and practices toward COVID-19 included the confidence of people to overcome this pandemic and adapting safety measures such as wearing mask while going out in recent days.

Results and Discussion A sample of 1,043 participants participated in this online survey. The overall correct rate of the knowledge questionnaire was 90%. More than half of the respondents (53.3%) had confidence that India can win the battle against COVID-19. All the participants believed that Ayurveda, Yoga, Unani, Siddha, and Homoeopathy (AYUSH) systems of medicine that are the rich heritage of India would be helpful in combating the viral illness (95.4%). Nearly all the participants (99%) wore masks when going out in recent days. In multiple logistic regression analyses, the COVID-19 knowledge score was significantly associated with a lower likelihood of negative attitudes and preventive practices toward COVID-19.

Conclusion The Indian residents showed good knowledge toward COVID-19 and this in turn helped them to hold optimistic attitudes and have appropriate practices toward COVID-19. More community-based health education program strategies if aimed would help further. The limitation of sample representativeness restricts to generalize the findings to population of rural areas with low socioeconomic status.

The Spectrum of Gastrointestinal Symptoms in Patients With Coronavirus Disease-19: Predictors, Relationship With Disease Severity, and Outcome

INTRODUCTION

We prospectively studied the frequency, spectrum, and predictors of gastrointestinal (GI) symptoms among patients with coronavirus disease-19 (COVID-19) and the relationship between GI symptoms and the severity and outcome.

METHODS

Consecutive patients with COVID-19, diagnosed in a university hospital referral laboratory in northern India, were evaluated for clinical manifestations including GI symptoms, their predictors, and the relationship between the presence of these symptoms, disease severity, and outcome on univariate and multivariate analyses.

RESULTS

Of 16,317 subjects tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in their oropharyngeal and nasopharyngeal swabs during April-May 2020, 252 (1.5%) were positive. Of them, 208 (82.5%) were asymptomatic; of the 44 symptomatic patients, 18 (40.9%) had non-GI symptoms, 15 (34.1%) had a combination of GI and non-GI symptoms, and 11 (25.0%) had GI symptoms only. Thirty-three had mild-to-moderate disease, 8 severe, and 5 critical. Five patients (1.98%) died. On multivariate analysis, the factors associated with the presence of GI symptoms included the absence of contact history and presence of non-GI symptoms and comorbid illnesses. Patients with GI synptoms more often had severe, critical illness and fatal outcome than those without GI symptoms.

DISCUSSION

Eighty-two percent of patients with COVID-19 were asymptomatic, and 10.3% had GI symptoms; severe and fatal disease occurred only in 5% and 2%, respectively. The presence of GI symptoms was associated with a severe illness and fatal outcome on multivariate analysis. Independent predictors of GI symptoms included the absence of contact history, presence of non-GI symptoms, and comorbid illnesses.(Equation is included in full-text article.).