Expected Impacts of COVID-19: Considering Resource-Limited Countries and Vulnerable Population

Infectious diseases ethics: a worldwide survey

OBJECTIVES

COVID-19 unravelled new ethical issues in the neglected field of infectious diseases ethics (IDE). We investigated IDE involvement among infectious diseases professionals.

METHODS

A global survey was disseminated during 2021-2022. Responses were stratified by demographics, WHO region, income, and ethics training. A confirmatory factor analysis was used to identify two themes representing IDE relevant areas (theme 1, including stigma, inequity, vulnerability, public health, and global impact) and emerging topics (theme 2, including inequity and research integrity in COVID-19, increased ethics interest, and gaps in IDE). Quantile and logistic regression analyses investigated determinants of ethics themes and responders' ethics attitude.

RESULTS

We included 477 participants from 71 countries. Most were females (282/460, 61%) and clinicians (327/457, 72%). Participants advocated further personal (289/443, 65%) or societies' (374/450, 83%) involvement in bioethics. Only 5% (22/477) of respondents claimed to have received enough bioethics training and 28% (114/412) were dissatisfied with it. Dedicated courses or expert case discussion were the preferred ways for receiving education in bioethics. Theme 1 and 2 median values were above 7 (on a 1-10 scale), showing high interest in IDE. Confirmatory factor analysis showed optimal and acceptable fit, respectively. Being from the region of Americas was associated with theme 1, whereas having received bioethics training was associated with both themes. Females and respondents from the Americas and Europe regions reported lower involvement in bioethics activities, whereas those aged between 44 and 54 years and trained in bioethics were more involved. Age above 55 years and nonclinical role were negatively associated with aspiration for further bioethics involvement.

DISCUSSION

We identified IDE themes that can inform on gaps in bioethics. Ethics training was associated with interest in IDE and bioethics activities and should be offered to integrate this discipline into daily clinical practice across age, gender, and different areas worldwide.

Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study

BACKGROUND

Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks.

OBJECTIVE

The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns.

METHODS

Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population.

RESULTS

COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment.

CONCLUSIONS

Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics.

Understanding the impacts of the COVID-19 response measures on Deaf adults in Cape Town

Background

International literature has evidenced that Deaf people have been disadvantaged during the COVID-19 pandemic; however, there is currently little research published within the South African context.

Objectives

This study investigated the ways in which the COVID-19 pandemic and its consequent response measures impacted Deaf adults in Cape Town.

Method

Using a descriptive approach, semi-structured, qualitative interviews were held with 15 Deaf adults in Cape Town, South Africa. Participants were purposively selected through a local Deaf organisation. Data were analysed using thematic analysis.

Results

Data revealed the challenges experienced when accessing information, the impact of communication barriers on daily life, and how the response measures impacted access to healthcare.

Conclusion

The findings of this study demonstrate how the needs of the Deaf community were overlooked and their voices disregarded during the planning of the national pandemic response, ultimately having detrimental consequences. Therefore, the authors argue for greater inclusion of Deaf representatives to ensure equal access to information and resources, especially during a crisis.

Contribution

This study contributes to the growing body of knowledge on the consequences of the COVID-19 pandemic in the field of disability and insights can inform both future research and interventions to promote equity and inclusion for Deaf people.

Global landscape of COVID-19 research: a visualization analysis of randomized clinical trials

The emergence of COVID-19 in 2019 has resulted in a significant global health crisis. Consequently, extensive research was published to understand and mitigate the disease. In particular, randomized controlled trials (RCTs) have been considered the benchmark for assessing the efficacy and safety of interventions. Hence, the present study strives to present a comprehensive overview of the global research landscape pertaining to RCTs and COVID-19. A bibliometric analysis was performed using the Scopus database. The search parameters included articles published from 2020 to 2022 using keywords specifically related to COVID-19 and RCTs. The data were analyzed using various bibliometric indicators. The volume of publications, contributions of countries and institutions, funding agencies, active journals, citation analysis, co-occurrence analysis, and future research direction analysis were specifically analyzed. A total of 223,480 research articles concerning COVID-19 were published, with 3,727 of them related to RCTs and COVID-19. The ten most productive countries collectively produced 75.8% of the documents, with the United States leading the way by contributing 31.77%, followed by the UK with 14.03% (n = 523), China with 12.96% (n = 483) and Canada with 7.16% (n = 267). Trials (n = 173, 4.64%), BMJ Open (n = 81, 2.17%), PLOS One (n = 73, 1.96%) and JAMA Network Open (n = 53, 1.42%) were the most active journals in publishing articles related to COVID-19 RCTs. The co-occurrence analysis identified four clusters of research areas: the safety and effectiveness of COVID-19 vaccines, mental health strategies to cope with the impact of the pandemic, the use of monoclonal antibodies to treat patients with COVID-19, and systematic reviews and meta-analyses of COVID-19 research. This paper offers a detailed examination of the global research environment pertaining to RCTs and their use in the context of the COVID-19 pandemic. The comprehensive body of research findings was found to have been generated by the collaborative efforts of multiple countries, institutions, and funding organizations. The predominant research areas encompassed COVID-19 vaccines, strategies for mental health, monoclonal antibodies, and systematic reviews. This information has the potential to aid researchers, policymakers, and funders in discerning areas of weakness and establishing areas of priority.

Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave

BACKGROUND

Indonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic.

METHODS

This is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes.

RESULTS

From 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered.

CONCLUSIONS

The mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.

A novel mathematical model for prioritization of individuals to receive vaccine considering governmental health protocols

Infectious diseases drive countries to provide vaccines to individuals. Due to the limited supply of vaccines, individuals prioritize receiving vaccinations worldwide. Although, priority groups are formed based on age groupings due to the restricted decision-making time. Governments usually ordain different health protocols such as lockdown policy, mandatory use of face masks, and vaccination during the pandemics. Therefore, this study considers the case of COVID-19 with a SEQIR (susceptible-exposed-quarantined-infected-recovered) epidemic model and presents a novel prioritization technique to minimize the social and economic impacts of the lockdown policy. We use retail units as one of the affected parts to demonstrate how a vaccination plan may be more effective if individuals such as retailers were prioritized and age groups. In addition, we estimate the total required vaccine doses to control the epidemic disease and compute the number of vaccine doses supplied by various suppliers. The vaccine doses are determined using optimal control theory in the solution technique. In addition, we consider the effect of the mask using policy in the number of vaccine doses allocated to each priority group. The model's performance is evaluated using an illustrative scenario based on a real case.

It's all not negative: a cross-section study on the impacts of Covid-19 pandemic on Iranian population

BACKGROUND

Covid-19 has had significant effects on the quality of life of individuals around the world. Research highlights many negative impacts related to Covid-19; however, there are also potential positive impacts. The current study aimed to identify both the perceived negative and positive effects of Covid-19 among the residents of Tabriz, Iran.

MATERIALS & METHODS

The descriptive cross-sectional study was conducted in 10 health centers in Tabriz city in 2021. Cluster random sampling was used to select the 861 study participants. A questionnaire was developed to collect demographic and Covid-19 impacts. Data were analyzed with descriptive and inferential statistics using SPSS 16 software.

RESULTS

The mean (SD) of negative and positive impacts of Covid-19 was 37.7 (5.10) and 36.35 (5.31), respectively. Significant negative impacts included restriction in participation in cultural (90.4%) and religious (88.9%) activities. Positive impacts were increased attention to personal hygiene (88.7%) and attention to elders (87.6%). Gender (p = 0.006), work status (p = 0.004) and age (p = 0. 01) had significant association with the mean of negative impacts and work status (p = 0.01), age (p < 0.001), history of Covid-19 (p = 0.01) and family history of Covid-19 (p < 0.001) had the significant association with the mean of positive impacts of Covid-19.

CONCLUSION

The findings revealed that the general population experienced many negative impacts of Covid-19. This may be related to the priority of religious gatherings in Iranian culture. Despite the unfavorable effects of Covid-19, its positive effects and post-traumatic growth should not be ignored. Covid-19 may be used as an opportunity to develop personal growth and a positive outlook on life. Healthcare workers should reinforce the positive impacts of Covid-19 while taking into consideration the importance of spirituality among Iranian individuals during times of community lockdowns.

Socioeconomic correlates of face mask use among pedestrians during the COVID-19 pandemic: An ecological study

Background

Many countries have recommended using face masks for the general population in public places to reduce the risk of COVID-19 transmission. This study aimed to assess the effects of socioeconomic status on face mask use among pedestrians during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted in Ahvaz, southwest Iran in August 2020. A total of 10,440 pedestrians have been studied from 92 neighborhoods of the city. Three socioeconomic indicators including Land price, Literacy rate, and the Employment rate for each neighborhood were used in this study. Analysis of Covariance and partial correlation coefficients were applied to assess the relationship between prevalence rates of mask usage and SES indicators.

Results

The mean ± SD age of the pedestrians was 32.2 ± 15.1 years. Of 10,440 observed participants, 67.9% were male. The overall prevalence of face mask usage was 45.6%. The prevalence of mask usage in older people and women was significantly higher than the others. The three assessed socioeconomic indicators were directly correlated to the prevalence of mask usage at individual and neighborhood levels.

Conclusion

We found that literacy had the strongest correlation with the prevalence of mask usage compared to the land price and employment rate among the three assessed SES indicators. Hence, it can be concluded that the social component of socioeconomic status has a greater effect on mask usage by people than the economic component of socioeconomic status.

COVID-19 public health and social measures: a comprehensive picture of six Asian countries

The COVID-19 pandemic will not be the last of its kind. As the world charts a way towards an equitable and resilient recovery, Public Health and Social Measures (PHSMs) that were implemented since the beginning of the pandemic need to be made a permanent feature of health systems that can be activated and readily deployed to tackle sudden surges in infections going forward. Although PHSMs aim to blunt the spread of the virus, and in turn protect lives and preserve health system capacity, there are also unintended consequences attributed to them. Importantly, the interactions between PHSMs and their accompanying key indicators that influence the strength and duration of PHSMs are elements that require in-depth exploration. This research employs case studies from six Asian countries, namely Indonesia, Singapore, South Korea, Thailand, the Philippines and Vietnam, to paint a comprehensive picture of PHSMs that protect the lives and livelihoods of populations. Nine typologies of PHSMs that emerged are as follows: (1) physical distancing, (2) border controls, (3) personal protective equipment requirements, (4) transmission monitoring, (5) surge health infrastructure capacity, (6) surge medical supplies, (7) surge human resources, (8) vaccine availability and roll-out and (9) social and economic support measures. The key indicators that influence the strength and duration of PHSMs are as follows: (1) size of community transmission, (2) number of severe cases and mortality, (3) health system capacity, (4) vaccine coverage, (5) fiscal space and (6) technology. Interactions between PHSMs can be synergistic or inhibiting, depending on various contextual factors. Fundamentally, PHSMs do not operate in silos, and a suite of PHSMs that are complementary is required to ensure that lives and livelihoods are safeguarded with an equity lens. For that to be achieved, strong governance structures and community engagement are also required at all levels of the health system.

The Impact of COVID-19 Pandemic on Health Inequities: A Photovoice Study With Nursing Students

INTRODUCTION

The COVID-19 pandemic has an amplified impact on vulnerable populations. Also, aspects related to health inequalities are insufficiently taught in higher education. This study aims to promote reflection in nursing students on the impact of the COVID-19 pandemic on vulnerable populations affected by health inequities.

METHODOLOGY

A photovoice method was used. Undergraduate nursing students (Spain and United Kingdom) took and explained photographs using SHOWED models.

RESULTS

108 students participated. Two-domain summary themes were created: The COVID-19 pandemic has impacted ethnic minorities and socioeconomically vulnerable groups, and Proposals to respond to the negative impact on ethnic minorities and socioeconomically vulnerable groups.

DISCUSSION

The students identified negative health scenarios by linking COVID-19 with aspects of work, salary, and housing of these two specific populations. Holistic actions were also proposed to protect their health. As future health professionals, they must recognize these communities and work to eliminate inequalities.

Lifestyle Changes and Psychological Well-Being in Older Adults During COVID-19 Pandemic

COVID-19 pandemic forced countries to adopt strategies aimed at responding to the health emergency by containing contagion. Lockdowns have ensured the achievement of this goal but imposed substantial restrictions to the freedom of movement and resulted in social isolation for a large share of vulnerable people. The aim of the present study was to evaluate the impact of COVID-19 pandemic and associated emergency restriction measures on the quality of life, lifestyle habits, and psychosocial status in older adults.

Advances in COVID-19 Vaccines and New Coronavirus Variants

With the successful development of the Corona Virus Disease 2019 (COVID-19) vaccines and increased vaccination coverage, great progress in global outbreak control has been made in several countries. However, new coronavirus variants emerge and their rapid spread, causing a new wave of economic and social upheaval worldwide. The spread of new coronavirus variants poses a new and enormous challenge to vaccination and pandemic control, so further studies to explore and develop vaccines for the prevention and control virus infection are warranted. In this review, we provide an overview of the most prevalent variants including Omicron, and explore the effectiveness of COVID-19 vaccines against related variants to better understand existing vaccines and to facilitate improved research into new vaccines. In addition, this review discusses existing strategies to increase vaccine efficacy and introduces novel vaccines by the non-injection route.

Clinical Characteristics and Outcome of Pediatric COVID-19 Patients in Ethiopia During the Early COVID-19 Pandemic: A Prospective Cohort Study

Introduction

Setting

Methods

Results

Conclusion

Gender Differences in Psychological Stress Factors of Physical Therapy Degree Students in the COVID-19 Pandemic: A Cross-Sectional Study

(1) Background: The aim of the study was to investigate how the COVID-19 pandemic impacted the mental health and quality of life of male and female physical therapy students at the European University of Madrid. (2) Methods: A cross-sectional online survey was conducted including a range of tests capturing different domains: 36-item Short Form Health Survey, six-item state version of the State–Trait Anxiety Inventory, Acceptance and Action Questionnaire, Three Items Loneliness Scale, four-item version of the Perceived Stress Scale, Beck Depression Inventory revised version, and Sleep Quality Numeric Rating Scale. (3) Results: A total of 151 students completed the study, consisting of 78 females and 73 males. Gender differences were observed on most of the domains evaluated. Female participants showed worse levels of general health perception, quality of life, depression symptoms, anxiety, stress, experiential avoidance and psychological inflexibility, sleep quality and loneliness compared to male physical therapy students. (4) Conclusions: The results of this study support the need of psychological interventions as preventive programs in situations such as COVID-19 pandemic. The aims of this study comprise of improving knowledge, awareness, and self-coping strategies or other psychological domains oriented to mitigate the effects of COVID-19 on mental health and health-related quality of life in university students, especially among female ones.

An ethical analysis of the impacts of the COVID-19 pandemic on the health of children and adolescents

ABSTRACT The COVID-19 pandemic has impacted the lives of children and adolescents around the world. Hence, this study aimed to examine how the pandemic has impacted children and adolescents in Brazil through an ethical analysis. An interpretive analysis of Brazilian research on child and adolescent health during the pandemic was conducted. Recognizing this ethical dimension is pivotal to shedding more light on how responses to crisis situations, such as the current situation of the COVID-19 pandemic, can be shaped and where the priorities for action are according to all interested parties, situating the child between these parts of interest. Our analysis highlighted both direct and indirect effects surrounding the decision-making processes for children in the COVID-19 pandemic reality. These decisional processes must sustain the child’s right to participation to ascertain that the action taken is in the child’s best interests. Nevertheless, the Brazilian reality has shown a structural exclusion of children’s voices in decisions affecting them, particularly concerning the effects of the pandemic on their lives. Further studies must be conducted to deepen the knowledge about children’s best interests and their participation in the actions planned during the pandemic.

Análise ética dos impactos da pandemia de COVID-19 na saúde de crianças e adolescentes

RESUMO A pandemia de COVID-19 trouxe impactos significativos para a vida de crianças e adolescentes em todo o mundo. Considerando esse contexto, o objetivo deste artigo foi examinar como as crianças e os adolescentes no Brasil foram impactados pela pandemia à luz de uma análise ética. Para tanto, uma análise interpretativa de estudos brasileiros sobre a saúde da criança e do adolescente durante a pandemia foi realizada. A tarefa de reconhecer essa dimensão ética é importante para entender como as respostas a situações de crise, tais como a presente situação da pandemia de COVID-19, podem ser moldadas e identificar quais as prioridades de ação de acordo com todas as partes interessadas, situando a criança entre essas partes de interesse. A análise demonstrou que tanto os efeitos diretos quanto os indiretos implicam em processos de tomada de decisão que precisam utilizar e sustentar o direito de participação da criança para que a ação tomada esteja o máximo possível focada nos melhores interesses da criança. Contudo, a realidade brasileira tem demonstrado uma exclusão estrutural das vozes infantis. Recomenda-se que mais estudos sejam conduzidos a fim de aprofundar o conhecimento sobre os melhores interesses das crianças e sua participação nas ações tomadas durante a pandemia.

One in Five Street Traditional Coffee Vendors Suffered from Depression During the COVID-19 Pandemic in Harar Town, Ethiopia

BACKGROUND

The COVID-19 crisis has already resulted in an economic and labor market shock and a rise of informal work sectors. Being an informal job, traditional coffee vending can predispose women to a myriad of mental disorders. Therefore, this study was aimed to assess depressive symptoms during the COVID-19 pandemic and associated factors among street traditional coffee vendors in Harar town, Eastern Ethiopia.

METHODS

A cross-sectional study was employed on 180 women engaged in street traditional coffee vending business in Harar town. Data were collected through a face-to-face interview using a Public Health Questionnaire and analyzed using SPSS version 20. Binary logistic regression was executed to identify factors associated with depression at a cut-off point of P < 0.05.

RESULTS

The mean age of the study participants was 31.83 (±10) years. The majority of the participants were currently married (n = 77, 42.8%), attended primary education (n = 68, 37.8%), had a family member of four or more (n = 60, 33.3%), and had two years or less work experience (n = 123, 68.3%). Most of the study participants obtained COVID-19-related information from television (n = 125, 69.4%). The prevalence of depression was found to be 18.9%. Attending primary education (AOR: 0.34; 95% CI: 0.12, 0.98), attending secondary education or higher (AOR: 0.23; 95% CI: 0.07, 0.69), and having four or more family members (AOR: 2.81; 95% CI: 1.14, 6.92) were significantly associated with depression.

CONCLUSION

One in five street traditional coffee vendors suffered from depression during the COVID-19 pandemic. Lower odds of being depressed were observed in those who attended a minimum of primary education. On the contrary, having a greater family size was associated with higher odds of being depressed. This finding will direct the government and other concerned bodies to be involved in the provision of psychological and material support for such informal workers during COVID-19.