Guidelines for Reopening a Nation in a SARS-CoV-2 Pandemic: A Path Forward

Fear of COVID-19 influences physical activity practice: a study in a Brazilian sample

The suspension of social activities combined with health insecurity, uncertainty and fear of COVID-19 may influence physical activity practice. We aimed to investigate the relationship between the fear of COVID-19 and anxiety on physical activity patterns during the pandemic period. This cross-sectional study was performed in a sample of 520 Brazilian participants recruited by online sampling and snowball method. We assessed demographic variables, health perceptions, anxiety, fear of COVID-19 and physical activity characteristics. Both fear scores and anxiety were higher in woman (p < 0.0001). We observed a remarkable reduction in the frequency and intensity of physical activity and a modification in the exercise practice environment (from gym or sports centers to home-based physical activity) (p < 0.05). Sedentary (sitting) behavior increased during pandemic both in the weekdays and in the weekend (p < 0.0001). Participants who have never been infected were more prone of being classified in higher levels for physical activity (OR: 1.916, CI = 1.043-3.521) versus those who were previously infected (p = 0.05). Participants with a low or moderate level of physical activity before the pandemic presented lower chances of being classified as high physical activity level during the pandemic in comparison to those with high level before pandemic (p < 0.001). The Fear of Covid-19 score was negatively associated with the physical activity level (the higher the fear, the lower the level of physical activity); that is, for every increase in scale score, the odds of vigorous physical activity decreased 3%. In conclusion, fear of COVID-19 and previous contact with the virus negatively influenced physical activity practice.

Personal protective equipment related skin changes among nurses working in pandemic intensive care unit: A qualitative study

AIM

The respiratory tract is the main transmission way of the SARS-CoV-2 virus and nurses who care for COVID-19 patients in intensive care units (ICUs) are required to constantly use personal protective equipment (PPE) during their daily work. This study aimed to examine the PPE-related skin changes experienced by the nurses working in pandemic ICU during the COVID-19 pandemic.

METHODS

Using a descriptive phenomenological approach, semi-structured interviews were conducted between November 1st and December 25th, 2020, in the pandemic ICU of a training and research hospital in Usak, Turkey. The nurses who worked in the pandemic ICU for at least one week and experienced skin changes due to PPE use were included. Individual interviews were carried out online through video conferencing. Colaizzi's method was used in data analysis by using the ATLAS.ti 8.0.

RESULTS

The main themes were main causes of PPE-related skin changes, its location along with secondary adverse effects, symptomatology, prevention, and therapeutic interventions used for curing PPE-related skin changes. Nurses mostly reported PPE-related skin changes behind their ears, over their nose, cheeks and jaw due to wearing N95 masks and on the forehead due to wearing face shields. Wearing PPE at least 2 h, the type/quality of PPE, and being dehydrated were identified as the common causes.

CONCLUSION

This study provides a deeper understanding into the PPE-related skin change experiences of pandemic ICU nurses and the importance of the quality of the PPE used. It is recommended to enable shortened working shifts and ergonomic PPE materials for ICU nurses.

[Ventilation concepts in schools for the prevention of transmission of highly infectious viruses (SARS-CoV-2) by aerosols in indoor air]

Exhaled aerosol particles play an important role in the transmission of SARS-CoV‑2, particularly when many people gather indoors. This article summarises the knowledge on virus transmission in schools and practical measures to reduce aerosol-driven infections. A central preventive measure is to enhance room and building ventilation, i.e. the exchange of possibly contaminated indoor air with ambient air. Besides the concentrations of possibly infectious particles, ventilation reduces carbon dioxide concentrations, humidity and other chemical substances in indoor air as well. Irrespective of ventilation, face masks (surgical or FFP2) represent a vital part of hygiene measures. Fixed or mobile air purifiers can support these measures particularly when rooms providing only poor ventilation must be utilized. The article reflects the state of knowledge in October 2021 of the various techniques that have been shown as useful for the prevention of indirect infections. New variants of SARS-CoV‑2, the progress of the vaccination campaign in children and adolescents, and the increase in general immunity might require a re-evaluation of the prevention strategies described. The COVID-19 pandemic has revealed common deficits in room and building ventilation, not least in schools. Apart from short-term measures for the prevention of airborne infectious diseases, a long-term strategy seems advisable to alleviate the deficits encountered in schools with respect to room and building ventilation. In view of a permanent improvement of indoor air and prevention against airborne infections the fitting of schools with fixed ventilation systems - preferably including heat and moisture recovery - appears to be a sustainable social investment.

The changing pattern of enteric pathogen infections in China during the COVID-19 pandemic: a nation-wide observational study

Background

Non pharmaceutical interventions (NPI) including hand washing directives were implemented in China and worldwide to combat the COVID-19 pandemic, which are likely to have had impacted a broad spectrum of enteric pathogen infections.

Methods

Etiologically diagnostic data from 45 937 and 67 395 patients with acute diarrhea between 2012 and 2020, who were tested for seven viral pathogens and 13 bacteria respectively, were analyzed to assess the changes of enteric pathogen infections in China during the first COVID-19 pandemic year compared to pre-pandemic years.

Findings

Test positive rates of all enteric viruses decreased during 2020, compared to the average levels during 2012−2019, with a relative decrease of 71•75% for adenovirus, 58•76% for norovirus, 53•50% for rotavirus A, and 72•07% for the combination of other four uncommon viruses. In general, a larger reduction of positive rate in viruses was seen among adults than pediatric patients. A rebound of rotavirus A was seen after September 2020 in North China rather than South China. Test positive rates of bacteria decreased during 2020, compared to the average levels during 2012−2019, excepting for nontyphoidal Salmonella and Campylobacter coli with 66•53% and 90•48% increase respectively. This increase was larger for pediatric patients than for adult patients.

Interpretation

The activity of enteric pathogens changed profoundly alongside the NPIs implemented during the COVID-19 pandemic in China. Greater reductions of the test positive rates were found for almost all enteric viruses than for bacteria among acute diarrhea patients, with further large differences by age and geography. Lifting of NPIs will lead to resurgence of enteric pathogen infections, particularly in children whose immunity may not have been developed and/or waned.

Funding

China Mega-Project on Infectious Disease Prevention; National Natural Science Funds.