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9 pages, 632 KiB

Open AccessArticle

Surveillance of Infections and Antibiotic Use in 21 Nursing Home Wards during the COVID-19 Pandemic: A Systematic Assessment

by Ida Hellum Sandbekken, Åsmund Hermansen, Ellen Karine Grov, Inger Utne and Borghild Løyland

Int. J. Environ. Res. Public Health 2024, 21(3), 358; https://doi.org/10.3390/ijerph21030358 - 18 Mar 2024

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Abstract

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and [...] Read more.

Residents in nursing homes are fragile and at high risk of serious illness or death from healthcare-associated infections. The COVID-19 pandemic posed a significant risk of suffering and mortality for residents of nursing homes. Surveillance of infections is essential for infection prevention and is missing in many countries. The aim of this study is to explore infection rates and antibiotic use in nursing homes during the COVID-19 pandemic. Data collection was conducted from February to September 2021. Each week, healthcare workers at 21 nursing home wards answered a questionnaire on infections, antibiotic use, deaths, and hospital admissions related to infections. A total of 495 infections were reported, and 97.6% were treated with antibiotics. The total infection rate was 5.37 per 1000 bed days, and there were reported 53 hospital admissions and 11 deaths related to or caused by infections. The infection rate and high use of antibiotics found in this study indicated that it is difficult to treat infections in residents in nursing homes and make it difficult to achieve the global goal of reducing infections and antibiotic resistance rates. This emphasizes the need for stricter infection control programs to reduce antibiotic use and patient suffering. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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11 pages, 626 KiB

Open AccessArticle

Potential Risk Factors to COVID-19 Severity: Comparison of SARS-CoV-2 Delta- and Omicron-Dominant Periods

by Daiki Yamaguchi, Odgerel Chimed-Ochir, Yui Yumiya, Eisaku Kishita, Tomoyuki Akita, Junko Tanaka and Tatsuhiko Kubo

Int. J. Environ. Res. Public Health 2024, 21(3), 322; https://doi.org/10.3390/ijerph21030322 - 10 Mar 2024

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Abstract

Background: Continued study of risk factors can inform future pandemic preparedness and response. We aimed to determine the potential risk factors of COVID-19 severity among patients admitted to the hospital during the Delta- and Omicron-dominant periods. Methods: We utilized the J-SPEED-style COVID-19 Hospital [...] Read more.

Background: Continued study of risk factors can inform future pandemic preparedness and response. We aimed to determine the potential risk factors of COVID-19 severity among patients admitted to the hospital during the Delta- and Omicron-dominant periods. Methods: We utilized the J-SPEED-style COVID-19 Hospital version, a pre-administered questionnaire, to collect data from hospitals in Hiroshima Prefecture between 8 August 2021 and 19 April 2022. Results: During the Delta-dominant period, patients aged over 65 (OR = 2.59, 95% CI = 1.75–3.84), males (OR = 1.42, 95% CI = 1.12–1.81) and with BMI exceeding 25 (OR = 1.99, 95% CI = 1.57–2.52), diabetes (OR = 2.03, 95% CI = 1.40–2.95), and those with fewer than two doses of vaccine (OR = 2.39, 95% CI = 1.46–3.91) were at a greater risk of severe COVID-19 compared to those without these risk factors. During the Omicron-dominant period, significantly greater severity was observed among patients over 65 years old (OR = 3.89, 95% CI = 2.95–5.12), males (OR = 1.76, 95% CI = 1.40–2.21), those with high blood pressure (OR = 1.30, 95% CI = 1.02–1.65), and mental disorder (OR = 2.22, 95% CI = 1.69–2.92) compared to patients without these risks. Conclusions: Our findings indicate that risk factors vary across different SARS-CoV-2 variants. Examining variant-specific risk factors for COVID-19 severity can aid policymakers, public health specialists, and clinicians in prioritizing screening, treatment, and vaccination efforts, especially during potential healthcare resource shortages. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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14 pages, 673 KiB

Open AccessArticle

Risk Factors for Mortality of Hospitalized Adult Patients with COVID-19 Pneumonia: A Two-Year Cohort Study in a Private Tertiary Care Center in Mexico

by Carlos Axel López-Pérez, Francisco J. Santa Cruz-Pavlovich, Juan Eduardo Montiel-Cortés, Adriana Núñez-Muratalla, Ruth Bibani Morán-González, Ricardo Villanueva-Gaona, Xochitl Franco-Mojica, Denisse Gabriela Moreno-Sandoval, Joselyn Anacaren González-Bañuelos, Alan Ulises López-Pérez, Marily Flores-González, Cristina Grijalva-Ruiz, Edna Daniela Valdez-Mendoza, Luis Renee González-Lucano and Martín López-Zendejas

Int. J. Environ. Res. Public Health 2023, 20(5), 4450; https://doi.org/10.3390/ijerph20054450 - 02 Mar 2023

Cited by 2 | Viewed by 1760

Abstract

During the COVID-19 pandemic, the high prevalence of comorbidities and the disparities between the public and private health subsystems in Mexico substantially contributed to the severe impact of the disease. The objective of this study was to evaluate and compare the risk factors [...] Read more.

During the COVID-19 pandemic, the high prevalence of comorbidities and the disparities between the public and private health subsystems in Mexico substantially contributed to the severe impact of the disease. The objective of this study was to evaluate and compare the risk factors at admission for in-hospital mortality of patients with COVID-19. A 2-year retrospective cohort study of hospitalized adult patients with COVID-19 pneumonia was conducted at a private tertiary care center. The study population consisted of 1258 patients with a median age of 56 ± 16.5 years, of whom 1093 recovered (86.8%) and 165 died (13.1%). In the univariate analysis, older age (p < 0.001), comorbidities such as hypertension (p < 0.001) and diabetes (p < 0.001), signs and symptoms of respiratory distress, and markers of acute inflammatory response were significantly more frequent in non-survivors. The multivariate analysis showed that older age (p < 0.001), the presence of cyanosis (p = 0.005), and previous myocardial infarction (p = 0.032) were independent predictors of mortality. In the studied cohort, the risk factors present at admission associated with increased mortality were older age, cyanosis, and a previous myocardial infarction, which can be used as valuable predictors for patients’ outcomes. To our knowledge, this is the first study analyzing predictors of mortality in COVID-19 patients attended in a private tertiary hospital in Mexico. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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18 pages, 8198 KiB

Open AccessArticle

Research on the Anti-Risk Mechanism of Mask Green Supply Chain from the Perspective of Cooperation between Retailers, Suppliers, and Financial Institutions

by Haibo Chen, Zongjun Wang, Xuesong Yu and Qin Zhong

Int. J. Environ. Res. Public Health 2022, 19(24), 16744; https://doi.org/10.3390/ijerph192416744 - 13 Dec 2022

Cited by 1 | Viewed by 1182

Abstract

Against the background of the pandemic, the mask supply chain faces the risk of pollution caused by discarded masks, the risk of insufficient funds of retailers, and the risk of mask overstock. To better guard against the above risks, this study constructed a [...] Read more.

Against the background of the pandemic, the mask supply chain faces the risk of pollution caused by discarded masks, the risk of insufficient funds of retailers, and the risk of mask overstock. To better guard against the above risks, this study constructed a two-party game model and a cusp catastrophe model from the perspective of the mask green supply chain, and studied the strategic choices of retailers and suppliers in the supply chain affected by the risk of capital constraints and overstock. The result shows that the risk shocks will lead to the disruption of the mask green supply chain, and the main factors affecting the strategy choice of mask suppliers and retailers are mask recycling rate, deposit ratio, risk occurrence time, etc. In further research, this study involved a mechanism for financial institutions, mask retailers, and the government to jointly deal with the risk of mask overstock, the risk of retailers’ insufficient funds, and the risk of environmental pollution from discarded masks. The research path and conclusion of this study reveal the risks in the circulation area of mask supplies during the pandemic, and provide recommendations for planning for future crises and risk prevention. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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12 pages, 541 KiB

Open AccessArticle

Impact of COVID-19 Pandemic Lockdown on the Prognosis, Morbidity, and Mortality of Patients Undergoing Elective and Emergency Abdominal Surgery: A Retrospective Cohort Study in a Tertiary Center, Saudi Arabia

by Rakan H. Alelyani, Ali H. Alghamdi, Saad M. Mahrous, Bader M. Alamri, Mudhawi H. Alhiniah, Maisa S. Abduh and Saleh M. Aldaqal

Int. J. Environ. Res. Public Health 2022, 19(23), 15660; https://doi.org/10.3390/ijerph192315660 - 25 Nov 2022

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Abstract

The SARS-CoV-2 pandemic’s main concerns are limiting the spread of infectious diseases and upgrading the delivery of health services, infrastructure, and therapeutic provision. The goal of this retrospective cohort study was to evaluate the emergency experience and delay of elective abdominal surgical intervention [...] Read more.

The SARS-CoV-2 pandemic’s main concerns are limiting the spread of infectious diseases and upgrading the delivery of health services, infrastructure, and therapeutic provision. The goal of this retrospective cohort study was to evaluate the emergency experience and delay of elective abdominal surgical intervention at King Abdul-Aziz University Hospital from October 2019 to October 2020, with a focus on post-operative morbidity and mortality before and during the COVID-19 pandemic. This study compares two groups of patients with emergent and elective abdominal surgical procedures between two different periods; the population was divided into two groups: the control group, which included 403 surgical patients, and the lockdown group, which included 253 surgical patients. During the lockdown, surgical activity was reduced by 37.2% (p = 0.014), and patients were more likely to require reoperations and blood transfusions during or after surgery (p= 0.002, 0.021, and 0.018, respectively). During the lockdown period, the average length of stay increased from 3.43 to 5.83 days (p = 0.002), and the patients who developed complications (53.9%) were more than those in the control period (46.1%) (p = 0.001). Our tertiary teaching hospital observed a significant decline in the overall number of surgeries performed during the COVID-19 pandemic and lockdown period. During the lockdown, abdominal surgery was performed only on four patients; they were positive for COVID-19. Three of them underwent exploratory laparotomy; two of the three developed shock post-operative; one patient had colon cancer (ASA score 3), one had colon disease (ASA score 2), and two had perforated bowels (ASA scores 2 and 4, respectively). Two out of four deaths occurred after surgery. Our results showed the impact of the COVID-19 lockdown on surgical care as both 30-day mortality and total morbidity have risen considerably. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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13 pages, 365 KiB

Open AccessArticle

Predictors of SARS-CoV-2 Infection in University Students: A Case-Control Study

by Giuseppe Migliara, Erika Renzi, Valentina Baccolini, Ambrogio Cerri, Pierluigi Donia, Azzurra Massimi, Carolina Marzuillo, Corrado De Vito, Leandro Casini, Antonella Polimeni, Eugenio Gaudio, Paolo Villari and The Collaborating Group

Int. J. Environ. Res. Public Health 2022, 19(21), 14376; https://doi.org/10.3390/ijerph192114376 - 03 Nov 2022

Cited by 1 | Viewed by 1331

Abstract

Closure of Higher Education Institutions in the early phase of the SARS-CoV-2 pandemic was largely diffused. With their reopening, numerous preventive measures have been enacted, but limited evidence exists on students’ behavior that could influence their infection risk. We conducted a case-control study [...] Read more.

Closure of Higher Education Institutions in the early phase of the SARS-CoV-2 pandemic was largely diffused. With their reopening, numerous preventive measures have been enacted, but limited evidence exists on students’ behavior that could influence their infection risk. We conducted a case-control study at the Sapienza University of Rome to identify protective and risk factors for SARS-CoV-2 infection. Students attending the campus within 48 h of SARS-CoV-2 infection were considered cases. Controls were students who come in contact with a confirmed case within the campus. Demographic features and activities carried out before positivity or contact were investigated. Multivariable logistic regression models were built to identify factors associated with SARS-CoV-2 infection, estimating adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). The analysis showed an increased risk of SARS-CoV-2 infection for attending the second year or above of university (aOR 17.7, 95% CI 2.21–142.82) and participating in private parties or ceremonies (aOR 15.9, 95% CI 2.30–109.67) while living outside the family (aOR 0.08, 95% CI 0.01–0.54) and attending practical activities or libraries on campus (aOR 0.29, 95% CI 0.08–0.97) reduced the risk. Data strongly suggests that it may be safe to participate in activities organized under strict infection prevention guidelines. Tailored prevention measures might reduce the risk of infection in university students. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

23 pages, 1125 KiB

Open AccessArticle

The Usefulness of the COVID-GRAM Score in Predicting the Outcomes of Study Population with COVID-19

by Agata Sebastian, Marcin Madziarski, Marta Madej, Krzysztof Proc, Małgorzata Szymala-Pędzik, Joanna Żórawska, Michał Gronek, Ewa Morgiel, Krzysztof Kujawa, Marek Skarupski, Małgorzata Trocha, Piotr Rola, Jakub Gawryś, Krzysztof Letachowicz, Adrian Doroszko, Barbara Adamik, Krzysztof Kaliszewski, Katarzyna Kiliś-Pstrusińska, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Janusz Sokołowski, Ewa Anita Jankowska and Katarzyna Madziarska Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(19), 12537; https://doi.org/10.3390/ijerph191912537 - 01 Oct 2022

Cited by 4 | Viewed by 1809

Abstract

Background: The COVID-GRAM is a clinical risk rating score for predicting the prognosis of hospitalized COVID-19 infected patients. Aim: Our study aimed to evaluate the use of the COVID-GRAM score in patients with COVID-19 based on the data from the COronavirus in the [...] Read more.

Background: The COVID-GRAM is a clinical risk rating score for predicting the prognosis of hospitalized COVID-19 infected patients. Aim: Our study aimed to evaluate the use of the COVID-GRAM score in patients with COVID-19 based on the data from the COronavirus in the LOwer Silesia (COLOS) registry. Material and methods: The study group (834 patients of Caucasian patients) was retrospectively divided into three arms according to the risk achieved on the COVID-GRAM score calculated at the time of hospital admission (between February 2020 and July 2021): low, medium, and high risk. The Omnibus chi-square test, Fisher test, and Welch ANOVA were used in the statistical analysis. Post-hoc analysis for continuous variables was performed using Tukey’s correction with the Games–Howell test. Additionally, the ROC analysis was performed over time using inverse probability of censorship (IPCW) estimation. The GRAM-COVID score was estimated from the time-dependent area under the curve (AUC). Results: Most patients (65%) had a low risk of complications on the COVID-GRAM scale. There were 113 patients in the high-risk group (13%). In the medium- and high-risk groups, comorbidities occurred statistically significantly more often, e.g., hypertension, diabetes, atrial fibrillation and flutter, heart failure, valvular disease, chronic kidney disease, and obstructive pulmonary disease (COPD), compared to low-risk tier subjects. These individuals were also patients with a higher incidence of neurological and cardiac complications in the past. Low saturation of oxygen values on admission, changes in C-reactive protein, leukocytosis, hyperglycemia, and procalcitonin level were associated with an increased risk of death during hospitalization. The troponin level was an independent mortality factor. A change from low to medium category reduced the overall survival probability by more than 8 times and from low to high by 25 times. The factor with the strongest impact on survival was the absence of other diseases. The medium-risk patient group was more likely to require dialysis during hospitalization. The need for antibiotics was more significant in the high-risk group on the GRAM score. Conclusion: The COVID-GRAM score corresponds well with total mortality. The factor with the strongest impact on survival was the absence of other diseases. The worst prognosis was for patients who were unconscious during admission. Patients with higher COVID-GRAM score were significantly less likely to return to full health during follow-up. There is a continuing need to develop reliable, easy-to-adopt tools for stratifying the course of SARS-CoV-2 infection. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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21 pages, 4790 KiB

Open AccessArticle

Impacts of COVID-19 Travel Restriction Policies on the Traffic Quality of the National and Provincial Trunk Highway Network: A Case Study of Shaanxi Province

by Yongji Ma, Jinliang Xu, Chao Gao and Xiaohui Tong

Int. J. Environ. Res. Public Health 2022, 19(15), 9387; https://doi.org/10.3390/ijerph19159387 - 31 Jul 2022

Cited by 2 | Viewed by 1345

Abstract

According to recent research, the COVID-19 pandemic has impacted road traffic quality. This study aims to analyze the impacts of COVID-19 travel restriction policies on the traffic quality of the national and provincial trunk highway network (NPTHN) in Shaanxi Province. We collected the [...] Read more.

According to recent research, the COVID-19 pandemic has impacted road traffic quality. This study aims to analyze the impacts of COVID-19 travel restriction policies on the traffic quality of the national and provincial trunk highway network (NPTHN) in Shaanxi Province. We collected the traffic data of the NPTHN for three consecutive years (from 2019 to 2021), before and after the COVID-19 outbreak, including weekly average daily traffic, weekly traffic interruption times, weekly traffic control time, weekly traffic accidents, weekly traffic injuries, and weekly traffic deaths. Using descriptive statistics and dynamic analysis methods, we studied the safety and service levels of the NPTHN. We set up an assessment model of the NPTHN operational orderliness through dissipative structure theory and entropy theory to study the operational orderliness of the NPTHN. Results show that in 2020, the service level, safety level, and operational orderliness of the NPTHN dropped to the lowest levels. The pandemic was gradually brought under control, and the travel restriction policies were gradually reduced and lifted. The adverse impacts on the operational orderliness of the NPTHN decreased, but the operational orderliness did not yet recover to the pre-pandemic level. Meanwhile, the service and safety levels of the NPTHN did not recover. Taken together, the COVID-19 travel restriction policies had adverse impacts on the traffic quality of the NPTHN in Shaanxi Province. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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13 pages, 2764 KiB

Open AccessArticle

Herbal Medicine Uses for Respiratory System Disorders and Possible Trends in New Herbal Medicinal Recipes during COVID-19 in Pasvalys District, Lithuania

by Zivile Pranskuniene, Ruta Balciunaite, Zenona Simaitiene and Jurga Bernatoniene

Int. J. Environ. Res. Public Health 2022, 19(15), 8905; https://doi.org/10.3390/ijerph19158905 - 22 Jul 2022

Cited by 12 | Viewed by 2958

Abstract

Despite some preliminary studies of the available herbal medicine preparations and their curative effects on COVID-19, experts still fear that unproper use of such homemade medicines could do more harm than good to people relying on unproven alternatives of questionable efficacy. The main [...] Read more.

Despite some preliminary studies of the available herbal medicine preparations and their curative effects on COVID-19, experts still fear that unproper use of such homemade medicines could do more harm than good to people relying on unproven alternatives of questionable efficacy. The main purpose of this study was to evaluate the safety of herbal medicines used for respiratory system disorders in the Pasvalys district during the COVID-19 pandemic in Lithuania. An archival source was also studied, looking for possible recipes for the treatment and prevention of respiratory diseases in Lithuanian traditional medicine, emphasizing the safety guidelines. The survey was conducted using the deep interview method. The respondents mentioned 60 species of medicinal plants from 29 different families used for the treatment and prevention of respiratory system disorders (for cough mostly, 51.70% of all indications). Twenty eight out of 60 plant species were not included in the European Medicines Agency monographs and only 50% of all included species were used as indicated by the European Medicines Agency for respiratory system disorders. The trends in the ethnopharmacological choices of modern consumers and the analysis of archival sources can be a great source of ideas for new herbal-based pharmaceutical preparations for COVID-19 symptoms in Lithuania considering the safety recommendations. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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17 pages, 1468 KiB

Open AccessArticle

Evaluation of Vulnerability Status of the Infection Risk to COVID-19 Using Geographic Information Systems (GIS) and Multi-Criteria Decision Analysis (MCDA): A Case Study of Addis Ababa City, Ethiopia

by Hizkel Asfaw, Shankar Karuppannan, Tilahun Erduno, Hussein Almohamad, Ahmed Abdullah Al Dughairi, Motrih Al-Mutiry and Hazem Ghassan Abdo

Int. J. Environ. Res. Public Health 2022, 19(13), 7811; https://doi.org/10.3390/ijerph19137811 - 25 Jun 2022

Cited by 10 | Viewed by 2823

Abstract

COVID-19 is a disease caused by a new coronavirus called SARS-CoV-2 and is an accidental global public health threat. Because of this, WHO declared the COVID-19 outbreak a pandemic. The pandemic is spreading unprecedently in Addis Ababa, which results in extraordinary logistical and [...] Read more.

COVID-19 is a disease caused by a new coronavirus called SARS-CoV-2 and is an accidental global public health threat. Because of this, WHO declared the COVID-19 outbreak a pandemic. The pandemic is spreading unprecedently in Addis Ababa, which results in extraordinary logistical and management challenges in response to the novel coronavirus in the city. Thus, management strategies and resource allocation need to be vulnerability-oriented. Though various studies have been carried out on COVID-19, only a few studies have been conducted on vulnerability from a geospatial/location-based perspective but at a wider spatial resolution. This puts the results of those studies under question while their findings are projected to the finer spatial resolution. To overcome such problems, the integration of Geographic Information Systems (GIS) and Multi-Criteria Decision Analysis (MCDA) has been developed as a framework to evaluate and map the susceptibility status of the infection risk to COVID-19. To achieve the objective of the study, data like land use, population density, and distance from roads, hospitals, bus stations, the bank, markets, COVID-19 cases, health care units, and government offices are used. The weighted overlay method was used; to evaluate and map the susceptibility status of the infection risk to COVID-19. The result revealed that out of the total study area, 32.62% (169.91 km²) falls under the low vulnerable category (1), and the area covering 40.9% (213.04 km²) under the moderate vulnerable class (2) for infection risk of COVID-19. The highly vulnerable category (3) covers an area of 25.31% (132.85 km²), and the remaining 1.17% (6.12 km²) is under an extremely high vulnerable class (4). Thus, these priority areas could address pandemic control mechanisms like disinfection regularly. Health sector professionals, local authorities, the scientific community, and the general public will benefit from the study as a tool to better understand pandemic transmission centers and identify areas where more protective measures and response actions are needed at a finer spatial resolution. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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19 pages, 1987 KiB

Open AccessArticle

Definition of an Indoor Air Sampling Strategy for SARS-CoV-2 Detection and Risk Management: Case Study in Kindergartens

by Laura Borgese, Giuseppe Tomasoni, Filippo Marciano, Annalisa Zacco, Fabjola Bilo, Elena Stefana, Paola Cocca, Diana Rossi, Paola Cirelli, Angelo Luigi Camillo Ciribini, Sara Comai, Silvia Mastrolembo Ventura, Michela Savoldi Boles, Diletta Micheletti, Daniela Cattivelli, Serena Galletti, Sophie Dubacq, Maria Grazia Perrone and Laura Eleonora Depero

Int. J. Environ. Res. Public Health 2022, 19(12), 7406; https://doi.org/10.3390/ijerph19127406 - 16 Jun 2022

Cited by 2 | Viewed by 2226

Abstract

In the last two years, the world has been overwhelmed by SARS-CoV-2. One of the most important ways to prevent the spread of the virus is the control of indoor conditions: from surface hygiene to ventilation. Regarding the indoor environments, monitoring the presence [...] Read more.

In the last two years, the world has been overwhelmed by SARS-CoV-2. One of the most important ways to prevent the spread of the virus is the control of indoor conditions: from surface hygiene to ventilation. Regarding the indoor environments, monitoring the presence of the virus in the indoor air seems to be promising, since there is strong evidence that airborne transmission through infected droplets and aerosols is its dominant transmission route. So far, few studies report the successful detection of SARS-CoV-2 in the air; moreover, the lack of a standard guideline for air monitoring reduces the uniformity of the results and their usefulness in the management of the risk of virus transmission. In this work, starting from a critical analysis of the existing standards and guidelines for indoor air quality, we define a strategy to set-up indoor air sampling plans for the detection of SARS-CoV-2. The strategy is then tested through a case study conducted in two kindergartens in the metropolitan city of Milan, in Italy, involving a total of 290 children and 47 teachers from 19 classrooms. The results proved its completeness, effectiveness, and suitability as a key tool in the airborne SARS-CoV-2 infection risk management process. Future research directions are then identified and discussed. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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8 pages, 689 KiB

Open AccessArticle

Home Working and Physical Activity during SARS-CoV-2 Pandemic: A Longitudinal Cohort Study

by Venerando Rapisarda, Carla Loreto, Laura De Angelis, Giuditta Simoncelli, Claudia Lombardo, Riccardo Resina, Nicola Mucci, Agata Matarazzo, Luigi Vimercati and Caterina Ledda

Int. J. Environ. Res. Public Health 2021, 18(24), 13021; https://doi.org/10.3390/ijerph182413021 - 10 Dec 2021

Cited by 11 | Viewed by 2654

Abstract

Background: Due to the SARS-CoV-2 pandemic, human lifestyles and occupational settings have changed in the workplace. This survey explores associations of home working employment and related physical activity (PA–MET min/week). Methods: A longitudinal cohort study was conducted between March 2020 and March 2021. [...] Read more.

Background: Due to the SARS-CoV-2 pandemic, human lifestyles and occupational settings have changed in the workplace. This survey explores associations of home working employment and related physical activity (PA–MET min/week). Methods: A longitudinal cohort study was conducted between March 2020 and March 2021. A standardized method for assessing PA and sedentary time, the Italian version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF), was used through the Microsoft Forms^® platform for self-administering the questionnaire. Baseline data were collected, and four follow-ups were performed; a full calendar year was observed. Results: In total, 310 home workers were recruited in this investigation. The average body mass index (BMI- kg/m²) was 21.4 ± 4.2 at baseline. The value increased at the first follow-up and fluctuated in the other recalls. The t-test of MET values of the four activities (Total PA, Vigorous-intensity activity, Moderate-intensity activity, Walking) show similar results; the total PA, at baseline 275.7 ± 138.6, decreased statistically significantly at the first (198.5 ± 84.6), third (174.9 ± 98.4), and fourth (188.7 ± 78.5) follow-ups, while it increased statistically significantly at the second follow-up (307.1 ± 106.1) compared to the baseline. Sedentary time was constant until the second follow-up, while it increased statistically significantly at the 3rd and 4th follow-up. Conclusion: workers involved reduced and reorganized their PA during this pandemic year. Each business company should intervene to improve the PA levels of workers and reduce sedentary behavior in the workplace. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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17 pages, 2255 KiB

Open AccessArticle

A Hybrid Convolutional Neural Network Model for Diagnosis of COVID-19 Using Chest X-ray Images

by Prabhjot Kaur, Shilpi Harnal, Rajeev Tiwari, Fahd S. Alharithi, Ahmed H. Almulihi, Irene Delgado Noya and Nitin Goyal

Int. J. Environ. Res. Public Health 2021, 18(22), 12191; https://doi.org/10.3390/ijerph182212191 - 20 Nov 2021

Cited by 33 | Viewed by 3619

Abstract

COVID-19 declared as a pandemic that has a faster rate of infection and has impacted the lives and the country’s economy due to forced lockdowns. Its detection using RT-PCR is required long time and due to which its infection has grown exponentially. This [...] Read more.

COVID-19 declared as a pandemic that has a faster rate of infection and has impacted the lives and the country’s economy due to forced lockdowns. Its detection using RT-PCR is required long time and due to which its infection has grown exponentially. This creates havoc for the shortage of testing kits in many countries. This work has proposed a new image processing-based technique for the health care systems named “C19D-Net”, to detect “COVID-19” infection from “Chest X-Ray” (XR) images, which can help radiologists to improve their accuracy of detection COVID-19. The proposed system extracts deep learning (DL) features by applying the InceptionV4 architecture and Multiclass SVM classifier to classify and detect COVID-19 infection into four different classes. The dataset of 1900 Chest XR images has been collected from two publicly accessible databases. Images are pre-processed with proper scaling and regular feeding to the proposed model for accuracy attainments. Extensive tests are conducted with the proposed model (“C19D-Net”) and it has succeeded to achieve the highest COVID-19 detection accuracy as 96.24% for 4-classes, 95.51% for three-classes, and 98.1% for two-classes. The proposed method has outperformed well in expressions of “precision”, “accuracy”, “F1-score” and “recall” in comparison with most of the recent previously published methods. As a result, for the present situation of COVID-19, the proposed “C19D-Net” can be employed in places where test kits are in short supply, to help the radiologists to improve their accuracy of detection of COVID-19 patients through XR-Images. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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13 pages, 2178 KiB

Open AccessArticle

Epidemiological Analysis of SARS-CoV-2 Transmission Dynamics in the State of Odisha, India: A Yearlong Exploratory Data Analysis

by Sourya Subhra Nasker, Ananya Nanda, Balamurugan Ramadass and Sasmita Nayak

Int. J. Environ. Res. Public Health 2021, 18(21), 11203; https://doi.org/10.3390/ijerph182111203 - 25 Oct 2021

Cited by 1 | Viewed by 2232

Abstract

COVID-19 remains a matter of global public health concern. Previous research suggested the association between local environmental factors and viral transmission. We present a multivariate observational analysis of SARS-CoV-2 transmission in the state of Odisha, India, hinting at a seasonal activity. We aim [...] Read more.

COVID-19 remains a matter of global public health concern. Previous research suggested the association between local environmental factors and viral transmission. We present a multivariate observational analysis of SARS-CoV-2 transmission in the state of Odisha, India, hinting at a seasonal activity. We aim to investigate the demographic characteristics of COVID-19 in the Indian state of Odisha for two specific timelines in 2020 and 2021. For a comparative outlook, we chose similar datasets from the state of New York, USA. Further, we present a critical analysis pertaining to the effects of environmental factors and the emergence of variants on SARS-CoV-2 transmission and persistence. We assessed the datasets for confirmed cases, death, age, and gender for 29 February 2020 to 31 May 2020, and 1 March 2021 to 31 May 2021. We determined the case fatalities, crude death rates, sex ratio, and incidence rates for both states along with monthly average temperature analysis. A yearlong epi-curve analysis was conducted to depict the coronavirus infection spread pattern in the respective states. The Indian state of Odisha reported a massive 436,455 confirmed cases and 875 deaths during the 2021 timeline as compared to a mere 2223 cases and 7 deaths during the 2020 timeline. We further discuss the demographic and temperature association of SARS-CoV-2 transmission during early 2020 and additionally comment on the variant-associated massive rise in cases during 2021. Along with the rapid rise of variants, the high population density and population behavior seem to be leading causes for the 2021 pandemic, whereas factors such as age group, gender, and average local temperature were prominent during the 2020 spread. A seasonal occurrence of SARS-CoV-2 transmission is also observed from the yearlong epidemiological plot. The recent second wave of COVID-19 is a lesson that emphasizes the significance of continuous epidemiological surveillance to predict the relative risk of viral transmission for a specific region. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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12 pages, 1104 KiB

Open AccessArticle

Differences in Perceived Risk of Contracting SARS-CoV-2 during and after the Lockdown in Sub-Saharan African Countries

by Uchechukwu Levi Osuagwu, Chikasirimobi G Timothy, Raymond Langsi, Emmanuel K Abu, Piwuna Christopher Goson, Khathutshelo P Mashige, Bernadine Ekpenyong, Godwin O Ovenseri-Ogbomo, Chundung Asabe Miner, Richard Oloruntoba, Tanko Ishaya, Deborah Donald Charwe, Esther Awazzi Envuladu, Obinna Nwaeze and Kingsley Emwinyore Agho

Int. J. Environ. Res. Public Health 2021, 18(21), 11091; https://doi.org/10.3390/ijerph182111091 - 21 Oct 2021

Cited by 2 | Viewed by 2192

Abstract

This study investigated risk perception of contracting and dying of SARS-CoV-2 in sub-Sahara Africa during and after the lockdown periods. Two online surveys were conducted one year apart, with participants 18 years and above living in sub-Sahara Africa or the diaspora. Each survey [...] Read more.

This study investigated risk perception of contracting and dying of SARS-CoV-2 in sub-Sahara Africa during and after the lockdown periods. Two online surveys were conducted one year apart, with participants 18 years and above living in sub-Sahara Africa or the diaspora. Each survey took four weeks. The first survey was taken from 18 April to 16 May 2020, i.e., during the lockdown. The second survey was taken from 14 April to 14 May 2021, i.e., after the lockdown. A cross-sectional study using adopted and modified questionnaires for both surveys were distributed through online platforms. Question about risks perception of contracting and dying of SARS-CoV-2 were asked. The Helsinki declaration was applied, and ethical approvals were obtained. Total responses for both surveys, i.e., both during and after the lockdown, was 4605. The mean age was similar in both surveys (18–28 years). The mean risk perception scores were higher after lockdown by 3.59%. Factors associated with risk perception of COVID-19 were survey period, age group, region of residence, and occupation. Non-health care workers had a lower risk perception of COVID-19. This first comparative study on the level of risk perception of Africans during and after the lockdown shows that one in every three and every four persons in sub-Sahara Africa felt at high risk of contracting COVID-19 and thought they could die from contracting the same, respectively. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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13 pages, 378 KiB

Open AccessArticle

Government Health Expenditure and Public Health Outcomes: A Comparative Study among EU Developing Countries

by Mihaela Onofrei, Anca-Florentina Vatamanu, Georgeta Vintilă and Elena Cigu

Int. J. Environ. Res. Public Health 2021, 18(20), 10725; https://doi.org/10.3390/ijerph182010725 - 13 Oct 2021

Cited by 17 | Viewed by 3942

Abstract

The aim of this paper was to empirically analyze the relationship between public health expenditure and health outcomes among EU developing countries. Using regression analysis and factor analysis, we documented that public health expenditure and health outcomes are in a long-run equilibrium relationship [...] Read more.

The aim of this paper was to empirically analyze the relationship between public health expenditure and health outcomes among EU developing countries. Using regression analysis and factor analysis, we documented that public health expenditure and health outcomes are in a long-run equilibrium relationship and the status of health expenditure can improve life expectancy and reduce infant mortality. Secondarily, we studied how the status of good governance, health care system performance, and socioeconomic vulnerabilities affect the public health’s outcomes in the selected countries. We found that the effectiveness of health and the way to reduce infant mortality or to improve life quality is directed conditioned by good governance status. Moreover, the consolidation of health care system performance directly improves the quality of life among EU developing countries, which indicates that public policymakers should intervene and provide political and financial support through policy mixes. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

13 pages, 824 KiB

Open AccessArticle

COVID-19-Associated Mortality in US Veterans with and without SARS-CoV-2 Infection

by Ayako Suzuki, Jimmy T. Efird, Thomas S. Redding IV, Andrew D. Thompson, Jr., Ashlyn M. Press, Christina D. Williams, Christopher J. Hostler and Christine M. Hunt

Int. J. Environ. Res. Public Health 2021, 18(16), 8486; https://doi.org/10.3390/ijerph18168486 - 11 Aug 2021

Cited by 6 | Viewed by 2895

Abstract

Background: We performed an observational Veterans Health Administration cohort analysis to assess how risk factors affect 30-day mortality in SARS-CoV-2-infected subjects relative to those uninfected. While the risk factors for coronavirus disease 2019 (COVID-19) have been extensively studied, these have been seldom compared [...] Read more.

Background: We performed an observational Veterans Health Administration cohort analysis to assess how risk factors affect 30-day mortality in SARS-CoV-2-infected subjects relative to those uninfected. While the risk factors for coronavirus disease 2019 (COVID-19) have been extensively studied, these have been seldom compared with uninfected referents. Methods: We analyzed 341,166 White/Black male veterans tested for SARS-CoV-2 from March 1 to September 10, 2020. The relative risk of 30-day mortality was computed for age, race, ethnicity, BMI, smoking status, and alcohol use disorder in infected and uninfected subjects separately. The difference in relative risk was then evaluated between infected and uninfected subjects. All the analyses were performed considering clinical confounders. Results: In this cohort, 7% were SARS-CoV-2-positive. Age >60 and overweight/obesity were associated with a dose-related increased mortality risk among infected patients relative to those uninfected. In contrast, relative to never smoking, current smoking was associated with a decreased mortality among infected and an increased mortality in uninfected, yielding a reduced mortality risk among infected relative to uninfected. Alcohol use disorder was also associated with decreased mortality risk in infected relative to the uninfected. Conclusions: Age, BMI, smoking, and alcohol use disorder affect 30-day mortality in SARS-CoV-2-infected subjects differently from uninfected referents. Advanced age and overweight/obesity were associated with increased mortality risk among infected men, while current smoking and alcohol use disorder were associated with lower mortality risk among infected men, when compared with those uninfected. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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11 pages, 1996 KiB

Open AccessArticle

The Global Interest in Vaccines and Its Prediction and Perspectives in the Era of COVID-19. Real-Time Surveillance Using Google Trends

by Magdalena Sycinska-Dziarnowska, Iwona Paradowska-Stankiewicz and Krzysztof Woźniak

Int. J. Environ. Res. Public Health 2021, 18(15), 7841; https://doi.org/10.3390/ijerph18157841 - 24 Jul 2021

Cited by 11 | Viewed by 3133

Abstract

Background: The COVID-19 pandemic has globally overwhelmed all sectors of life. The fast development of vaccines against COVID-19 has had a significant impact on the course of the pandemic. Methods: Global data from Google Trends was analyzed for vaccines against flu, BCG, HPV, [...] Read more.

Background: The COVID-19 pandemic has globally overwhelmed all sectors of life. The fast development of vaccines against COVID-19 has had a significant impact on the course of the pandemic. Methods: Global data from Google Trends was analyzed for vaccines against flu, BCG, HPV, pneumococcal disease, polio, and COVID-19. The time frame includes the last five-year period starting from 17 April 2016. Multiple training of time series models with back testing, including Holt–Winters forecasting, Exponential Smoothing State Space, Linear model with trend and seasonal components (tlsm), and ARIMA was conducted. Forecasting according to the best fitting model was performed. Results: Correlation analysis did not reveal a decrease in interest in vaccines during the analyzed period. The prediction models provided a short-term forecast of the dynamics of interest for flu, HPV, pneumococcal and polio vaccines with 5–10% growth in interest for the first quarter of 2022 when compared to the same quarter of 2021. Conclusions: Despite the huge interest in the COVID-19 vaccine, there has not been a detectable decline in the overall interest in the five analyzed vaccines. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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10 pages, 1378 KiB

Open AccessArticle

Influence of Face Masks on the Use of Contact Lenses

by Clara Martinez-Perez, Bruno Monteiro, Mafalda Soares, Fatima Portugues, Sonia Matos, Ana Ferreira, Cristina Alvarez-Peregrina and Miguel Ángel Sánchez-Tena

Int. J. Environ. Res. Public Health 2021, 18(14), 7407; https://doi.org/10.3390/ijerph18147407 - 11 Jul 2021

Cited by 10 | Viewed by 3299

Abstract

Background: The COVID-19 epidemic is largely controlled by the use of face masks. The use of a face mask has been indicated as a strong cause of dry eye, although it is not yet described in the literature. This study aims to compare [...] Read more.

Background: The COVID-19 epidemic is largely controlled by the use of face masks. The use of a face mask has been indicated as a strong cause of dry eye, although it is not yet described in the literature. This study aims to compare the impact of the use of masks on the visual quality of patients. The symptoms in the human eye intensified during the pandemic versus the symptoms before the pandemic, in a Portuguese population. Methods: A fifteen-question questionnaire was conducted to find out what changes occurred in the use of soft contact lenses during the pandemic in relation to the use of masks. Statistical analysis was performed with SPSS 27.0 software (SPSS Inc., Chicago, IL, USA). Results: The use of contact lenses decreased compared with before the pandemic (p < 0.001). The number of hours of wear decreased significantly compared with before the pandemic (p < 0.001). The sensation of dry eyes was found to be worse in those using monthly replacement contact lenses (p = 0.034), and the need to remove contact lenses was more frequent in women (p = 0.026) after using a mask. Conclusions: Mask use increases dry eye symptoms in contact lens wearers, negatively impacting visual quality. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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12 pages, 1280 KiB

Open AccessArticle

Mental Health Crisis and Stress Coping among Healthcare College Students Momentarily Displaced from Their Campus Community Because of COVID-19 Restrictions in Japan

by Masatoshi Tahara, Yuki Mashizume and Kayoko Takahashi

Int. J. Environ. Res. Public Health 2021, 18(14), 7245; https://doi.org/10.3390/ijerph18147245 - 06 Jul 2021

Cited by 31 | Viewed by 4582

Abstract

College students are one of the most affected groups by self-quarantine due to COVID-19, as they may live in loneliness and anxiety, increasing their risk of mental health crisis. This study aimed to identify risk factors for poor mental health and stress coping [...] Read more.

College students are one of the most affected groups by self-quarantine due to COVID-19, as they may live in loneliness and anxiety, increasing their risk of mental health crisis. This study aimed to identify risk factors for poor mental health and stress coping strategies among healthcare college students during the COVID-19 pandemic in Japan. A cross-sectional survey was conducted over 7 consecutive days starting on 28 April 2020 using a web-based questionnaire. The survey assessed socioeconomic characteristics and the General Health Questionnaire-12 score, self-reported health status, anxiety, and satisfaction with daily life, work, leisure, and new activities. Approximately 70% of 223 respondents had poor mental health. Less communication with friends was the main risk factor for mental health problems. Good health status and satisfaction with leisure and new activities were associated with reduced risk of mental health problems. Students with poor mental health tended to seek social support as a stress coping strategy. This study showed that the mental health of students declined during self-quarantine, and loneliness could be the major reason. There is a need for a new form of communication and learning that deals with the isolation and loneliness of students, especially for students living alone. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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13 pages, 658 KiB

Open AccessArticle

Differences in the Protection Motivation Theory Constructs between People with Various Latent Classes of Motivation for Vaccination and Preventive Behaviors against COVID-19 in Taiwan

by Yi-Lung Chen, Yen-Ju Lin, Yu-Ping Chang, Wen-Jiun Chou and Cheng-Fang Yen

Int. J. Environ. Res. Public Health 2021, 18(13), 7042; https://doi.org/10.3390/ijerph18137042 - 01 Jul 2021

Cited by 24 | Viewed by 4031

Abstract

The present study aimed to identify the distinct classes of motivations to get vaccinated and to adopt preventive behaviors against the coronavirus disease 2019 (COVID-19) among people in Taiwan and to examine the roles of Protection Motivation Theory (PMT) cognitive constructs in these [...] Read more.

The present study aimed to identify the distinct classes of motivations to get vaccinated and to adopt preventive behaviors against the coronavirus disease 2019 (COVID-19) among people in Taiwan and to examine the roles of Protection Motivation Theory (PMT) cognitive constructs in these unique classes of motivations to get vaccinated and to adopt preventive behaviors. We recruited 1047 participants by using a Facebook advertisement. Participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19, PMT constructs of threat appraisal (perceived severity and perceived vulnerability), and PMT constructs of coping appraisal (self-efficacy, response efficacy, response cost, knowledge, and previous vaccination for seasonal influenza) were determined. We analyzed participants’ motivations to get vaccinated and to adopt preventive behaviors against COVID-19 by using latent profile analysis. The present study identified three latent classes, including the participants with high motivation for vaccination and preventive behaviors (the class of Both High), those with low motivation for vaccination and preventive behaviors (the class of Both Low), and those with high motivation for vaccination but low motivation for preventive behaviors (the class of High Vaccination but Low Preventive Behaviors). Compared with the participants in the class of Both High, participants in the class of Both Low had lower levels of perceived vulnerability, perceived severity, self-efficacy to have vaccination, response efficacy of vaccination, knowledge about vaccination, and previous vaccination for seasonal influenza; participants in the class of High Vaccination but Low Preventive Behaviors had lower levels of perceived vulnerability and perceived severity but higher levels of response cost of vaccination. We concluded that varieties of motivations, threat, and coping appraisals should be considered in intervention programs aiming to increase motivation to adopt recommended protective behaviors against COVID-19. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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20 pages, 3935 KiB

Open AccessPerspective

A Clinical Decision Web to Predict ICU Admission or Death for Patients Hospitalised with COVID-19 Using Machine Learning Algorithms

by Rocío Aznar-Gimeno, Luis M. Esteban, Gorka Labata-Lezaun, Rafael del-Hoyo-Alonso, David Abadia-Gallego, J. Ramón Paño-Pardo, M. José Esquillor-Rodrigo, Ángel Lanas and M. Trinidad Serrano

Int. J. Environ. Res. Public Health 2021, 18(16), 8677; https://doi.org/10.3390/ijerph18168677 - 17 Aug 2021

Cited by 13 | Viewed by 2669

Abstract

The purpose of the study was to build a predictive model for estimating the risk of ICU admission or mortality among patients hospitalized with COVID-19 and provide a user-friendly tool to assist clinicians in the decision-making process. The study cohort comprised 3623 patients [...] Read more.

The purpose of the study was to build a predictive model for estimating the risk of ICU admission or mortality among patients hospitalized with COVID-19 and provide a user-friendly tool to assist clinicians in the decision-making process. The study cohort comprised 3623 patients with confirmed COVID-19 who were hospitalized in the SALUD hospital network of Aragon (Spain), which includes 23 hospitals, between February 2020 and January 2021, a period that includes several pandemic waves. Up to 165 variables were analysed, including demographics, comorbidity, chronic drugs, vital signs, and laboratory data. To build the predictive models, different techniques and machine learning (ML) algorithms were explored: multilayer perceptron, random forest, and extreme gradient boosting (XGBoost). A reduction dimensionality procedure was used to minimize the features to 20, ensuring feasible use of the tool in practice. Our model was validated both internally and externally. We also assessed its calibration and provide an analysis of the optimal cut-off points depending on the metric to be optimized. The best performing algorithm was XGBoost. The final model achieved good discrimination for the external validation set (AUC = 0.821, 95% CI 0.787–0.854) and accurate calibration (slope = 1, intercept = −0.12). A cut-off of 0.4 provides a sensitivity and specificity of 0.71 and 0.78, respectively. In conclusion, we built a risk prediction model from a large amount of data from several pandemic waves, which had good calibration and discrimination ability. We also created a user-friendly web application that can aid rapid decision-making in clinical practice. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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10 pages, 1437 KiB

Open AccessBrief Report

Relationship of Test Positivity Rates with COVID-19 Epidemic Dynamics

by Yuki Furuse, Yura K. Ko, Kota Ninomiya, Motoi Suzuki and Hitoshi Oshitani

Int. J. Environ. Res. Public Health 2021, 18(9), 4655; https://doi.org/10.3390/ijerph18094655 - 27 Apr 2021

Cited by 19 | Viewed by 6336

Abstract

Detection and isolation of infected people are believed to play an important role in the control of the COVID-19 pandemic. Some countries conduct large-scale screenings for testing, whereas others test mainly people with high prior probability of infection such as showing severe symptoms [...] Read more.

Detection and isolation of infected people are believed to play an important role in the control of the COVID-19 pandemic. Some countries conduct large-scale screenings for testing, whereas others test mainly people with high prior probability of infection such as showing severe symptoms and/or having an epidemiological link with a known or suspected case or cluster of cases. However, what a good testing strategy is and whether the difference in testing strategy shows a meaningful, measurable impact on the COVID-19 epidemic remain unknown. Here, we showed that patterns of association between effective reproduction number (Rt) and test positivity rate can illuminate differences in testing situation among different areas, using global and local data from Japan. This association can also evaluate the adequacy of current testing systems and what information is captured in COVID-19 surveillance. The differences in testing systems alone cannot predict the results of epidemic containment efforts. Furthermore, monitoring test positivity rates and severe case proportions among the nonelderly can predict imminent case count increases. Monitoring test positivity rates in conjunction with the concurrent Rt could be useful to assess and strengthen public health management and testing systems and deepen understanding of COVID-19 epidemic dynamics. Full article

(This article belongs to the Special Issue Risk Assessment for COVID-19)

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