Research

15 pages, 374 KiB

Open AccessArticle

COVID-19-Associated Mental Health Impact on Menstrual Function Aspects: Dysmenorrhea and Premenstrual Syndrome, and Genitourinary Tract Health: A Cross Sectional Study among Jordanian Medical Students

by Iman Aolymat, Ashraf I. Khasawneh and Mohammad Al-Tamimi

Int. J. Environ. Res. Public Health 2022, 19(3), 1439; https://doi.org/10.3390/ijerph19031439 - 27 Jan 2022

Cited by 20 | Viewed by 3736

Abstract

The physiology of reproduction is affected by psychological distress through neuroendocrine pathways. Historically, COVID-19 is one of the most stressful events with devastating consequences. This research aims to investigate the relationship between dysmenorrhea, PMS, and reproductive tract health on one hand, and COVID-19-related [...] Read more.

The physiology of reproduction is affected by psychological distress through neuroendocrine pathways. Historically, COVID-19 is one of the most stressful events with devastating consequences. This research aims to investigate the relationship between dysmenorrhea, PMS, and reproductive tract health on one hand, and COVID-19-related anxiety, depression, and stress on the other among medical students in Jordan. Medical students were invited through teaching platforms and social media to complete an online survey. SPSS software was used to analyze data. A total of 385 medical students participated in this research. Hence, 49.9% of the study population reported severe dysmenorrhea during COVID-19 compared to 36.9% before COVID-19 (p = 0.000). Dysmenorrhea was significantly associated with disruptions of sport and daily activities during COVID-19 (p = 0.015 and p = 0.002, respectively). The prevalence of PMS components, e.g., mastalgia, fatigue, headache, palpitation, and emotional and sleep disturbances, was raised during COVID-19 compared with before (p < 0.05). Symptoms of genitourinary tract infections, such as lower abdominal pain, vaginal discharge, genitalia rash/ulcers and itching, and urgency, were significantly increased after COVID-19 (p < 0.05). Positive Pearson correlations between COVID-19-associated mental health disorders and dysmenorrhea severity, PMS, and genital tract health abnormalities were observed (p < 0.05). The multiple linear regression model revealed that dysmenorrhea severity, PMS symptoms like palpitation, and genitourinary symptoms like lower abdominal pain and urgency were associated with worsening of depression, while dysuria was associated with a protective effect against depression. Moreover, it was observed that dysmenorrhea severity, PMS symptoms, such as headache and palpitation, and urinary urgency were associated with aggravation of anxiety. However, food craving and dysuria were protective against anxiety. Finally, dysmenorrhea severity, PMS symptoms of headache and palpitation, lower abdominal pain, and urgency were related to worsening of stress, whereas the premenstrual symptom of breast pain was a protective factor against stress. This work showed that COVID-19 pandemic-related psychological distress and menstrual, premenstrual, and genitourinary symptoms are closely related. Further future work is required to evaluate the long lasting-effects of the pandemic on mental health and the physiology of reproduction. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

16 pages, 18688 KiB

Open AccessArticle

Surveillance Web System and Mouthwash-Saliva qPCR for Labor Ambulatory SARS-CoV-2 Detection and Prevention

by Gustavo Mora-Aguilera, Verónica Martínez-Bustamante, Gerardo Acevedo-Sánchez, Juan J. Coria-Contreras, Eduardo Guzmán-Hernández, Oscar E. Flores-Colorado, Coral Mendoza-Ramos, Gabriel Hernández-Nava, Ikuri Álvarez-Maya, M. Alejandra Gutiérrez-Espinosa, Raael Gómez-Linton, Ana Carolina Robles-Bustamante and Alberto Gallardo-Hernández

Int. J. Environ. Res. Public Health 2022, 19(3), 1271; https://doi.org/10.3390/ijerph19031271 - 24 Jan 2022

Cited by 3 | Viewed by 3704

Abstract

This study provides a safe and low-cost in-house protocol for RT-qPCR-based detection of SARS-CoV-2 using mouthwash–saliva self-collected specimens to achieve clinical and epidemiological surveillance in a real-time web environment applied to ambulatory populations. The in-house protocol comprises a mouthwash–saliva self-collected specimen, heat virus [...] Read more.

This study provides a safe and low-cost in-house protocol for RT-qPCR-based detection of SARS-CoV-2 using mouthwash–saliva self-collected specimens to achieve clinical and epidemiological surveillance in a real-time web environment applied to ambulatory populations. The in-house protocol comprises a mouthwash–saliva self-collected specimen, heat virus inactivation, and primers to target virus N-gene region and the human RPP30-gene. Aligning with 209 SARS-CoV-2 sequences confirmed specificity including the Alpha variant from the UK. Development, validation, and statistical comparison with official nasopharyngeal swabbing RT-qPCR test were conducted with 115 specimens of ambulatory volunteers. A web–mobile application platform was developed to integrate a real-time epidemiological and clinical core baseline database with mouthwash–saliva RT-qPCR testing. Nine built-in algorithms were generated for decision-making on testing, confining, monitoring, and self-reports to family, social, and work environments. Epidemiological and clinical follow-up and SARS-CoV-2 testing generated a database of 37,351 entries allowing individual decision-making for prevention. Mouthwash–saliva had higher sensitivity than nasopharyngeal swabbing in detecting asymptomatic and mild symptomatic cases with 720 viral copy number (VCN)/mL as the detection limit (Ct = 37.6). Cycling threshold and viral loading were marginally different (p = 0.057) between asymptomatic (35 Ct ± 2.8; 21,767.7 VCN/mL, range 720–77,278) and symptomatic (31.3 Ct ± 4.5; 747,294.3 VCN/mL, range 1433.6–3.08 × 10⁶). We provided proof-of-concept evidence of effective surveillance to target asymptomatic and moderate symptomatic ambulatory individuals based on integrating a bio-safety level II laboratory, self-collected, low-risk, low-cost detection protocol, and a real-time digital monitoring system. Mouthwash–saliva was effective for SARS-CoV-2 sampling for the first time at the community level. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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13 pages, 767 KiB

Open AccessArticle

Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data

by Enrico Grande, Ugo Fedeli, Marilena Pappagallo, Roberta Crialesi, Stefano Marchetti, Giada Minelli, Ivano Iavarone, Luisa Frova, Graziano Onder and Francesco Grippo

Int. J. Environ. Res. Public Health 2022, 19(2), 805; https://doi.org/10.3390/ijerph19020805 - 12 Jan 2022

Cited by 29 | Viewed by 2757

Abstract

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to [...] Read more.

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015–2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015–2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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8 pages, 1105 KiB

Open AccessArticle

Defining Antibody Seroprevalence and Duration of Humoral Responses to SARS-CoV-2 Infection and/or Vaccination in a Greek Community

by Ourania S. Kotsiou, Dimitrios Papagiannis, Evangelos C. Fradelos, Dimitra I. Siachpazidou, Garifallia Perlepe, Angeliki Miziou, Athanasios Kyritsis, George D. Vavougios, Georgios Kalantzis and Konstantinos I. Gourgoulianis

Int. J. Environ. Res. Public Health 2022, 19(1), 407; https://doi.org/10.3390/ijerph19010407 - 31 Dec 2021

Cited by 2 | Viewed by 2931

Abstract

Background: In this work, we aimed to evaluate antibody-response longevity to SARS-CoV-2 infection and/or vaccination in one of the Greek communities that was worst hit by the pandemic, Deskati, five months after a previous serosurveillance and nine months after the pandemic wave initiation [...] Read more.

Background: In this work, we aimed to evaluate antibody-response longevity to SARS-CoV-2 infection and/or vaccination in one of the Greek communities that was worst hit by the pandemic, Deskati, five months after a previous serosurveillance and nine months after the pandemic wave initiation (October 2020). Methods: The SARS-CoV-2 IgG II Quant method (Architect, Abbott, IL, USA) was used for antibody testing. Results: A total of 69 subjects, who previously tested positive or negative for COVID-19 antibodies, participated in the study. We found that 48% of participants turned positive due to vaccination. 27% of participants were both previously infected and vaccinated. However, all previously infected participants retained antibodies to the virus, irrespective of their vaccination status. The antibody titers were significantly higher in previously infected participants that had been vaccinated than those who were unvaccinated and in those that had been previously hospitalized for COVID-19 than those with mild disease. Conclusions: Antibody responses to SARS-CoV-2 infection were maintained nine months after the pandemic. Vaccination alone had generated an immune response in almost half of the population. Higher antibody titers were found in the case of vaccination in previously infected subjects and especially in those with severe disease leading to hospitalization. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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10 pages, 920 KiB

Open AccessArticle

Impact of COVID-19 Lockdown, during the Two Waves, on Drug Use and Emergency Department Access in People with Epilepsy: An Interrupted Time-Series Analysis

by Ippazio Cosimo Antonazzo, Carla Fornari, Sandy Maumus-Robert, Eleonora Cei, Olga Paoletti, Sara Conti, Paolo Angelo Cortesi, Lorenzo Giovanni Mantovani, Rosa Gini and Giampiero Mazzaglia

Int. J. Environ. Res. Public Health 2021, 18(24), 13253; https://doi.org/10.3390/ijerph182413253 - 16 Dec 2021

Cited by 8 | Viewed by 2315

Abstract

Background: In 2020, during the COVID-19 pandemic, Italy implemented two national lockdowns aimed at reducing virus transmission. We assessed whether these lockdowns affected anti-seizure medication (ASM) use and epilepsy-related access to emergency departments (ED) in the general population. Methods: We performed a population-based [...] Read more.

Background: In 2020, during the COVID-19 pandemic, Italy implemented two national lockdowns aimed at reducing virus transmission. We assessed whether these lockdowns affected anti-seizure medication (ASM) use and epilepsy-related access to emergency departments (ED) in the general population. Methods: We performed a population-based study using the healthcare administrative database of Tuscany. We defined the weekly time series of prevalence and incidence of ASM, along with the incidence of epilepsy-related ED access from 1 January 2018 to 27 December 2020 in the general population. An interrupted time-series analysis was used to assess the effect of lockdowns on the observed outcomes. Results: Compared to pre-lockdown, we observed a relevant reduction of ASM incidence (0.65; 95% Confidence Intervals: 0.59–0.72) and ED access (0.72; 0.64–0.82), and a slight decrease of ASM prevalence (0.95; 0.94–0.96). During the post-lockdown the ASM incidence reported higher values compared to pre-lockdown, whereas ASM prevalence and ED access remained lower. Results also indicate a lower impact of the second lockdown for both ASM prevalence (0.97; 0.96–0.98) and incidence (0.89; 0.80–0.99). Conclusion: The lockdowns implemented during the COVID-19 outbreaks significantly affected ASM use and epilepsy-related ED access. The potential consequences of these phenomenon are still unknown, although an increased incidence of epilepsy-related symptoms after the first lockdown has been observed. These findings emphasize the need of ensuring continuous care of epileptic patients in stressful conditions such as the COVID-19 pandemic. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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12 pages, 2396 KiB

Open AccessArticle

Confirmed COVID-19 Cases per Economic Activity during Autumn Wave in Belgium

by Johan Verbeeck, Godelieve Vandersmissen, Jannes Peeters, Sofieke Klamer, Sharon Hancart, Tinne Lernout, Mathias Dewatripont, Lode Godderis and Geert Molenberghs

Int. J. Environ. Res. Public Health 2021, 18(23), 12489; https://doi.org/10.3390/ijerph182312489 - 27 Nov 2021

Cited by 7 | Viewed by 2387

Abstract

Some occupational sectors, such as human health and care, food service, cultural and sport activities, have been associated with a higher risk of SARS-CoV-2 infection than other sectors. To curb the spread of SARS-CoV-2, it is preferable to apply targeted non-pharmaceutical interventions on [...] Read more.

Some occupational sectors, such as human health and care, food service, cultural and sport activities, have been associated with a higher risk of SARS-CoV-2 infection than other sectors. To curb the spread of SARS-CoV-2, it is preferable to apply targeted non-pharmaceutical interventions on selected economic sectors, rather than a full lockdown. However, the effect of these general and sector-specific interventions on the virus circulation has only been sparsely studied. We assess the COVID-19 incidence under different levels of non-pharmaceutical interventions per economic activity during the autumn 2020 wave in Belgium. The 14-day incidence of confirmed COVID-19 cases per the Statistical Classification of Economic Activities in the European Community (NACE–BEL) sector is modelled by a longitudinal Gaussian-Gaussian two-stage approach. This is based on exhaustive data on all employees in all sectors. In the presence of sanitary protocols and minimal non-pharmaceutical interventions, many sectors with close contact with others show considerably higher COVID-19 14-day incidences than other sectors. The effect of stricter non-pharmaceutical interventions in the general population and non-essential sectors is seen in the timing of the peak incidence and the width and height of the post-peak incidence. In most sectors incidences returned to higher levels after the peak than before and this decrease took longer for the health and care sector. Sanitary protocols for close proximity occupations may be sufficient during periods of low-level virus circulation, but progressively less with increasing circulation. Stricter general and sector-specific non-pharmaceutical interventions adequately decrease COVID-19 incidences, even in close proximity in essential sectors under solely sanitary protocols. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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16 pages, 752 KiB

Open AccessArticle

Social Distancing Policies in the Coronavirus Battle: A Comparison of Denmark and Sweden

by Ida Seing, Nina Thórný Stefánsdóttir, Jeanette Wassar Kirk, Ove Andersen, Tine Tjørnhøj-Thomsen, Thomas Kallemose, Evert Vedung, Karsten Vrangbæk and Per Nilsen

Int. J. Environ. Res. Public Health 2021, 18(20), 10990; https://doi.org/10.3390/ijerph182010990 - 19 Oct 2021

Cited by 6 | Viewed by 4202

Abstract

Social distancing measures have been a key component in government strategies to mitigate COVID-19 globally. Based on official documents, this study aimed to identify, compare and analyse public social distancing policy measures adopted in Denmark and Sweden regarding the coronavirus from 1 March [...] Read more.

Social distancing measures have been a key component in government strategies to mitigate COVID-19 globally. Based on official documents, this study aimed to identify, compare and analyse public social distancing policy measures adopted in Denmark and Sweden regarding the coronavirus from 1 March 2020 until 1 October 2020. A key difference was the greater emphasis on laws and executive orders (sticks) in Denmark, which allowed the country to adopt many stricter policy measures than Sweden, which relied mostly on general guidelines and recommendations (sermons). The main policy adopters in Denmark were the government and the Danish Parliament, whereas the Public Health Agency issued most policies in Sweden, reflecting a difference in political governance and administrative structure in the two countries. During the study period, Sweden had noticeably higher rates of COVID-19 deaths and hospitalizations per 100,000 population than Denmark, yet it is difficult to determine the impact or relative effectiveness of sermons and sticks, particularly with regard to broader and longer-term health, economic and societal effects. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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15 pages, 369 KiB

Open AccessArticle

Public Knowledge, Attitude, and Perception towards COVID-19 Vaccination in Saudi Arabia

by Salman Mohammed Al-Zalfawi, Syed Imam Rabbani, Syed Mohammed Basheeruddin Asdaq, Abdulhakeem S. Alamri, Walaa F. Alsanie, Majid Alhomrani, Yahya Mohzari, Ahmed A. Alrashed, Abdulaziz H. AlRifdah and Thabet Almagrabe

Int. J. Environ. Res. Public Health 2021, 18(19), 10081; https://doi.org/10.3390/ijerph181910081 - 25 Sep 2021

Cited by 30 | Viewed by 8141

Abstract

Coronavirus disease-19 (COVID-19) is a highly contagious infection that mainly affects the respiratory system of patients. To date, more than 10 million people have been affected by this virus, and Saudi Arabia has also reported over 210 million cases. At present, there is [...] Read more.

Coronavirus disease-19 (COVID-19) is a highly contagious infection that mainly affects the respiratory system of patients. To date, more than 10 million people have been affected by this virus, and Saudi Arabia has also reported over 210 million cases. At present, there is no established treatment for COVID-19. Vaccination is one of the ways to defeat the pandemic. Recent reports have indicated rare but serious adverse events after vaccination, causing an anxious response from the general public worldwide. Therefore, this study was aimed at evaluating the knowledge, attitude, and perception of the COVID-19 vaccine among the Saudi population. This study is a cross-sectional, web-based online survey conducted using a snowball sampling technique. A self-administered questionnaire prepared in Arabic and English was used to collect feedback from the general population on their knowledge, attitudes, and perceptions about the COVID-19 vaccine. Participants (n = 2022) from different regions of the country replied to the questions. The responses to the questions were recorded on a spreadsheet and analyzed using the SPSS software. Statistical analysis was performed using one-way ANOVA and non-parametric tests to draw conclusions about the results. Multivariate stepwise regression analysis was performed to determine the association between the knowledge, attitude, and perception scores and the demographic variables. p < 0.05 was used to indicate the significance of the data. The data from the study indicated that most of the participants were males (81%), between 18 and 59 years of age (85.9%), Saudi nationals (98.3%), and possessed graduation or above as a qualification (62.9%). The results suggest that a major portion of respondents have satisfactory knowledge (76%), a positive attitude (72.4%), and perception (71.3%) towards the use of COVID-19 vaccines. Their responses can be categorized as between ‘good’ and ‘fair’. However, 30–40% of respondents lacked information about COVID-19 vaccination availability for under 18-year-olds as well as for pregnant women, in addition to the lack of knowledge about the serious unreported adverse reactions and long-term protection offered by the vaccine against coronavirus. The correlation analysis between the variables (p > 0.05) indicated that the response to the KAP domains has no direct relationship. The survey results suggest that most of the Saudi population has sound knowledge and a positive attitude and perception. Since the COVID-19 vaccines have been approved for use in pregnancy and above 12-year-old children by health authorities, the lack of information shown by a significant percentage of participants requires strategies to update this information. Awareness programs targeting all sections of the population must be continued to provide all the updates, including vaccinations for pregnant women and children. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

12 pages, 572 KiB

Open AccessArticle

Analysis of COVID-19 in Professionals Working in Geriatric Environment: Multicenter Prospective Study

by Anca-Maria Mihai, Jérémy Barben, Mélanie Dipanda, Jérémie Vovelle, Valentine Nuss, Camille Baudin-Senegas, Alain Putot and Patrick Manckoundia

Int. J. Environ. Res. Public Health 2021, 18(18), 9735; https://doi.org/10.3390/ijerph18189735 - 15 Sep 2021

Cited by 2 | Viewed by 1676

Abstract

Healthcare workers (HCWs) are exposed to a higher risk of coronavirus disease (COVID-19) contamination. This prospective multicenter study describes the characteristics of HCWs tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) while working in a geriatric environment. We also compared HCWs with [...] Read more.

Healthcare workers (HCWs) are exposed to a higher risk of coronavirus disease (COVID-19) contamination. This prospective multicenter study describes the characteristics of HCWs tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) while working in a geriatric environment. We also compared HCWs with a positive reverse transcription polymerase chain reaction (RTPCR) assay (RTPCR+ group) and those with a negative test result (RTPCR− group). Between 15/5/2020 and 15/9/2020, 258 HCWs, employed in the acute geriatric unit (AGU), geriatric rehabilitation unit (GRU) or nursing home of three hospitals in Burgundy (France) were invited to complete an online survey. Among the 171 respondents, 83 participants, with mean age 42 years and 87.9% female, were tested for SARS-CoV-2 infection. Among these 83 participants, COVID-19 was confirmed in 38 cases (RTPCR+ group) of which 36 were symptomatic, and the RTPCR assay was negative in 45 cases (RTPCR− group) of which 20 participants were symptomatic. A total of 22.9% (of 83) had comorbidities, 21.7% were active smokers, and 65.1% had received the flu vaccine. A total of 37.3% worked in AGU, 19.3% in GRU and 16.9% in nursing homes. The most common symptom described was headache (23.2%), followed by fatigue or cough (12.5% each), and fever or myalgia (10.7% each). There were more participants with normal body mass index (p = 0.03) in the RTPCR+ group. In contrast, there were more users of non-steroidal anti-inflammatory drugs (p = 0.01), active smokers (p = 0.03) and flu vaccinated (p = 0.01) in the RTPCR− group. No difference was found between the two groups for the type of work (p = 0.20 for physicians and p = 0.18 for nurses). However, acquiring COVID-19 was significantly associated with working in AGU (p < 0.001) and nursing homes (p = 0.001). There were significantly more users of surgical masks (p = 0.035) in the RTPCR+ group and more filtering facepiece-2 mask users (p = 0.016) in the RTPCR− group. Our results reflect the first six months of the COVID-19 pandemic in France. Further studies are needed to evaluate and track the risks and consequences of COVID-19 in HCWs. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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13 pages, 12338 KiB

Open AccessArticle

Reopening International Borders without Quarantine: Contact Tracing Integrated Policy against COVID-19

by Zidong Yu, Xiaolin Zhu, Xintao Liu, Tao Wei, Hsiang-Yu Yuan, Yang Xu, Rui Zhu, Huan He, Hui Wang, Man Sing Wong, Peng Jia, Song Guo, Wenzhong Shi and Wu Chen

Int. J. Environ. Res. Public Health 2021, 18(14), 7494; https://doi.org/10.3390/ijerph18147494 - 14 Jul 2021

Cited by 11 | Viewed by 4495

Abstract

With the COVID-19 vaccination widely implemented in most countries, propelled by the need to revive the tourism economy, there is a growing prospect for relieving the social distancing regulation and reopening borders in tourism-oriented countries and regions. This need incentivizes stakeholders to develop [...] Read more.

With the COVID-19 vaccination widely implemented in most countries, propelled by the need to revive the tourism economy, there is a growing prospect for relieving the social distancing regulation and reopening borders in tourism-oriented countries and regions. This need incentivizes stakeholders to develop border control strategies that fully evaluate health risks if mandatory quarantines are lifted. In this study, we have employed a computational approach to investigate the contact tracing integrated policy in different border-reopening scenarios in Hong Kong, China. Explicitly, by reconstructing the COVID-19 transmission from historical data, specific scenarios with joint effects of digital contact tracing and other concurrent measures (i.e., controlling arrival population and community nonpharmacological interventions) are applied to forecast the future development of the pandemic. Built on a modified SEIR epidemic model with a 30% vaccination coverage, the results suggest that scenarios with digital contact tracing and quick isolation intervention can reduce the infectious population by 92.11% compared to those without contact tracing. By further restricting the inbound population with a 10,000 daily quota and applying moderate-to-strong community nonpharmacological interventions (NPIs), the average daily confirmed cases in the forecast period of 60 days can be well controlled at around 9 per day (95% CI: 7–12). Two main policy recommendations are drawn from the study. First, digital contact tracing would be an effective countermeasure for reducing local virus spread, especially when it is applied along with a moderate level of vaccination coverage. Second, implementing a daily quota on inbound travelers and restrictive community NPIs would further keep the local infection under control. This study offers scientific evidence and prospective guidance for developing and instituting plans to lift mandatory border control policies in preparing for the global economic recovery. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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10 pages, 315 KiB

Open AccessArticle

COVID-19 Scientific Facts vs. Conspiracy Theories: Is Science Failing to Pass Its Message?

by Marios Constantinou, Antonios Kagialis and Maria Karekla

Int. J. Environ. Res. Public Health 2021, 18(12), 6343; https://doi.org/10.3390/ijerph18126343 - 11 Jun 2021

Cited by 28 | Viewed by 10281

Abstract

Science may be failing to convince a significant number of people about COVID-19 scientific facts and needed public health measures. Individual and social factors are behind believing conspiracy theories. Adults (N = 1001) were asked to rate their beliefs in various conspiracy theories [...] Read more.

Science may be failing to convince a significant number of people about COVID-19 scientific facts and needed public health measures. Individual and social factors are behind believing conspiracy theories. Adults (N = 1001) were asked to rate their beliefs in various conspiracy theories circulating in social media, rate their psychological distress relating to COVID-19, rate their trust in science to solve COVID-19 problems, and rate their willingness to adhere to measures regarding social distancing and quarantine. The findings showed conspiracy theories are widely believed and related to lower age, lower education, living in less densely populated areas, and lower income. Stronger conspiracy theory beliefs predicted science mistrust and unwillingness to adhere to public health measures. Psychological state was a strong predictor of conspiracy beliefs. Recommendations, stemming from the findings, for reducing such beliefs and better serving public health are discussed. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

13 pages, 384 KiB

Open AccessArticle

Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil

by Célia Landmann Szwarcwald, Deborah Carvalho Malta, Marilisa Berti de Azevedo Barros, Paulo Roberto Borges de Souza Júnior, Dália Romero, Wanessa da Silva de Almeida, Giseli Nogueira Damacena, André Oliveira Werneck, Danilo Rodrigues Pereira da Silva, Margareth Guimarães Lima, Crizian Saar Gomes, Luiz Otávio Azevedo, Arthur Pate de Souza Ferreira, Renata Gracie and Maria de Fátima de Pina

Int. J. Environ. Res. Public Health 2021, 18(11), 6160; https://doi.org/10.3390/ijerph18116160 - 07 Jun 2021

Cited by 24 | Viewed by 5217

Abstract

This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. [...] Read more.

This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the “virtual snowball” sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems—sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents’ emotional status throughout the COVID-19 pandemic. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

11 pages, 2450 KiB

Open AccessArticle

Incidence of Reported Flu-Like Syndrome Cases in Brazilian Health Care Workers in 2020 (March to June)

by Ada Ávila Assunção, Emanuella Gomes Maia, Renata Jardim and Tânia Maria de Araújo

Int. J. Environ. Res. Public Health 2021, 18(11), 5952; https://doi.org/10.3390/ijerph18115952 - 01 Jun 2021

Cited by 3 | Viewed by 2668

Abstract

Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, [...] Read more.

Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, FS corresponds to a suspected case of COVID-19. The manuscript analyzed cases of FS in five Brazilian states, estimating the incidence rates of cases of FS and clinical and epidemiological characteristics. Registered cases (March to June 2020) totaled about 1,100,000 cases of FS. HCWs represented 17% of the registers, whose incidence was 20.41/100 vs. 2.15/100 in the GC. FS cases in HCWs concentrated the highest percentages in the age group of 30 to 49 years (65.15%) and among the nursing staff (46.86%). This study was the first interstate evaluation in Brazil to estimate suspected cases of FS by COVID-19 in HCWs. In order to control the spread of viral respiratory infections in HCWs, including COVID-19, it is necessary to review the management of health information to identify who they are, how many they are, and to what situations these workers are most frequently exposed, as well as in what professions they have. This information can guide specific, practical, and far-reaching actions. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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12 pages, 598 KiB

Open AccessArticle

Exploring the Impact of COVID-19 Response on Population Health in Saudi Arabia: Results from the “Sharik” Health Indicators Surveillance System during 2020

by Nasser F. BinDhim, Nora A. Althumiri, Mada H. Basyouni, Norah AlMousa, Mohammed F. AlJuwaysim, Alanoud Alhakbani, Najat Alrashed, Elaf Almahmoud, Rawan AlAloula and Saleh A. Alqahtani

Int. J. Environ. Res. Public Health 2021, 18(10), 5291; https://doi.org/10.3390/ijerph18105291 - 16 May 2021

Cited by 12 | Viewed by 406270

Abstract

Background: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. Objective: To explore the prevalence of some behavioral health risk [...] Read more.

Background: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. Objective: To explore the prevalence of some behavioral health risk factors, intermediate risk factors, and chronic diseases at different timepoints during 2020 using the data available from a currently used surveillance system in Saudi Arabia. Methods: This study undertook a secondary analysis of data from the Sharik Health Indicators Surveillance System (SHISS). The SHISS employs short cross-sectional phone interviews, conducted in all 13 administrative regions of Saudi Arabia on a quarterly basis. Each interview lasts approximately 4 min and is conducted by a trained data collector. The SHISS collects demographic data, as well as data on the major behavioral and intermediate chronic disease risk factors and the major chronic diseases, including diabetes, heart disease, stroke, cancer, and chronic respiratory diseases. Results: Of the 44,782 potential participants contacted in 2020, 30,134 completed the interview, with a response rate of 67.29%. Out of the total participants, 51.2% were female. The mean age was 36.5. The behavioral risk factors in this period exhibited significant changes compared to those in the first quarter (Q1) of 2020, when there were no significant restrictions on daily activities. These significant changes are related to reductions in fruit and vegetable intake (adjusted odds ratio (AOR), 0.23) and physical activity (AOR, 0.483), and a significant increase in e-cigarette use (AOR 1.531). In terms of the intermediate risk factors observed in the SHISS, significant increases in hypercholesterolemia (AOR, 1.225) and hypertension (AOR, 1.190) were observed. Finally, heart disease (AOR, 1.279) and diabetes (AOR, 1.138) displayed significant increases compared to Q1. Conclusions: This study shows some evidence of the impact of responses to COVID-19 on the health of the population in Saudi Arabia. Significant reductions in fruit and vegetable intake and physical activity, and significant increases in e-cigarette use, hypertension, and hypercholesterolemia may increase the burden of chronic diseases in Saudi Arabia in the near future. Thus, continuous monitoring of the health risk factors within the population, and early interventions, are recommended to prevent future increases in chronic diseases. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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13 pages, 1733 KiB

Open AccessArticle

A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

by Mar Muñoz-Chápuli Gutiérrez, Ana Durán-Vila, Javier Ruiz-Labarta, Pilar Payá-Martínez, Pilar Pintado Recarte, Julia Bujan, Miguel A. Ortega and Juan De León-Luis

Int. J. Environ. Res. Public Health 2021, 18(10), 5144; https://doi.org/10.3390/ijerph18105144 - 12 May 2021

Cited by 4 | Viewed by 2477

Abstract

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference [...] Read more.

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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7 pages, 307 KiB

Open AccessCommunication

COVID-19 Severity and Neonatal BCG Vaccination among Young Population in Taiwan

by Wei-Ju Su, Chia-Hsuin Chang, Jiun-Ling Wang, Shu-Fong Chen and Chin-Hui Yang

Int. J. Environ. Res. Public Health 2021, 18(8), 4303; https://doi.org/10.3390/ijerph18084303 - 18 Apr 2021

Cited by 7 | Viewed by 2809

Abstract

Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established [...] Read more.

Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established a web-based National Immunization Information System (NISS) in 2003 and included all citizens’ BCG vaccination records in NISS for those born after 1985. We identified COVID-19 Taiwanese patients born after 1985 between 21 January and 19 March 2021. Study participants were further classified into ages 4–24 years (birth year 1996–2016) and 25–33 years (birth year 1986–1995). We described their clinical syndrome defined by the World Health Organization and examined the relation between the COVID-19 severity and BCG vaccination status. Results: In the 4–24 age group, among 138 BCG vaccinated individuals, 80.4% were asymptomatic or had mild disease, while 17.4% had moderate disease, 1.5% had severe disease, and 0.7% had acute respiratory distress syndrome but none of them died. In contrast, all 6 BCG unvaccinated individuals in this age group experienced mild illness. In the 25–33 age group, moderate disease occurred in 14.2% and severe disease occurred in 0.9% of the 106 patients without neonatal BCG vaccination records, as compared to 19.2% had moderate disease and none had severe or critical disease of the 78 patients with neonatal BCG vaccination records. Conclusions: Our finding indicated that BCG immunization might not relate to COVID-19 severity in the young population. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

17 pages, 10794 KiB

Open AccessArticle

Fine-Scale Space-Time Cluster Detection of COVID-19 in Mainland China Using Retrospective Analysis

by Min Xu, Chunxiang Cao, Xin Zhang, Hui Lin, Zhong Yao, Shaobo Zhong, Zhibin Huang and Robert Shea Duerler

Int. J. Environ. Res. Public Health 2021, 18(7), 3583; https://doi.org/10.3390/ijerph18073583 - 30 Mar 2021

Cited by 12 | Viewed by 2576

Abstract

Exploring spatio-temporal patterns of disease incidence can help to identify areas of significantly elevated or decreased risk, providing potential etiologic clues. The study uses the retrospective analysis of space-time scan statistic to detect the clusters of COVID-19 in mainland China with a different [...] Read more.

Exploring spatio-temporal patterns of disease incidence can help to identify areas of significantly elevated or decreased risk, providing potential etiologic clues. The study uses the retrospective analysis of space-time scan statistic to detect the clusters of COVID-19 in mainland China with a different maximum clustering radius at the family-level based on case dates of onset. The results show that the detected clusters vary with the clustering radius. Forty-three space-time clusters were detected with a maximum clustering radius of 100 km and 88 clusters with a maximum clustering radius of 10 km from 2 December 2019 to 20 June 2020. Using a smaller clustering radius may identify finer clusters. Hubei has the most clusters regardless of scale. In addition, most of the clusters were generated in February. That indicates China’s COVID-19 epidemic prevention and control strategy is effective, and they have successfully prevented the virus from spreading from Hubei to other provinces over time. Well-developed provinces or cities, which have larger populations and developed transportation networks, are more likely to generate space-time clusters. The analysis based on the data of cases from onset may detect the start times of clusters seven days earlier than similar research based on diagnosis dates. Our analysis of space-time clustering based on the data of cases on the family-level can be reproduced in other countries that are still seriously affected by the epidemic such as the USA, India, and Brazil, thus providing them with more precise signals of clustering. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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9 pages, 565 KiB

Open AccessArticle

Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients

by Agostino Gaudio, Andrea Ruben Murabito, Antonella Agodi, Arturo Montineri, Pietro Castellino and D.O.CoV Research

Int. J. Environ. Res. Public Health 2021, 18(7), 3491; https://doi.org/10.3390/ijerph18073491 - 27 Mar 2021

Cited by 15 | Viewed by 3220

Abstract

The coronavirus disease 2019 (COVID-19) pandemic poses a worldwide healthcare challenge that needs an efficient response. Unfortunately, to date there is no highly effective treatment, so a deep understanding of COVID-19 risk factors could be an important step in treating the disease. Vitamin [...] Read more.

The coronavirus disease 2019 (COVID-19) pandemic poses a worldwide healthcare challenge that needs an efficient response. Unfortunately, to date there is no highly effective treatment, so a deep understanding of COVID-19 risk factors could be an important step in treating the disease. Vitamin D affects the immune system in many different ways, and other authors already found that COVID-19 patients have low levels of vitamin D. In our retrospective study, we evaluated the vitamin D status at the time of hospital admission in 50 COVID-19 patients in Sicily, which is the southernmost region of Italy, and compared them with 100 control subjects matched for age and sex. Our data showed markedly low levels of vitamin D in patients with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but no association was found with inflammation markers or clinical severity. Vitamin D levels were reduced at the time of hospital admission in Sicilian SARS-CoV-2-positive patients, but it is not clear whether this condition has an impact on the clinical course of COVID-19. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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10 pages, 329 KiB

Open AccessArticle

Investigating the Self-Reported Health Status of Domestic and Overseas Chinese Populations during the COVID-19 Pandemic

by Zhuxin Mao, Bohao Chen, Wei Wang, Paul Kind and Pei Wang

Int. J. Environ. Res. Public Health 2021, 18(6), 3043; https://doi.org/10.3390/ijerph18063043 - 16 Mar 2021

Cited by 7 | Viewed by 2017

Abstract

To control the spread of COVID-19, governments in different countries and regions implemented various types of lockdown and outdoor restrictions. The research aimed to describe and compare the health status of Chinese people both domestically and abroad in this global health crisis. An [...] Read more.

To control the spread of COVID-19, governments in different countries and regions implemented various types of lockdown and outdoor restrictions. The research aimed to describe and compare the health status of Chinese people both domestically and abroad in this global health crisis. An online questionnaire survey was distributed to Chinese mainland citizens living in Hubei (the lockdown province), outside Hubei, and those living abroad in 2020. A total of 1000 respondents were recruited and reported worse health status compared with Chinese population norms. People living in Hubei reported worse health status than those living outside Hubei but revealed better health status than overseas respondents. It was clear that the pandemic as well as strict lockdown and outdoor restriction policies affected Chinese people’s health. It is important for the Chinese government to be aware of the negative impact of such strict policies and to take measures to reduce the panic of society when implementing similar policies in the future. It also implies that governments in other countries should promote social support for those who live far from home and actively call for support for non-discriminatory attitudes toward ethnic minorities. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

13 pages, 4803 KiB

Open AccessArticle

Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients

by Joanna Dolar-Szczasny, Mario D. Toro, Anna Dworzańska, Tomasz Wójtowicz, Izabela Korona-Glowniak, Rafał Sawicki, Anastazja Boguszewska, Małgorzata Polz-Dacewicz, Krzysztof Tomasiewicz, Wojciech Załuska, Robert Rejdak, Paola Bagnoli and Dario Rusciano

Int. J. Environ. Res. Public Health 2021, 18(6), 2916; https://doi.org/10.3390/ijerph18062916 - 12 Mar 2021

Cited by 14 | Viewed by 2220

Abstract

The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by [...] Read more.

The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by COVID-19. A consecutive series of 74 COVID-19-positive patients (age 21–89) were enrolled at two Polish COVID-19 hospitals for 4 months and were characterized by PCR for the presence of the SARS-CoV-2 genetic material in nasopharyngeal (NP) and ocular swabs, while their respiratory and ocular symptoms were noted. Almost 50% of them presented with severe/critical respiratory involvement, and some degree of eye disease. No tight correlation was observed between the presence of ocular and respiratory symptoms. Three male patients presenting with severe/critical lung disease tested positive in ocular swab, however with mild/moderate ocular symptoms. In conclusion, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not such a frequent occurrence. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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15 pages, 6555 KiB

Open AccessArticle

Intolerance of COVID-19-Related Uncertainty and Negative Emotions among Chinese Adolescents: A Moderated Mediation Model of Risk Perception, Social Exclusion and Perceived Efficacy

by Qi Li, Ronglei Luo, Xiaoya Zhang, Guangteng Meng, Bibing Dai and Xun Liu

Int. J. Environ. Res. Public Health 2021, 18(6), 2864; https://doi.org/10.3390/ijerph18062864 - 11 Mar 2021

Cited by 33 | Viewed by 4419

Abstract

The uncertainty caused by the COVID-19 pandemic has exacerbated negative emotions, especially among adolescents, who feel unable to tolerate the uncertainty of the epidemic. However, the mechanism by which the intolerance of COVID-19-related uncertainty (COVID-19 IU) affects negative emotions in adolescents remains unclear. [...] Read more.

The uncertainty caused by the COVID-19 pandemic has exacerbated negative emotions, especially among adolescents, who feel unable to tolerate the uncertainty of the epidemic. However, the mechanism by which the intolerance of COVID-19-related uncertainty (COVID-19 IU) affects negative emotions in adolescents remains unclear. This study explored the underlying mechanism from COVID-19 IU to negative emotions using a moderated mediation model in adolescents. In total, 3037 teenagers completed a cross-sectional survey including measures of COVID-19 IU, risk perception, social exclusion, perceived efficacy, and negative emotions. The results showed that COVID-19 IU positively predicted negative emotions and that risk perception and social exclusion mediated this relationship. In addition, both the direct effect of COVID-19 IU on negative emotions and the mediating effect of risk perception on this relationship were moderated by perceived efficacy; in particular, COVID-19 IU had a greater impact on negative emotions among adolescents with lower levels of perceived efficacy. These findings suggest that COVID-19 IU is closely associated with negative emotions among adolescents and that effective measures should be taken to enable adolescents to improve their perceived efficacy and develop a reasonable perception of risk, help them eliminate the stigma of the disease, and strengthen their connections with society. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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14 pages, 600 KiB

Open AccessFeature PaperArticle

Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG–OCCUPATION–COVID-19 Study

by Paola Della Valle, Marco Fabbri, Fabiana Madotto, Pietro Ferrara, Paolo Cozzolino, Elisabetta Calabretto, Marco Italo D’Orso, Ermanno Longhi, Riccardo Polosa, Michele Augusto Riva, Giampiero Mazzaglia, Carmen Sommese, Lorenzo Giovanni Mantovani and The MUSTANG–OCCUPATION–COVID-19 Study Group

Int. J. Environ. Res. Public Health 2021, 18(5), 2567; https://doi.org/10.3390/ijerph18052567 - 04 Mar 2021

Cited by 20 | Viewed by 3669

Abstract

Sero-epidemiological surveys are valuable attempts to estimate the circulation of SARS-CoV-2 in general or selected populations. Within this context, a prospective observational study was conducted to estimate the prevalence and persistence of SARS-CoV-2 antibodies in different categories of workers and factors associated with [...] Read more.

Sero-epidemiological surveys are valuable attempts to estimate the circulation of SARS-CoV-2 in general or selected populations. Within this context, a prospective observational study was conducted to estimate the prevalence and persistence of SARS-CoV-2 antibodies in different categories of workers and factors associated with positivity, through the detection of virus-specific immunoglobulin G and M (IgG/IgM) in serum samples. Enrollees were divided in low exposure and medium-high groups on the basis of their work activity. Antibody responders were re-contacted after 3 months for the follow-up. Of 2255 sampled workers, 4.8% tested positive for SARS-CoV-2 IgG/IgM antibodies, with 81.7% to IgG only. Workers who continued to go to their place of work, were healthcare workers, or experienced at least one COVID-19-related symptom were more likely to test positive for SARS-CoV-2 antibodies. SARS-CoV-2 antibodies prevalence was significantly higher in the medium-high risk vs. low-risk group (7.2% vs. 3.0%, p < 0.0001). At 3-month follow-up, 81.3% of subjects still had antibody response. This study provided important information of SARS-CoV-2 infection prevalence among workers in northern Italy, where the impact of COVID-19 was particularly intense. The presented surveillance data give a contribution to refine current estimates of the disease burden expected from the SARS-CoV-2. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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10 pages, 799 KiB

Open AccessArticle

Relations between Air Quality and Covid-19 Lockdown Measures in Valencia, Spain

by Gabriele Donzelli, Lorenzo Cioni, Mariagrazia Cancellieri, Agustin Llopis-Morales and María Morales-Suárez-Varela

Int. J. Environ. Res. Public Health 2021, 18(5), 2296; https://doi.org/10.3390/ijerph18052296 - 26 Feb 2021

Cited by 30 | Viewed by 3538

Abstract

The set of measures to contain the diffusion of COVID-19 instituted by the European governments gave an unparalleled opportunity to improve our understanding of the transport and industrial sectors’ contribution to urban air pollution. The purpose of this study was to assess the [...] Read more.

The set of measures to contain the diffusion of COVID-19 instituted by the European governments gave an unparalleled opportunity to improve our understanding of the transport and industrial sectors’ contribution to urban air pollution. The purpose of this study was to assess the impacts of the lockdown measures on air quality and pollutant emissions in Valencia, Spain. For this reason, we determined if there was a significant difference in the concentration levels of different particulate matter (PM) sizes, PM₁₀, PM_2.5, and NO_x, NO₂, NO, and O_3, between the period of restrictions in 2020 and the same period in 2019. Our findings indicated that PM pollutant levels during the lockdown period were significantly different from the same period of the previous year, even if there is variability in the different local areas. The highest variations reduction in the PM₁₀ and PM_2.5 levels were observed for the València Centre, València Avd Francia, and València Pista de Silla (all of the urban traffic type) in which there was a reduction of 58%–42%, 56%–53%, and 60%–41% respectively. Moreover, consistent with recent studies, we observed a significant reduction in nitric oxide levels in all the air monitoring stations. In all seven monitoring stations, it was observed, in 2020, NO_x, NO₂, and NO concentrations decreased by 48.5%–49.8%–46.2%, 62.1%–67.4%–45.7%, 37.4%–35.7%–35.3%, 60.7%–67.7%–47.1%, 65.5%–65.8%–63.5%, 60.0%–64.5%–41.3%, and 60.4%–61.6%–52.5%, respectively. Lastly, overall O₃ levels decreased during the lockdown period, although this phenomenon was more closely related to weather conditions. Overall, no significant differences were observed between the meteorological conditions in 2019 and 2020. Our findings suggest that further studies on the effect of human activities on air quality are needed and encourage the adoption of a holistic approach to improve urban air quality. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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17 pages, 2780 KiB

Open AccessArticle

Different Responses to Stress, Health Practices, and Self-Care during COVID-19 Lockdown: A Stratified Analysis

by Elena Bermejo-Martins, Elkin O. Luis, Ainize Sarrionandia, Martín Martínez, María Sol Garcés, Edwin Y. Oliveros, Cristian Cortés-Rivera, Maider Belintxon and Pablo Fernández-Berrocal

Int. J. Environ. Res. Public Health 2021, 18(5), 2253; https://doi.org/10.3390/ijerph18052253 - 25 Feb 2021

Cited by 24 | Viewed by 5854

Abstract

The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from [...] Read more.

The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from Spain, Chile, Colombia, and Ecuador took part in this study. Irrespective of the country, and controlling for income level, young people, especially females, suffered a greater level of stress, perceived the situation as more severe, showed less adherence to health guidelines, and reported lower levels of health consciousness, in comparison to their male peers and older groups. However, in the case of self-care, it seems that older and female groups are generally more involved in self-care activities and adopt more healthy daily routines. These results are mostly similar between Colombia, Ecuador, and Spain. However, Chile showed some different tendencies, as males reported higher levels of healthy daily routines and better adherence to health guidelines compared to females and people over the age of 60. Differences between countries, genders, and age ranges should be considered in order to improve health recommendations and adherence to guidelines. Moreover, developing community action and intersectoral strategies with a gender-based approach could help to reduce health inequalities and increase the success of people’s adherence to health guidelines and self-care-promoting interventions. Future studies should be addressed to explore the possible causations of such differences in more cultural-distant samples and at later stages of the current outbreak. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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12 pages, 2501 KiB

Open AccessArticle

Socioeconomic Inequalities in COVID-19 in a European Urban Area: Two Waves, Two Patterns

by Marc Marí-Dell’Olmo, Mercè Gotsens, M Isabel Pasarín, Maica Rodríguez-Sanz, Lucía Artazcoz, Patricia Garcia de Olalla, Cristina Rius and Carme Borrell

Int. J. Environ. Res. Public Health 2021, 18(3), 1256; https://doi.org/10.3390/ijerph18031256 - 30 Jan 2021

Cited by 76 | Viewed by 12674

Abstract

Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by [...] Read more.

Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41–1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44–1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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13 pages, 2248 KiB

Open AccessArticle

Estimating Unreported COVID-19 Cases with a Time-Varying SIR Regression Model

by Zhenghong Peng, Siya Ao, Lingbo Liu, Shuming Bao, Tao Hu, Hao Wu and Ru Wang

Int. J. Environ. Res. Public Health 2021, 18(3), 1090; https://doi.org/10.3390/ijerph18031090 - 26 Jan 2021

Cited by 10 | Viewed by 2816

Abstract

Background: Potential unreported infection might impair and mislead policymaking for COVID-19, and the contemporary spread of COVID-19 varies in different counties of the United States. It is necessary to estimate the cases that might be underestimated based on county-level data, to take better [...] Read more.

Background: Potential unreported infection might impair and mislead policymaking for COVID-19, and the contemporary spread of COVID-19 varies in different counties of the United States. It is necessary to estimate the cases that might be underestimated based on county-level data, to take better countermeasures against COVID-19. We suggested taking time-varying Susceptible-Infected-Recovered (SIR) models with unreported infection rates (UIR) to estimate factual COVID-19 cases in the United States. Methods: Both the SIR model integrated with unreported infection rates (SIRu) of fixed-time effect and SIRu with time-varying parameters (tvSIRu) were applied to estimate and compare the values of transmission rate (TR), UIR, and infection fatality rate (IFR) based on US county-level COVID-19 data. Results: Based on the US county-level COVID-19 data from 22 January (T₁) to 20 August (T₂₁₂) in 2020, SIRu was first tested and verified by Ordinary Least Squares (OLS) regression. Further regression of SIRu at the county-level showed that the average values of TR, UIR, and IFR were 0.034%, 19.5%, and 0.51% respectively. The ranges of TR, UIR, and IFR for all states ranged from 0.007–0.157 (mean = 0.048), 7.31–185.6 (mean = 38.89), and 0.04–2.22% (mean = 0.22%). Among the time-varying TR equations, the power function showed better fitness, which indicated a decline in TR decreasing from 227.58 (T₁) to 0.022 (T₂₁₂). The general equation of tvSIRu showed that both the UIR and IFR were gradually increasing, wherein, the estimated value of UIR was 9.1 (95%CI 5.7–14.0) and IFR was 0.70% (95%CI 0.52–0.95%) at T₂₁₂. Interpretation: Despite the declining trend in TR and IFR, the UIR of COVID-19 in the United States is still on the rise, which, it was assumed would decrease with sufficient tests or improved countersues. The US medical system might be largely affected by severe cases amidst a rapid spread of COVID-19. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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8 pages, 718 KiB

Open AccessArticle

Reduction of Multidrug-Resistant (MDR) Bacterial Infections during the COVID-19 Pandemic: A Retrospective Study

by Enrico Bentivegna, Michelangelo Luciani, Luca Arcari, Iolanda Santino, Maurizio Simmaco and Paolo Martelletti

Int. J. Environ. Res. Public Health 2021, 18(3), 1003; https://doi.org/10.3390/ijerph18031003 - 23 Jan 2021

Cited by 64 | Viewed by 4935

Abstract

Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case–control study to identify if the incidence of [...] Read more.

Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case–control study to identify if the incidence of MDR bacterial infections while using pandemic-related preventive measures is lower than in previous years. From 2017 to 2020, we monitored hospital discharges over a four-month period (P #) (1 March to 30 June) in St. Andrea Hospital, Rome. In total, we reported 1617 discharges. Pearson’s chi-squared test was used to identify significant differences. A value of p ≤ 0.05 was considered statistically significant. A significant reduction in the incidence of total MDR bacterial infections was observed during the pandemic compared to in prepandemic years (p < 0.05). We also found a significantly higher incidence of MDR bacterial infections in COVID-19 departments compared with other medical departments (29% and 19%, respectively), with extended-spectrum β-lactamase Klebsiella pneumoniae as the pathogens presenting the highest increase. This study demonstrates that maintaining a high level of preventive measures could help tackle an important health problem such as that of the spread of MDR bacteria. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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9 pages, 1044 KiB

Open AccessArticle

Keeping Low Reproductive Number Despite the Rebound Population Mobility in Korea, a Country Never under Lockdown during the COVID-19 Pandemic

by Soyoung Kim, Yae-Jean Kim, Kyong Ran Peck, Youngsuk Ko, Jonggul Lee and Eunok Jung

Int. J. Environ. Res. Public Health 2020, 17(24), 9551; https://doi.org/10.3390/ijerph17249551 - 20 Dec 2020

Cited by 16 | Viewed by 2838

Abstract

Nonpharmaceutical intervention has been one of the most important strategies to prevent the spread of the SARS-CoV-2 in the communities during the COVID-19 pandemic. Korea has a unique experience that we had the first large outbreak during the early pandemic and could flatten [...] Read more.

Nonpharmaceutical intervention has been one of the most important strategies to prevent the spread of the SARS-CoV-2 in the communities during the COVID-19 pandemic. Korea has a unique experience that we had the first large outbreak during the early pandemic and could flatten the epidemic curve without lockdown. In this study, the effective reproductive numbers were calculated for the entire nation and Seoul (the capital city) Metropolitan Area from February 16–15 July, where 60% of the population reside. We compared the changes in population mobility data and reproductive number trends according to the changes in the government’s nonpharmaceutical intervention strategy. The total daily mobility decreased when Korea had the first wave of a large outbreak in February–March 2020, which was mainly caused by the decrease of daily noncommuting mobility. However, daily commuting mobility from 16 February to 30 June 2020 was maintained at a similar level since there was no national lockdown for workers who commute between home and work. During the first half-year of 2020, Korea could control the outbreak to a manageable level without a significant decrease in daily public mobility. However, it may be only possible when the public follows personal hygiene principles and social distancing without crisis fatigue or reduced compliance. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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16 pages, 3320 KiB

Open AccessArticle

Analysis of COVID-19 Prevention and Control Effects Based on the SEITRD Dynamic Model and Wuhan Epidemic Statistics

by Yusheng Zhang, Liang Li, Yuewen Jiang and Biqing Huang

Int. J. Environ. Res. Public Health 2020, 17(24), 9309; https://doi.org/10.3390/ijerph17249309 - 12 Dec 2020

Cited by 4 | Viewed by 1984

Abstract

Since December 2019, millions of people worldwide have been diagnosed with COVID-19, which has caused enormous losses. Given that there are currently no effective treatment or prevention drugs, most countries and regions mainly rely on quarantine and travel restrictions to prevent the spread [...] Read more.

Since December 2019, millions of people worldwide have been diagnosed with COVID-19, which has caused enormous losses. Given that there are currently no effective treatment or prevention drugs, most countries and regions mainly rely on quarantine and travel restrictions to prevent the spread of the epidemic. How to find proper prevention and treatment methods has been a hot topic of discussion. The key to the problem is to understand when these intervention measures are the best strategies for disease control and how they might affect disease dynamics. In this paper, we build a transmission dynamic model in combination with the transmission characteristics of COVID-19. We thoroughly study the dynamical behavior of the model and analyze how to determine the relevant parameters, and how the parameters influence the transmission process. Furthermore, we subsequently compare the impact of different control strategies on the epidemic, the variables include intervention time, control duration, control intensity, and other model parameters. Finally, we can find a better control method by comparing the results under different schemes and choose the proper preventive control strategy according to the actual epidemic stage and control objectives. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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Review

Jump to: Research, Other

21 pages, 2928 KiB

Open AccessReview

Air Pollution and COVID-19: A Possible Dangerous Synergy for Male Fertility

by Luigi Montano, Francesco Donato, Pietro Massimiliano Bianco, Gennaro Lettieri, Antonino Guglielmino, Oriana Motta, Ian Marc Bonapace and Marina Piscopo

Int. J. Environ. Res. Public Health 2021, 18(13), 6846; https://doi.org/10.3390/ijerph18136846 - 25 Jun 2021

Cited by 20 | Viewed by 4383

Abstract

Several studies indicate that semen quality has strongly declined in the last decades worldwide. Air pollution represents a significant co-factor with the COVID-19 impact and has negative effects on the male reproductive system, through pro-oxidant, inflammatory and immune-dysregulating mechanisms. It has recently been [...] Read more.

Several studies indicate that semen quality has strongly declined in the last decades worldwide. Air pollution represents a significant co-factor with the COVID-19 impact and has negative effects on the male reproductive system, through pro-oxidant, inflammatory and immune-dysregulating mechanisms. It has recently been reported that chronic exposure to PM2.5 causes overexpression of the alveolar ACE2 receptor, the entry route of SARS-CoV-2 into the organism shared by the lungs and testis where expression is highest in the body. In the testis, the ACE2/Ang-(1–7)/MasR pathway plays an important role in the regulation of spermatogenesis and an indirect mechanism of testicular damage could be due to the blockade of the ACE2 receptor by SARS-CoV-2. This prevents the conversion of specific angiotensins, and their excess causes inflammation with the overproduction of cytokines. PM2.5-induced overexpression of the alveolar ACE2 receptor, in turn, could increase local viral load in patients exposed to pollutants, producing ACE2 receptor depletion and compromising host defenses. By presenting an overall view of epidemiological data and molecular mechanisms, this manuscript aims to interpret the possible synergistic effects of both air pollution and COVID-19 on male reproductive function, warning that the spread of SARS-CoV-2 in the fertile years may represent a significant threat to global reproductive health. All of this should be of great concern, especially for men of the age of maximum reproductive capacity, and an important topic of debate for policy makers. Altered environmental conditions, together with the direct and indirect short- and long-term effects of viral infection could cause a worsening of semen quality with important consequences for male fertility, especially in those areas with higher environmental impact. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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11 pages, 748 KiB

Open AccessReview

COVID-19 and Recreational Skiing: Results of a Rapid Systematic Review and Possible Preventive Measures

by Vincenza Gianfredi, Nicole Sibilla Mauer, Leandro Gentile, Matteo Riccò, Anna Odone and Carlo Signorelli

Int. J. Environ. Res. Public Health 2021, 18(8), 4349; https://doi.org/10.3390/ijerph18084349 - 20 Apr 2021

Cited by 11 | Viewed by 3461

Abstract

COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. [...] Read more.

COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. These measures were mostly upheld throughout the 2020 and 2021 winter season, generating significant economic loss for mountain communities. The aim of this rapid systematic review was to explore the association between recreational skiing and the spread of COVID-19. This review was conducted according to the WHO practical guidelines on rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, MedRxiv and Promed-mail were screened to identify relevant scientific and grey literature published since the emergence of COVID-19. Among the 11 articles included, seven focused on cases recorded during the first epidemic wave, when COVID-19 containment measures were not yet mandatory. Most infection clusters could be directly linked to public gatherings which took place without the enforcement of restrictions. There is currently no evidence to suggest an association between COVID-19 spread and recreational skiing. It may be reasonable to consider the reopening of ski areas in compliance with strict rules and preventive measures. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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15 pages, 1964 KiB

Open AccessReview

Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19)

by Amira Mohammed Ali and Hiroshi Kunugi

Int. J. Environ. Res. Public Health 2021, 18(5), 2772; https://doi.org/10.3390/ijerph18052772 - 09 Mar 2021

Cited by 38 | Viewed by 5409

Abstract

Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is [...] Read more.

Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients—MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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Other

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7 pages, 2516 KiB

Open AccessBrief Report

The Association between Wearing a Mask and COVID-19

by Mana Sugimura, Odgerel Chimed-Ochir, Yui Yumiya, Hiroki Ohge, Nobuaki Shime, Takemasa Sakaguchi, Junko Tanaka, Toshiro Takafuta, Michi Mimori, Masao Kuwabara, Toshimasa Asahara, Eisaku Kishita and Tatsuhiko Kubo

Int. J. Environ. Res. Public Health 2021, 18(17), 9131; https://doi.org/10.3390/ijerph18179131 - 30 Aug 2021

Cited by 26 | Viewed by 5029

Abstract

With the widespread and increasing number of cases of Coronavirus Disease (2019) globally, countries have been taking preventive measures against this pandemic. However, there is no universal agreement across cultures on whether wearing face masks are an effective physical intervention against disease transmission. [...] Read more.

With the widespread and increasing number of cases of Coronavirus Disease (2019) globally, countries have been taking preventive measures against this pandemic. However, there is no universal agreement across cultures on whether wearing face masks are an effective physical intervention against disease transmission. We investigated the relationship between mask wearing and COVID-19 among close contacts of COVID-19 patients in the Hiroshima Prefecture, Japan. In the Hiroshima Prefecture, a COVID-19 form adapted from the reporting form, “Japanese Surveillance in Post-Extreme Emergencies and Disasters”, was developed to collect data from COVID-19 patients’ close contacts under active epidemiological surveillance at Public Health Centers. The relative risk of COVID-19 for mask users versus non-mask users was calculated. A total of 820 interviewees were included in the analysis and 53.3% of them responded that they wore masks. Non-mask users were infected at a rate of 16.4%, while mask users were infected at a rate of 7.1%. Those who wore masks were infected at a rate of 0.4 times that of those who did not wear masks. (RR = 0.4, 95%CI = 0.3–0.6; Adjusted RR = 0.6, 95%CI = 0.3–0.9). These findings implied that COVID-19 could be avoided to a certain degree by wearing a mask. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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3 pages, 267 KiB

Open AccessReply

Reply to Ialongo et al. Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on “Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491”

by Agostino Gaudio, Andrea Ruben Murabito, Antonella Agodi, Arturo Montineri, Pietro Castellino and D.O.CoV Research

Int. J. Environ. Res. Public Health 2021, 18(13), 7036; https://doi.org/10.3390/ijerph18137036 - 01 Jul 2021

Viewed by 1846

Abstract

We read the comment by Ialongo et al. [...] Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

4 pages, 882 KiB

Open AccessComment

Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491

by Cristiano Ialongo, Antonella Farina, Raffaella Labriola, Antonio Angeloni and Emanuela Anastasi

Int. J. Environ. Res. Public Health 2021, 18(13), 6793; https://doi.org/10.3390/ijerph18136793 - 24 Jun 2021

Cited by 1 | Viewed by 1674

Abstract

We read with great interest the paper by Gaudio and colleagues on vitamin D and on the state of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of admission [...] Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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16 pages, 2853 KiB

Open AccessCommentary

Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

by Roberto A. Sussman, Eliana Golberstein and Riccardo Polosa

Int. J. Environ. Res. Public Health 2021, 18(4), 1437; https://doi.org/10.3390/ijerph18041437 - 03 Feb 2021

Cited by 9 | Viewed by 7691

Abstract

We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces [...] Read more.

We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces with non-users. The fact that the respiratory flow associated with vaping is visible (as opposed to other respiratory activities) clearly delineates a safety distance of 1–2 m along the exhaled jet to prevent direct exposure. Vaping is a relatively infrequent and intermittent respiratory activity for which we infer a mean emission rate of 79.82 droplets per puff (6–200, standard deviation 74.66) comparable to mouth breathing, it adds into shared indoor spaces (home and restaurant scenarios) a 1% extra risk of indirect COVID-19 contagion with respect to a “control case” of existing unavoidable risk from continuous breathing. As a comparative reference, this added relative risk increases to 44–176% for speaking 6–24 min per hour and 260% for coughing every 2 min. Mechanical ventilation decreases absolute emission levels but keeps the same relative risks. As long as direct exposure to the visible exhaled jet is avoided, wearing of face masks effectively protects bystanders and keeps risk estimates very low. As a consequence, protection from possible COVID-19 contagion through vaping emissions does not require extra interventions besides the standard recommendations to the general population: keeping a social separation distance of 2 m and wearing of face masks. Full article

(This article belongs to the Special Issue A Public Health View on COVID-19: Epidemiology, Implications and Responses)

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