Burden of COVID-19 in Different Countries

There is little evidence on how different COVID-19 pandemic phases influence the alcohol use behaviour of adults. The objective of this study is to investigate alcohol use frequency over different COVID-19 pandemic phases and to identify vulnerable subgroups for risky use behaviour in the German adult population. Survey waves of 14/15 April 2020 (n = 1032), 23/24 June 2020 (n = 993), and 26/27 January 2021 (n = 1001) from the COVID-19 Snapshot Monitoring (COSMO) were analysed. The mean age was 46 ± 15.3 years in April, 46 ± 15.5 years in June, and 45 ± 15.5 years in January. The gender ratio was mostly equal in each survey wave. Descriptive analyses and univariate and multivariate logistic regression analyses for individuals with increased alcohol use frequency (AUF) were performed. 13.2% in April (lockdown), 11.3% in June (easement), and 8.6% in January (lockdown) of participants showed an increased AUF. Individuals with perceived burden, high frustration levels due to protective measures, and young to middle-aged adults were more likely to increase their AUF during different pandemic phases. In conclusion, unfavourable alcohol behaviour might occur as a potentially maladaptive coping strategy in pandemics. Because of potential negative long-term consequences of problematic alcohol use behaviour on health, public health strategies should consider mental health consequences and target addictive behaviour, while also guiding risk groups towards healthy coping strategies such as physical activities during pandemics/crises. Full article

The COVID-19 pandemic has caused an overall increase in stress and depression in society. The aim of the present research was to evaluate the psychological condition of college students during the COVID-19 pandemic and explore factors influencing their daily functioning. The study focused on four main aspects such as mental well-being, sexuality, concern about financial status, and trust in medical authorities. The study was based on a specially designed survey. The questionnaire was created using Google Forms and shared on social media sites. A total of 630 students participated in the survey, 17 surveys were excluded due to incomplete data and 613 surveys (97.30%) were considered for the final analysis. During isolation, 68.0% of students experienced fear of missing out (FOMO). A total of 73.4% were frustrated due to spending a lot of time in front of a computer. A significant decrease in motivation to study was reported by 78.1% of the respondents. Students showed significantly different attitudes towards sexuality. Concern about the financial situation was reported by 48.7% of respondents. The state of the Polish economy was of concern to 86.4% of respondents. A total of 74.5% of students declared concern about their career development. During the pandemic, 59.0% of respondents became concerned about their health. The attitude towards vaccination was described as positive by 82.5% of the respondents. The percentage of respondents experiencing negative psychological effects relative to the overall epidemiological situation of COVID-19 is troubling. Given the unexpected length and severity of the pandemic, we suggest that students’ concerns be more thoroughly understood and addressed. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that caused the coronavirus disease 2019 (COVID-19) pandemic. Though previous studies have suggested that SARS-CoV-2 cellular tropism depends on the host-cell-expressed proteins, whether transcriptional regulation controls SARS-CoV-2 tropism factors in human lung cells remains unclear. In this study, we used computational approaches to identify transcription factors (TFs) regulating SARS-CoV-2 tropism for different types of lung cells. We constructed transcriptional regulatory networks (TRNs) controlling SARS-CoV-2 tropism factors for healthy donors and COVID-19 patients using lung single-cell RNA-sequencing (scRNA-seq) data. Through differential network analysis, we found that the altered regulatory role of TFs in the same cell types of healthy and SARS-CoV-2-infected networks may be partially responsible for differential tropism factor expression. In addition, we identified the TFs with high centralities from each cell type and proposed currently available drugs that target these TFs as potential candidates for the treatment of SARS-CoV-2 infection. Altogether, our work provides valuable cell-type-specific TRN models for understanding the transcriptional regulation and gene expression of SARS-CoV-2 tropism factors. Full article

We examine the psychosocial factors influencing community adoption of non-pharmaceutical interventions (NPI) to limit the spread of COVID-19. Using data from 990 respondents in communities across Nigeria, we examine the correlation of health behaviors and socioeconomic indicators. We conduct logistic regression to estimate the relationship between mask wearing as a health-seeking NPI with demographic and socioeconomic variables. We estimate separate models in the sensitivity robustness checks with other NPIs and control for differences across sex, age, education, number in household, and the presence of a student in the respondent’s household. A crucial finding is that health-seeking NPI behaviors are statistically significantly affected in different ways by the menu of socioeconomic indicators. The control for age, sex, education, and household size indicates that there is intersectionality of how these factors influence specific mitigation practices. We find that women are more likely to engage in mask wearing, hand washing, and use of hand sanitizers and tissues than men, and the provision of palliatives and access to family supplies significantly enhances community mitigation. Palliatives and access to family supplies enhance most health-seeking behaviors. The implication for pandemic mitigation policy is that minimizing incidence rates requires having responsive initiatives such as information updates on pandemic progression. Full article

Background: During the COVID-19 outbreak, patients with mental disorders have faced more negative psychological consequences than the public. For people with treatment-resistant depression (TRD), it is unclear whether research engagement would protect them from the deterioration of their symptoms. The study aimed to examine if chronic depressive patients would have improved resilience and mental distress levels after follow-up interviews during an observation period under COVID-19. Methods: The study was nested within a three-year prospective cohort study. A two-group comparison design was conducted, i.e., the follow-up group with regular research interviews every three months after baseline assessment and the control group with one assessment-only interview. The two groups were compared with demographics, psychosocial, and suicide information. Results: Baseline assessments were not significantly different in sociodemographic variables, suicide risks, mental distress, and resilience between groups. Significant differences were detected in resilient coping and mental distress levels (p < 0.05). The follow-up group (n = 46) experienced a higher level of resilient coping (37% vs. 25%) and lower level of mental distress (47.8% vs. 64.7%) than the control group (n = 68). Conclusions: Findings highlight under universal government strategy against COVID-19, TRD patients receiving regular research follow-ups exhibited better resilience and less mental distress than those without regular support from healthcare providers. Full article

Background: Health equity is an important aspect of responsible governance. COVID-19 exposed existing shortfalls of Global Health Governance (GHG). A considerable amount of related literature is produced. This scoping review aims at mapping the present knowledge and at identifying research gaps. Methods: This scoping review is based on the Joanna Briggs Institute’s guideline for standardized methods and PRISMA-ScR guidelines for reporting. Documents published from December 2019 to October 2021 were searched using PubMed, Scopus, Google Scholar, World cat, and WHO-Global Index Medicus. Two reviewers screened and reviewed eligible studies in three stages: duplicates identification and elimination, title and abstract screening, and full-text assessment. Data was charted and results were classified into conceptual categories. Analysis was done in three stages: open descriptive coding, focused thematic analysis, and frequency, commonality and significance analysis. Results: forty-nine studies met the inclusion criteria. Areas of research were grouped into seven themes: “human rights and inequities”, “solidarity, collaboration and partnership”, “GHG structure change”, “political and economic power and finance”, “approaches to address inequity”, “law and regulations”, and “private investment and public-private partnerships (PPPs) in GHG”. The highest number of papers were in the first theme, “human rights and inequities”. However, the themes are interrelated. Authors who contributed to research were mostly affiliated to developed countries indicating a gap in knowledge and expertise in developing countries. Conclusion: Through this scoping review we found that the seven themes are interconnected. Disciplinary collaboration in research relating GHG to health inequities is solicited. Collaboration in research, information sharing, and research capacity development are in needed in developing countries. Full article

Quality of life (QoL) is considered one of the measures of health outcomes. Limited research studies have assessed family caregivers’ QoL, especially among patients diagnosed with chronic disease. This study measures the QoL of caregivers who guardian patients diagnosed with cardiovascular disease, diabetes, cancer, and/or other diseases during the COVID-19 pandemic. Participants were primary caregivers who were supporting, in the last six months, individuals diagnosed with one of the previously mentioned chronic diseases. This included caregivers of patients admitted to a tertiary hospital from January 2021 to July of the same year (n = 1081); all participants completed the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF) questionnaire. Caregivers of patients with cancer reported the highest mean level of QoL, followed by diabetes, cardiovascular diseases, then other different diseases (M = 3.80; M = 3.38; M = 3.37; and M = 2.51, respectively). A chi-square test of independence was performed to examine the relationship between the QoL of the four groups and their behaviors (i.e., caregivers’ psychological onuses and physical actions/reactions). The relation between these variables was significant, X² (3, n = 1081) = 8.9, p = 0.001. The Kruskal–Wallis test indicated significant differences among the four groups (p ≤ 0.001). While the overall results of the QoL level of participants were low, a major recommendation of this study was to incorporate a QoL assessment to caregivers of chronically ill patients. Regular psychological and physical health check-ups of caregivers should be mandated in the healthcare system. Research studies should consider investigating and identifying the factors affecting health outcomes and positive developments which have a great impact on the wellbeing of both caregivers and patients on personal, organizational, and national levels. Full article

Since the onset of the COVID-19 pandemic, four SARS-CoV-2 variants of concern have emerged, which have shifted the clinical and epidemiological characteristics of the disease. Of concern is the impact of the emerging variants on COVID-19 vaccination programmes, with vaccination perceived as a key global pandemic control strategy. Variants of concern can reduce the effectiveness of the currently available vaccines, shift herd immunity thresholds, and promote wider vaccine inequities as richer countries hoard vaccines for booster shots for their populations without accounting for the needs of the underdeveloped countries of sub-Saharan Africa. Currently, Africa lags far behind the rest of the world, with most sub-Saharan Africa countries still to reach 50% vaccination of their eligible populations against global herd immunity thresholds of 70–90%. As long as the vaccination gap between sub-Saharan Africa and the rest of the world persists, SARS-CoV-2 will most likely persist as a significant global health threat, with continued emergence of variants of concern. Therefore, strategies to ensure wider reach of different types of vaccines on the African continent are urgently required alongside fighting vaccine hesitancy and logistical barriers to access for the marginalized populations. Sub-Saharan Africa must look for opportunities to manufacture vaccines on the continent and enhance genomic sequencing capacity as key pandemic-control strategies. Full article

The aim of this study is to evaluate factors associated with the subjective well-being (SWB) and suspected depression measured with WHO-5 among German adults during different phases of the COVID-19 pandemic. Survey data were analyzed from the COVID-19 Snapshot Monitoring (COSMO) study, which collected data from 972, 1013, and 973 participants in time point 1 (19–20 May 2020), time point 2 (15–16 September 2020), and time point 3 (21–22 December 2020), respectively. Descriptive analyses and logistic regression analyses to identify the factors associated with suspected depression (WHO-5 ≤ 50) were conducted. Data showed that the mean WHO-5 scores in three time points were 56.17, 57.27, and 53.93, respectively. The risk of suspected depression was increased by about 1.5 times for females, 2.5–3 times among 18–24 year-olds compared to ages above 65 years, 1.5 times for singles, 2 times for those with chronic illnesses, and 2–3 times for people living in poverty. The main study findings show that German adult SWB is lower than pre-pandemic reference values. Special focus should be placed on vulnerable groups, such as females, younger persons, and people living in poverty who are most prone to a reduction in SWB and therefore suspected depression. Full article

Most vulnerable individuals are particularly affected by the COVID-19 pandemic. This study takes place in a large city in France. The aim of this study is to describe the mobility of the homeless population at the beginning of the health crisis and to analyze its impact in terms of COVID-19 prevalence. From June to August 2020 and September to December 2020, 1272 homeless people were invited to be tested for SARS-CoV-2 antibodies and virus and complete questionnaires. Our data show that homeless populations are sociologically different depending on where they live. We show that people that were living on the street were most likely to be relocated to emergency shelters than other inhabitants. Some neighborhoods are points of attraction for homeless people in the city while others emptied during the health crisis, which had consequences for virus circulation. People with a greater number of different dwellings reported became more infected. This first study of the mobility and epidemiology of homeless people in the time of the pandemic provides unique information about mobility mapping, sociological factors of this mobility, mobility at different scales, and epidemiological consequences. We suggest that homeless policies need to be radically transformed since the actual model exposes people to infection in emergency. Full article

An early detection tool for latent COVID-19 infections in oncology staff and patients is essential to prevent outbreaks in a cancer center. (1) Background: In this study, we developed and implemented two early detection tools for the radiotherapy area to identify COVID-19 cases opportunely. (2) Methods: Staff and patients answered a questionnaire (electronic and paper surveys, respectively) with clinical and epidemiological information. The data were collected through two online survey tools: Real-Time Tracking (R-Track) and Summary of Factors (S-Facts). Cut-off values were established according to the algorithm models. SARS-CoV-2 qRT-PCR tests confirmed the positive algorithms individuals. (3) Results: Oncology staff members (n = 142) were tested, and 14% (n = 20) were positives for the R-Track algorithm; 75% (n = 15) were qRT-PCR positive. The S-Facts Algorithm identified 7.75% (n = 11) positive oncology staff members, and 81.82% (n = 9) were qRT-PCR positive. Oncology patients (n = 369) were evaluated, and 1.36% (n = 5) were positive for the Algorithm used. The five patients (100%) were confirmed by qRT-PCR. (4) Conclusions: The proposed early detection tools have proved to be a low-cost and efficient tool in a country where qRT-PCR tests and vaccines are insufficient for the population. Full article

Background: Global COVID-19 outbreaks in early 2020 have burdened health workers, among them surveillance workers who have the responsibility to undertake routine disease surveillance activities. The aim of this study was to describe the quality of the implementation of Indonesia’s Early Warning and Response Alert System (EWARS) for disease surveillance and to measure the burden of disease surveillance reporting quality before and during the COVID-19 epidemic in Indonesia. Methods: A mixed-method approach was used. A total of 38 informants from regional health offices participated in Focus Group Discussion (FGD) and In-Depth Interview (IDI) for informants from Ministry of Health. The FGD and IDI were conducted using online video communication. Yearly completeness and timeliness of reporting of 34 provinces were collected from the application. Qualitative data were analyzed thematically, and quantitative data were analyzed descriptively. Results: Major implementation gaps were found in poorly distributed human resources and regional infrastructure inequity. National reporting from 2017–2019 showed an increasing trend of completeness (55%, 64%, and 75%, respectively) and timeliness (55%, 64%, and 75%, respectively). However, the quality of the reporting dropped to 53% and 34% in 2020 concomitant with the SARS-CoV2 epidemic. Conclusions: Report completeness and timeliness are likely related to regional infrastructure inequity and the COVID-19 epidemic. It is recommended to increase report capacities with an automatic EWARS application linked systems in hospitals and laboratories. Full article

The SARS-CoV-2 health emergency has led to a restructuring of health care systems and the reassignment of medical specialists from their usual duties to attend COVID-19 patients. The aim of this paper is to describe the levels of insomnia, anxiety, depression, and the impact on quality of life of doctors who were on the frontline of COVID-19 during the first two waves of the pandemic. Self-report surveys were conducted on said physicians during both waves, with 83 and 61 responses in the first and second waves, respectively. The reported presence of insomnia was frequent (71.8%), although it decreased in the second survey. Anxiety was moderate, decreasing from 57.1% to 43.1% between measurements. Overall, depression rates decreased between the two surveys. Substance use was found to have an indirect correlation with personal and professional satisfaction. In the light of the unforeseeable evolution of the pandemic and the medium- to long-term repercussions on professionals, we believe the adaptation of health resources is crucial to meet the new unpredictable mental health needs of this group. Full article

The fear of the new coronavirus infection has driven many non-COVID-19 patients away from essential healthcare. Our study aimed to investigate the perception of risk and feelings of danger for the contagion in a sample of Italian psychiatric patients. We conducted a cross-sectional observational study during the second wave of the COVID-19 pandemic and the lockdown in Italy. The risk perception and risk-related variables were assessed in a sample of 150 consecutive patients with a previous diagnosis of major depression (50), bipolar I disorder (50), and schizophrenia seeking ambulatory care using a questionnaire previously administered to the general Italian population. Our results showed that patients were more concerned about economic, psychological, and interpersonal consequences of COVID-19 pandemic, rather than about their own health. At the multiple regression analysis, the likelihood of COVID-19 resolution was positively influenced by the diagnosis of schizophrenia, the increased perceived effectiveness, and the presence of positive emotions. Indeed, positive emotions and uncertainty positively influenced interpersonal risk. Our study highlights the need to provide more support to psychiatric patients during emergency events to prevent them from engaging in risky behaviors. Full article

This study investigates the changes in prevalence estimates, severity, and risk factors of anxiety among healthcare workers (HCWs) over the first year of the COVID-19 pandemic. A survey was distributed among HCWs using snowball sampling, collecting their socio-demographics, occupation, and anxiety symptoms as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. It was distributed one month after the pandemic’s onset in Jordan between 15 and 30 April 2020 (onset group) and after one year between 15 and 30 March 2021 (one-year group). A total of 422 HCWs were included (211 in each group). The one-year group reported a higher risk of GAD (30.8% vs. 16.6%; p = 0.001), a higher mean (SD) GAD-7 score (7.94 (5.29) vs. 6.15 (4.15); p < 0.001), and more severe symptoms (p = 0.003). Univariate analyses showed that participants who were younger, women, unmarried, had lower monthly incomes, underwent testing for COVID-19, had higher contact with COVID-19 patients, did not receive special education, and were unsatisfied with the institutional COVID-19 preparedness scored higher on the GAD-7 scale and had more severe symptoms than their counterparts in both groups. Unlike the onset group, occupation as a physician, COVID-19 infection history, and perception of remarkable changes in work were associated with higher anxiety scores and severity among the one-year group. The COVID-19 vaccine was a relative protective action. Logistic regression analyses showed that the female gender was a risk factor for developing GAD at the pandemic onset, while poor satisfaction with institutional preparedness was a significant GAD risk factor in the one-year group. Low monthly income and lack of special education were the shared risk factors for GAD in both groups. This study reveals a significant rise in anxiety among HCWs over a year of the COVID-19 pandemic and shows the vulnerable sub-groups who likely need psychological interventions. Full article

Background: The SARS-CoV-2 pandemic has led most countries to take restrictive measures affecting social activities and individual freedoms to limit viral transmission. It was shown that practical, motivational and social barriers impact on adherence to the isolation and social distancing measures advocated by the health authorities. The purpose of this study was to develop and validate a COVID-19 Knowledges and Behavior Questionnaire adapted to a teenager and adult French population. Methods: CoVQuest-CC was developed by a multidisciplinary team made of infectious diseases physicians, medical virologist, specialists of infectious control, experts of the questionnaires methodology, experts in public health and prevention, and statisticians. CoVQuest-CC was responded to by a big cohort from the general population during their participation in a massive SARS-CoV-2 screening campaign in 2021 in Saint-Etienne, France. Results: The confirmatory factorial analysis yielded good results (CFI = 0.94, TLI = 0.94, RMSEA = 0.04), and confirmed the five-dimensional structure of the questionnaire. Each dimension had a satisfying internal consistency, with Cronbach alphas of 0.83, 0.71, 0.65, 0.72 and 0.83 for transmission knowledge, barrier gesture respect, tests acceptability, home isolation possibility and test practicability, respectively. Conclusions: According to our knowledge, CoVQuest-CC is the first validated, consistent and reliable self-administrated French-specific questionnaire investigating the general population’s knowledge and attitudes towards COVID-19. It shows acceptable psychometric properties and can be use by Public Health teams or caregivers for public health and research purposes. Trial Registration: The study protocol was approved by the IRB ILE-DE-FRANCE 1 (No. IRB: I ORG0009918). All participants were given written and verbal information about the study and gave informed consent to participate. ClinicalTrials.gov identifier (NCT number): NCT04859023. Full article

In December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of coronavirus disease 2019 (COVID-19), emerged in Wuhan, China. Several variants of concern (VOCs) have been identified so far. Recently, the B.1.1.529 (Omicron) variant of SARS-CoV-2 spread rapidly worldwide. We describe the first case of the Omicron genetic lineage BA.1 in our region. The patient is a physician who traveled to Johannesburg (South Africa) and returned to Reggio Calabria (Italy). He underwent a SARS-CoV-2 screening before leaving—a required procedure where travelers present a negative PCR test one-day prior to departing. Three days after arriving in Italy, he started experiencing cold symptoms. Clinically, he was without fever or severe respiratory symptoms and reported suffering from a cold and sore throat. The nasopharyngeal swab specimen was tested by TaqPath COVID-19 RT-PCR and sequenced by Sanger sequencing, and next-generation sequencing (NGS) data were processed with their relative software. A peculiar drop-off of the S gene was obtained with TaqPath COVID-19 RT-PCR. S gene mutations indicative of the Omicron variant were obtained with both sequencing methods, pointing out 17 mutations in the 29 recognized by Sanger and the 28 recognized by NGS. Full article

By the end of spring (31 May), the COVID-19 death rate was remarkably unevenly distributed across the countries in Europe. While the risk of COVID-19 mortality is known to increase with age, age-specific COVID-19 death rates across Europe were similarly unevenly distributed. To explain these mortality distributions, we present a simple model where more favorable survival environments promote longevity and the accumulation of health frailty among the elderly while less favorable survival environments induce a mortality selection process that results in lower health frailty. Because the age-related conditions of frailty render the elderly less resistant to SARS-CoV-2, pre-existing survival environments may be non-obviously positively related to the COVID-19 death rate. To quantify the survival environment parameter of our model, we leveraged historic cohort- and period-based age-specific probabilities of death and life expectancies at age 65 across Europe. All variables are significantly correlated with indicators of frailty like elderly dependence on others for personal and household care for a subset of European countries. With respect to COVID-19 death rates, we find significant positive relationships between our survival indicators and COVID-19 death rates across Europe, a result that is robust to statistical control for the capacity of a healthcare system to treat and survive infected persons, the timing and stringency of non-pharmaceutical interventions, population density, age structure, case rates and the volume of inbound international travelers, among other factors. To address possible concerns over reporting heterogeneity across countries, we show that results are robust to the substitution of our response variable for a measure of cumulative excess mortality. Also consistent with the intuition of our model, we also show a strong negative association between age-specific COVID-19 death rates and pre-existing all-cause age-specific mortality rates for a subset of European countries. Overall, results support the notion that variation in pre-existing frailty, resulting from heterogeneous survival environments, partially accounts for striking differences in COVID-19 death during the first wave of the pandemic. Full article

Coronavirus disease 19 (COVID-19) is an ongoing global pandemic that is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severity and mortality rates of COVID-19 are affected by several factors, such as respiratory diseases, diabetes, and hypertension. Bacterial coinfections are another factor that could contribute to the severity of COVID-19. Limited studies have investigated morbidity and mortality due to microbial coinfections in COVID-19 patients. Here, we retrospectively studied the effects of bacterial coinfections on intensive care unit (ICU)-admitted patients with COVID-19 in Asir province, Saudi Arabia. We analyzed electronic medical records of hospitalized patients with COVID-19 at Asir Central Hospital. A total of 34 patients were included, and the clinical data of 16 patients infected with SARS-CoV-2 only and 18 patients coinfected with SARS-CoV-2 and bacterial infections were analyzed in our study. Our data showed that the length of stay at the hospital for patients infected with both SARS-CoV-2 and bacterial infection was 35.2 days, compared to 16.2 days for patients infected with only SARS-CoV-2 (p = 0.0001). In addition, higher mortality rates were associated with patients in the coinfection group compared to the SARS-CoV-2-only infected group (50% vs. 18.7%, respectively). The study also showed that gram-negative bacteria are the most commonly isolated bacteria in COVID-19 patients. To conclude, this study found that individuals with COVID-19 who presented with bacterial infections are at higher risk for a longer stay at the hospital and potentially death. Further studies with a larger population are warranted to better understand the clinical outcomes of COVID-19 with bacterial infections. Full article

Introduction: The first wave of the COVID-19 pandemic resulted in the closure of all Polish medical universities. Simultaneously, due to staff shortages and the Polish health-care system being seriously challenged, many students were eager to contribute to the fight against the outbreak. This study explores medial student volunteers’ (MSV) perspectives and their lived experiences during the COVID-19 pandemic in Poland. Material and Methods: Semi-structured interviews were conducted with twenty-one students. Results: A total of seven major themes emerged from the interviews: 1. students’ reactions to the COVID-19 pandemic, 2. students’ experiences of the outbreak, 3. motivations for volunteering, 4. students’ perceptions of the COVID-19 volunteering, 5. organization of students’ volunteering, 6. benefits and costs of volunteering during COVID-19, and 7. social perception of MSVs. Although students volunteering was an example of civic responsibility and created new learning opportunities, many students felt unprepared for the pandemic, lacked social skills and access to psychological support, and were the target of stigmatization and discrimination. Discussion: Because during the first wave of the COVID-19 pandemic medical universities were closed and classes were held online, students’ volunteering became an important part of service learning and created an opportunity for education. Consequently, while it benefited students, patients and the healthcare system, students’ involvement reinforced such important values of medical ethos as: altruism, public service, and (professional) solidarity. However, some systemic approach should be undertaken that would prepare students better for future crises. Full article

The data on seroprevalence of anti-SARS-CoV-2 antibodies in Kazakhstani population are non-existent, but are needed for planning of public health interventions targeted to COVID-19 containment. The aim of the study was to estimate the seropositivity of SARS-CoV-2 infection in the Kazakhstani population from 2020 to 2021. We relied on the data obtained from the results from “IN VITRO” laboratories of enzyme-linked immunosorbent assays for class G immunoglobulins (IgG) and class M (IgM) to SARS-CoV-2. The association of COVID-19 seropositivity was assessed in relation to age, gender, and region of residence. Additionally, we related the monitoring of longitudinal seropositivity with COVID-19 statistics obtained from Our World in Data. The total numbers of tests were 68,732 for SARS-CoV-2 IgM and 85,346 for IgG, of which 22% and 63% were positive, respectively. The highest rates of positive anti-SARS-CoV-2 IgM results were seen during July/August 2020. The rate of IgM seropositivity was the lowest on 25 October 2020 (2%). The lowest daily rate of anti-SARS-CoV-2 IgG was 17% (13 December 2020), while the peak of IgG seropositivity was seen on 6 June 2021 (84%). A longitudinal serological study should be envisaged to facilitate understanding of the dynamics of the epidemiological situation and to forecast future scenarios. Full article

(1) Background: Burnout syndrome (BOS) is defined as a psychological state of physical and mental fatigue associated with work. The COVID-19 pandemic greatly impacted the physical and mental wellbeing of health professionals. The objective of this work was to determine the impact on personnel, monitoring the frequency of BOS throughout the pandemic. (2) Methods: The Maslach Burnout Inventory (MBI) was self-applied in four periods of the pandemic according to sociodemographic and employment characteristics. In this study, all hospital personnel were included; the association of BOS with sex, age, type of participant (civilian or military), military rank and profession was analyzed. (3) Results: The frequency of BOS was 2.4% (start of the pandemic), 7.9% (peak of the first wave), 3.7% (end of the first wave) and 3.6% (peak of the third wave). Emotional exhaustion (EE) was the most affected factor, and the groups most affected were men under 30 years of age, civilians, chiefs and doctors, especially undergraduate medical doctors and specialty resident doctors, and nursing personnel were less affected. (4) Conclusions: The low BOS levels show that the containment measures and military training implemented by the hospital authorities were effective, although the chief personnel were more affected in the first wave. It is probable that this combination allowed the containment of BOS, which was not observed in civilians. Full article

As aging causes challenges in several countries globally, more and more people are suffering from bad health conditions. Nowadays, COVID-19 causes many problems—and one of the root causes of these problems is the isolation of people from each other. The aim of our article is to investigate the effects of COVID-19 on people’s physical activity. Physical activity is strongly correlated with health status and health preservation is very important to minimize the negative effects of the pandemic. In order to investigate this topic, we prepared an extended literature review, citing the most important sources of COVID-related health-preservation issues. Our results showed that the negative economic effects of the coronavirus pandemic have caused a decrease in physical activities in several cases. A reduction in possible physical activities has a potential negative effect on the life expectancies of elderly people. In order to underline the importance of physical activities, we prepared an extended literature review, aiming to summarize the available knowledge related to COVID-19. As a conclusion we recommend to strengthen, maintain, and develop available sporting possibilities for people. The most important of these recommendations is the development of physical activities that are available for free. Full article

This review sought to understand what is currently known about how the ongoing COVID-19 pandemic and restrictive measures are affecting food security and equality between women and men in all of Africa. A review of both the academic and grey literature was performed by following PRISMA guidelines. Results showed that a general disparity exists in gender-inclusive/-sensitive research. Most reported increases in inequalities between women and men were predictive only. Evidence-based articles found were mainly conducted online and target tertiary educated populations, among which neutral effects were found. A general lack of disaggregated data (e.g., women vs. men) was found to be a barrier in gaining a complete understanding of the situation on-the-ground. Furthermore, documents reporting on food security seldom included all four pillars (i.e., availability, access, utility, stability) in their analysis despite the reciprocal connection between them all. Within household disparities and the impacts on power relationships within households were also overlooked. Future studies must focus on rural settings and gender disaggregated interview processes as well as consider all pillars of food security. Doing so will help to better inform governments and humanitarian groups leading to better designed policies and social supports that target where they are most needed. Full article

The SARS-CoV-2 virus emergency prompted unprecedented safety measures, which were accepted by the population of each country to different degrees, for example, with more or less willingness to use personal protective elements (PPEs). We have developed a mathematical model of the contagion process, based on chilean data, to assess the interaction between biological factors (such as the impact of vaccination) and behavioral factors (such as the population’s perception of risk). The model clearly shows that the virus spreads through three waves of contagion, the second being the most prominent, regardless of any alteration in the variables taken into account, which only affect the overall number of people infected. By considering alternative values of the risk perception variable and examining the different possible scenarios, we have also found that the less reaction to change the population has (and the lower the disposition to use PPEs), the higher the waves of contagion and the death toll are. Full article

This paper presents an efficiency assessment of social distancing as an internationally adopted measure to tackle the COVID-19 pandemic in 2020. The simple framework adopted for the assessment accounts for two kinds of costs that a society may bear in a pandemic. The first is welfare loss due to infection and its consequences, and the second is welfare loss resulting from a slowdown in economic transactions. We call the first infection costs, and the second economic costs, for convenience in the paper. Efficient social distancing should minimize the sum of these costs. Infection costs are likely to decrease with social distancing at a decreasing rate as intensified social distancing eases pressure on scarce resources for intensive care. Economic costs on the other hand are likely to increase at an increasing rate as extreme slowdown in economic life may entail job losses and business failures. The resulting U-shaped total costs curve implies parity between infection costs and economic costs as a necessary condition for efficiency. In a simplified implementation of the framework, we approximate infection costs by the value of (statistical) lives lost, and economic costs by the gap between the actual gross domestic product (GDP) in 2020 and the potential GDP as predicted by the within-country growth trend during the preceding decade. The results for 158 countries suggest that the global community perhaps reacted with overly strict social distancing measures. The results for the subgroup of high-income countries, however, suggest that these countries were more successful in maintaining the parity between infection and economic costs. Full article

Background: The COVID-19 pandemic is a major challenge for health systems, citizens and policymakers worldwide. It is not known how many people are affected with longer term sequelae after acute COVID-19 and a wide range of prevalence estimates have been reported with a high heterogeneity between studies. Methods: We designed a cross-sectional study to estimate the prevalence of post COVID-19 conditions in a community setting. We selected a random sample of 579 individuals from three different primary health care centers and collected information on symptoms through a standardized questionnaire. Results: Our main study finding was an overall population prevalence of 14.34% (95% CI 11.58–17.46%) of post COVID-19. Only 9% of patients were hospitalized in our study. Prevalence was higher in women than men (15.63% versus 13.06%) and the most frequent persistent symptoms were fatigue (44.6%), smell impairment (27.7%) and dyspnea (24.09%). Conclusions: The prevalence of post COVID-19 condition was lower than expected according to other studies published in the literature. The prevalence was higher in women than men, and the most frequent persistent symptoms were fatigue, smell impairment, and dyspnea. Full article

The purpose of this study was to identify the latent class for changes in health behavior due to COVID-19, reveal the characteristics of participants by type, and identify predictive factors for these types. The participants of this study were office workers between the ages of 40 and 60 and secondary data from the 2020 Community Health Survey of G city was utilized. Latent class analysis was performed on physical activities such as walking and exercise, eating fast food or carbonated drinks, eating delivered food, drinking alcohol, and smoking. Three types of health behavior changes due to COVID-19 were found: (1) decrease in all health behavior type, (2) increase in fast food and delivered food type, and (3) increase in smoking maintenance type. Second, the variables predicting the three types after controlling for general characteristics were health problems, social distancing among the COVID-19 quarantine rules, refraining from going out, and meeting with friends and neighbors and had an impact on COVID-19 life. It is necessary to strengthen non-face-to-face health promotion activities along with quarantine rules for COVID-19. In addition, there is a need for a health management plan for people with non-visible risk factors such as obesity and high blood pressure. Full article

Despite the proximity of both countries, Danes and Germans differ in the level of trust in their government. This may play a role with respect to the disruptive impact of the COVID-19 pandemic on university students. This study investigated the association between trust in governmental regulations, trust in university regulations, risk perceptions, and academic frustration among Danish and German students. As part of the COVID-19 International Student Well-being Study, an online survey was distributed among university students in participating European and non-European universities. In Denmark, 2945 students and Germany, 8725 students responded to the questionnaire between May and July 2020. Students from both countries reported approximately the same level of academic frustration concerning their progress and quality of education. However, German students perceived a higher risk of contracting SARS-CoV-2 compared to Danish respondents. Danish students showed higher trust in their government’s COVID-19 regulations than German students. Lower trust in government and university COVID-19 regulations and higher risk perception were associated with higher academic frustration. These results indicate that the level of trust in COVID-19 regulations might have an impact the overall frustration of students regarding their study conditions. Full article

Atopic dermatitis (AD) can have a significantly negative impact on quality of life (QoL). The impact of coronavirus disease 2019 (COVID-19) on the AD population is not yet well established. The study comprised 195 patients with diagnosed AD who were asked about their cognitive and preventive behaviors regarding COVID-19 and the accessibility of medical support, including online consultations. Moreover, the patients responded to the self-reported Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS). Most of the patients were worried about being infected with COVID-19. Most of the patients believed that people suffering from skin disease were more prone to be infected with COVID-19 compared with the general population. Most the patients negatively assessed the availability of dermatological treatment during the pandemic. Furthermore, 66.1% of the patients declared using telemedicine. Nearly 50% of patients were discontented with telemedicine, and 1/3 of the patients did not mind the use of telemedicine. AD during the COVID-19 pandemic was associated with a lower overall health rating and life satisfaction and impaired QoL related to mental health in a Polish population. These results provide original information that can be applied in dermatologic patient screenings to evaluate the state of depression and anxiety during the epidemic period. Full article

In 2020, the first case of COVID-19 was confirmed in Korea, and social distancing was implemented to prevent its spread. This reduced the movement of people, and changes in air quality were expected owing to reduced emissions. In the present paper, the impact of traffic volume change caused by COVID-19 on air quality in Seoul, Korea, is examined. Two regression analyses were performed using the generalized additive model (GAM), assuming a Gaussian distribution; the relationships between (1) the number of confirmed COVID-19 cases in 2020–2021 and the rate of change in the traffic volume in Seoul, and (2) the traffic volume and the rate of change in the air quality in Seoul from 2016 to 2019 were analyzed. The regression results show that traffic decreased by 0.00431% per COVID-19 case; when traffic fell by 1%, the PM₁₀, PM_2.5, CO, NO₂, O₃, and SO₂ concentrations fell by 0.48%, 0.94%, 0.39%, 0.74%, 0.16%, and −0.01%, respectively. This mechanism accounts for air quality improvements in PM₁₀, PM_2.5, CO, NO₂, and O₃ in Seoul during 2020–2021. From these results, the majority of the reduction in pollutant concentrations in 2020–2021 appears to be the result of a long-term declining trend rather than COVID-19. Full article

Introduction: Healthcare workers experience a significant risk of exposure to and infection from SARS-CoV-2, COVID-19. Nonetheless, little research has focused on physicians’ use of personal protective equipment (PPE), their concerns about becoming infected and their social distancing maneuvers. Methods: All staff physicians at Advocate Lutheran General Hospital were invited to participate. Their COVID-19 IgG antibody level was measured and an online questionnaire was completed. The questionnaire assessed the risk of COVID-19 exposure, PPE usage, concern for contracting COVID-19, the performance of high-risk procedures, work in high-risk settings, and social distancing practices. Testing was performed in September (T0), and December 2020 (T1) at the height of the global pandemic. Results: A total of 481 (26.7%) of 1800 AGLH physicians were enrolled at T0 and 458 (95% of the original group) at T1. A total of 21 (4.3%) and 39 (8.5%) participants had antibodies at T0 and T1. A total of 63 (13.8%) worked in high-risk settings and 111 (24.2%) performed high-risk procedures. Participants working in high-risk settings had increased exposure to COVID-19 infected patients (OR = 4.464 CI = 2.522–8.459, p < 0.001). Participants were highly adherent to the use of PPE and social distancing practices including mask-wearing in public (86%, 82.1%), avoiding crowds (85.1%, 85.6%), six feet distancing (83.8%, 83.4%), and avoiding public transportation (78%, 83.8%). A total of 251 (55.4%) participants expressed moderate to extreme concern about becoming infected with COVID-19. Conclusions and Relevance: Among a group of community physicians, consistent PPE use and social distancing practices were common. These practices were associated with a low level of initial acquisition of COVID-19 infections and a relatively low longitudinal risk of infection. Full article

The severe acute respiratory syndrome coronavirus 2 disease (SARS-CoV-2) is the most severe manifestation of the coronavirus disease 2019 (COVID-19) pandemic. Accruing evidence indicates that the COVID-19 pandemic may have profound deleterious neurological, psychiatric, and psychological outcomes. The number of systematic reviews (SRs) and meta-analyses (MAs) on this topic has grown exponentially. This protocol aims to synthesize all evidence from SRs and MAs on the associations between the COVID-19 pandemic and neuropsychiatric outcomes. The following electronic databases will be systematically searched from inception up to 15 January 2022: PubMed, Embase, APA PsycINFO, and Cochrane Reviews. An umbrella review (UR) of SRs and MAs of observational studies will be conducted. SRs and/or MAs of observational studies examining any direct or indirect association of COVID-19 with the neuropsychiatric outcomes will be deemed eligible for potential inclusion in this UR. The direct associations include the impact on the (1) prognosis of COVID-19 and (2) neuropsychiatric sequelae after COVID-19 infection. The indirect associations include the influence of the COVID-19 pandemic on the (1) treatments and (2) outcomes of neurological and psychiatric conditions associated with the COVID-19 pandemic. Full article

Facing the worldwide coronavirus disease 2019 (COVID-19) pandemic, a new fitting method (QDF, quasi-distribution fitting) which can be used to analyze the data of COVID-19 is developed based on piecewise quasi-uniform B-spline curves. For any given country or district, it simulates the distribution histogram data which is made from the daily confirmed cases (or the other data including daily recovery cases and daily fatality cases) of COVID-19 with piecewise quasi-uniform B-spline curves. After using the area normalization method, the fitting curves could be regarded as a kind of probability density function (PDF): its mathematical expectation and the variance could be used to analyze the situation of the coronavirus pandemic. Numerical experiments based on the data of certain countries have indicated that the QDF method demonstrates the intrinsic characteristics of COVID-19 data of a given country or district, and because the interval of data used in this paper is over one year (500 days), it reveals the fact that after the multi-wave transmission of the coronavirus, the case fatality rate has obviously declined. These results show that the QDF method is effective and feasible as an appraisal method. Full article

The coronavirus disease of 2019 (COVID-19) pandemic is currently a global challenge, with 210 countries, including Indonesia, seeking to minimize its spread. Therefore, this study aims to determine the spatiotemporal spread pattern of this virus in Surabaya using various data on confirmed cases from 28 April to 26 October 2021. It also aims to determine the relationship between pollutant parameters, such as carbon monoxide (CO), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and ozone (O₃), as well as the government’s high social restrictions policy in Java-Bali. Several methods, such as the weighted mean center, directional distribution, Getis–Ord Gi*, Moran’s I, and geographically weighted regression, were used to identify the spatial spread pattern of the virus. The weighted mean center indicated that the epicenter location of the outbreak moved randomly. The directional distribution demonstrated a decrease of 21 km² at the end of the study phase, which proved that its spread has significantly reduced in Surabaya. Meanwhile, the Getis–Ord Gi* results demonstrated that the eastern and southern parts of the study region were highly infected. Moran’s I demonstrate that COVID-19 cases clustered during the spike. The geographically weighted regression model indicated a number of influence zones in the northeast, northwest, and a few in the southwest parts at the peak of R² 0.55. The relationship between COVID-19 cases and air pollution parameters proved that people living at the outbreak’s center have low pollution levels due to lockdown. Furthermore, the lockdown policy reduced CO, NO₂, SO₂, and O₃. In addition, increase in air pollutants; namely, NO₂, CO, SO₂ and O₃, was recorded after 7 weeks of lockdown implementation (started from 18 August). Full article

Unselected data of nationwide studies of hospitalized patients with COVID-19 are still sparse, but these data are of outstanding interest to avoid exceeding hospital capacities and overloading national healthcare systems. Thus, we sought to analyze seasonal/regional trends, predictors of in-hospital case-fatality, and mechanical ventilation (MV) in patients with COVID-19 in Germany. We used the German nationwide inpatient samples to analyze all hospitalized patients with a confirmed COVID-19 diagnosis in Germany between 1 January and 31 December in 2020. We analyzed data of 176,137 hospitalizations of patients with confirmed COVID-19-infection. Among those, 31,607 (17.9%) died, whereby in-hospital case-fatality grew exponentially with age. Overall, age ≥ 70 years (OR 5.91, 95%CI 5.70–6.13, p < 0.001), pneumonia (OR 4.58, 95%CI 4.42–4.74, p < 0.001) and acute respiratory distress syndrome (OR 8.51, 95%CI 8.12–8.92, p < 0.001) were strong predictors of in-hospital death. Most COVID-19 patients were treated in hospitals in urban areas (n = 92,971) associated with the lowest case-fatality (17.5%), as compared to hospitals in suburban (18.3%) or rural areas (18.8%). MV demand was highest in November/December 2020 (32.3%, 20.3%) in patients between the 6th and 8th age decade. In the first age decade, 78 of 1861 children (4.2%) with COVID-19-infection were treated with MV, and five of them died (0.3%). The results of our study indicate seasonal and regional variations concerning the number of COVID-19 patients, necessity of MV, and case fatality in Germany. These findings may help to ensure the flexible allocation of intensive care (human) resources, which is essential for managing enormous societal challenges worldwide to avoid overloaded regional healthcare systems. Full article

Objective: The aim of this current study was to identify the prevalence of burnout manifestation in a sample recruited from the emergency department of a hospital. Moreover, we aimed to assess the role of professional experience, age, and the professional category in shaping burnout manifestations. Results: The results showed that higher proportions of burnout symptoms were reported by resident physicians, nurses, and physicians whereas lower proportions were encountered in the orderly group. Moreover, the results revealed a significant difference between men and women in the nurse group concerning depersonalization; men presented higher levels of depersonalization compared with women. Concerning emotional exhaustion and depersonalization, multiple comparisons showed differences among the professional categories. Conclusions: The implications of these results for preventing burnout syndrome are discussed. Full article

Aging of the population has led to an increasing number of caregivers. While research has been conducted on caregiver experiences, less is known about the experiences of African American males in the U.S. This qualitative descriptive study describes the experiences of 13 African American men who acted as caregivers to adult chronically ill or debilitated loved ones, the majority of whom provided care during the COVID-19 pandemic. The revised Sociocultural Stress and Coping Model (R-SSCM) guided this study. Individual interviews were conducted via the Zoom application. Content analysis revealed four themes: (1) “My time to take the reins”, (2) “It’s a male thang”, (3) “Caring amid a pandemic”, and (4) “Effects of the caregiver’s journey”. This study’s findings in relation to the literature provide overdue attention to the African American male caregiving experience, especially in relation to the COVID-19 pandemic. The implications of our findings include the need for more culturally congruent support services for African American male caregivers, as well as increased efforts to encourage trust in the healthcare system—especially in relation to vaccination for the SARS-CoV-2 virus. Full article

(1) Background: Current COVID-19 research has mainly focused on negative outcomes associated with fear of the pandemic with the examination of potentially positive outcomes remaining underexplored. Based on the dual-factor model of mental health, which postulates positive and negative dimensions, we assessed the influence of COVID-19 fear on both negative and positive mental health outcomes and examined the mediational role of coping strategies. (2) Methods: A convenience sample of 231 respondents participated in an online survey reporting on measures of pandemic fear (SFS), distress (HADS), post-traumatic growth (PTGI) and individual differences in terms of coping strategies (CSI-SF). (3) Results: Respondents’ main concerns related with the pandemic highlighted the interpersonal and social dimensions implicated in fear of COVID-19. As expected, fear of the pandemic was associated not just with negative but also positive outcomes, while different coping strategies played a role in determining such effects. More specifically, disengagement coping mediated the effects of fear on anxiety and depression, whereas engagement coping was the only mediator of the relationship between COVID-19 fear and post-traumatic growth. (4) Conclusions: Approaches to promote psychological wellbeing in the context of the COVID-19 pandemic should on the one hand be sensitive to the needs of the more vulnerable population groups, while on the other leverage existing resources to harness the potential for growth. Strengthening engagement coping in the context of fears triggered by the pandemic may constitute a valuable target to protect against negative and optimize positive mental health outcomes in the general population. Full article

(1) Background: COVID-19 has had psychological impacts, particularly anxiety, depression, anger, and suicidal ideation, on the world’s populace, including young persons who were prone to mental health disorders even before the pandemic. We described the psychological impacts of COVID-19 among emerging adults aged 18–30 years in Saudi Arabia. (2) Methods: A cross-sectional survey was done among a randomly sampled population in Saudi Arabia between July 2020 and May 2021 using the DSM-5 Self-rated Level 1 Cross-Cutting Symptom Measure and Ask Suicide Questionnaire. Logistic regression was used to assess participant characteristics associated with reporting symptoms of mental disorders under each of the 13 domains that would warrant further investigation. (3) Results: Approximately, 91% of participants experienced different mental health symptoms; these participants are more likely to be young, female students, those who had a history of being diagnosed with a mental disorder, and those diagnosed or treated for COVID-19. (4) Conclusion: This study strongly showed an increased prevalence of mental health symptoms among young persons during the COVID-19 pandemic. Addressing the mental health burden among young persons in time using simple, self-administered screening tools linked to interventions will prevent dire consequences in the future. Full article

The onset of COVID-19 has escalated healthcare workers’ psychological distress. Multiple factors, including prolonged exposure to COVID-19 patients, irregular working hours, and workload, have substantially contributed to stress and burnout among healthcare workers. To explore the impact of COVID-19 on healthcare workers, our study compares the job stress, social support, and intention to leave the job among healthcare workers working in a pandemic (H_P) and a non-pandemic hospital (H_NP) in Turkey during the pandemic. The cross-sectional, paper-based survey involved 403 healthcare workers including physicians, registered nurses, health technicians, and auxiliary staff across two hospitals from 1 September 2020 to 31 November 2020. The findings indicate a significant impact of ‘Job stress’ on ‘Intent to leave’ job among participants in the H_P. We noted that ‘intent to leave’ and ‘job stress’ were significantly higher among the H_P healthcare workers than those working in the H_NP, respectively. However, workers’ ‘social support’ was significantly lower in the H_P. Healthcare workers, during COVID-19, face several hurdles such as job stress, reduced social support, and excessive workload, all of which are potential factors influencing a care provider’s intent to leave the job. Full article

The aim of this cross-national longitudinal study was to evaluate the prevalence and sociodemographic predictors of mental health indicators (coronavirus-related post-traumatic stress disorder (PTSD), perceived stress, anxiety, depression, and suicidal/self-harm ideation) during the coronavirus disease-2019 (COVID-19) pandemic in a three-month period among representative samples of young adults from Germany, Israel, Poland, and Slovenia. The participants were 1724 young adults between 20 and 40 years of age (M = 30.74, SD = 5.74). The first measurement (T1) was in February 2021 and the second (T2) was in May–June 2021. The samples were representative of young adults in each country: Germany (n = 418, 24%), Israel (n = 428, 25%), Poland (n = 446, 26%), and Slovenia (n = 431, 25%). Women constituted 54% (n = 935) of the total sample. The mental health indicators were coronavirus-related PTSD measured by PCL-S, perceived stress (PSS-10), anxiety (GAD-7), depression (PHQ-8), and suicidal ideation (PHQ-9). The participants completed an online questionnaire that also included a physical activity (PA) measurement and sociodemographic variables. The Pearson’s χ² independence test was used for prevalence comparisons and McNemar’s χ² was used for longitudinal changes, whereas generalized estimating equations (GEEs) were used for the predictors of change in mental health indices. Significant differences were found between countries in each mental health dimension in both T1 and T2, with moderate effect sizes for coronavirus-related PTSD and suicidal ideation. The highest rate of PTSD and depression risk was in Germany, the highest rates of stress and anxiety risk were in Poland, and there was insufficient PA in Slovenia. The anxiety, depression, and suicidal ideation rates were the lowest in Israel and Slovenia. Israeli participants reported the lowest rate of coronavirus-related PTSD among the other countries in T1 and T2. Significant decreases in coronavirus-related PTSD and stress were observed during T2 compared to T1 in the total sample. There was no change in the risk of anxiety, depression, or suicidal ideation. Being single was a predictor of changes in all mental health indices. Having children was a risk factor for coronavirus-related PTSD and high stress. Being a student was a predictor of depression and suicidal ideation. A younger age (20–29 years) predicted coronavirus-related PTSD risk, whereas female gender predicted high stress. The mental health indices improved over time or remained stable. The groups that are most prone to mental health problems were single individuals, students, and parents in young adulthood across all countries. Future intervention programs for young adults should consider these factors when prioritizing, planning, and implementing such programs. Full article

COVID-19 has posed massive challenges related to health, economy, and the social fabric of the entire human population. To curb the spread of the virus, the Government of Pakistan initiated a vaccination campaign against COVID-19. The objective of this research was to assess the factors associated with COVID-19 vaccine acceptance or hesitancy. The data were collected telephonically using a cross-sectional survey design through a close-ended structured questionnaire from a sample of 1325 vaccinated and non-vaccinated individuals with a response rate of 38%. SPSS v. 26 was used to analyze the data. The study revealed that 73% of the respondents were male, half in the 40–49 age group, 78% living in urban areas, and 45% had a monthly income between 20,001–50,000 Pakistani rupees. People felt reluctant to get vaccinated because of myths and misinformation related to it. The socio-demographic factors including male, age 60–69, middle or higher level of education, marital status, currently employed, from middle socio-economic status, living in urban areas, high access to mass media, history of influenza vaccination, physical activity, and perceived good health status were significantly associated with COVID-19 vaccination uptake. Concerted efforts are needed to achieve vaccine targets for the broader population through understanding and identifying barriers to vaccination. Full article

Digital technologies have been extensively employed in response to the SARS-CoV-2 pandemic worldwide. This study describes the methodology of the two-phase internet-based EPICOVID19 survey, and the characteristics of the adult volunteer respondents who lived in Italy during the first (April–May 2020) and the second wave (January–February 2021) of the epidemic. Validated scales and ad hoc questionnaires were used to collect socio-demographic, medical and behavioural characteristics, as well as information on COVID-19. Among those who provided email addresses during phase I (105,355), 41,473 participated in phase II (mean age 50.7 years ± 13.5 SD, 60.6% females). After a median follow-up of ten months, 52.8% had undergone nasopharyngeal swab (NPS) testing and 13.2% had a positive result. More than 40% had undergone serological test (ST) and 11.9% were positive. Out of the 2073 participants with at least one positive ST, 72.8% had only negative results from NPS or never performed it. These results indicate that a large fraction of individuals remained undiagnosed, possibly contributing to the spread of the virus in the community. Participatory online surveys offer a unique opportunity to collect relevant data at individual level from large samples during confinement. Full article

While the COVID-19 pandemic is ongoing, early outcome studies indicate severe and pervasive global effects of the pandemic and associated measures to prevent the spread of the virus. General population studies, as well as insight into the outcomes for particular groups, will be necessary in order to mitigate potentially long-term effects as well as to prepare for future epidemics or pandemics. The pandemic conditions have been marked by rapid and abrupt changes and unpredictability which are circumstances that leave the autistic population particularly vulnerable to adverse outcomes following the distinctive features of the diagnosis. Studies are only beginning to delineate the outcomes of the global autism community and the present study adds to these findings by providing a local, multi-perspective, qualitative analysis of the lived experiences of the Swedish autism community. In this study, autistic youth and adults, caregivers of autistic individuals, as well as representatives of Swedish interest organizations were interviewed. Thematic analysis was performed on the population as a whole and patterns of results were formalized according to the International Classification of Function, Disability and Health (ICF-CY). Participants report wide-ranging adverse outcomes of the pandemic relating to mental health and access to support, participation in daily activities and socialization, education, and work as well as parental resources. However, participants also report positive outcomes relating to a reduction in specific social and everyday demands, and normalization of lived experiences. Additionally, interviews outlined some strategies used to cope during pandemic conditions. Implications of these findings are discussed. Full article

The ability to retain and engage employees is now, more than ever, a major strategic issue for organizations in the context of a pandemic paired with a persistent labor shortage. To this end, teleworking is among the work organization conditions that merit consideration. The purpose of this cross-sectional study is to examine the direct and indirect effects of teleworking on work engagement and intention to quit, as well as the potential moderating effect of organizational and individual characteristics on the relationship between teleworking, work engagement, and intention to quit during the COVID-19 pandemic, based on a sample of 254 Canadian employees from 18 small and medium organizations. To address these objectives, path analyses were conducted. Overall, we found that teleworking, use of emotion, skill utilization, and recognition appear to be key considerations for organizations that wish to increase work engagement and decrease intention to quit, in the context of a pandemic paired with a labor shortage. Our results extend the literature by revealing the pathways through which teleworking, use of emotion, skill utilization, and recognition are linked to work engagement and intention to quit, and by suggesting specific interventions and formation plans that are needed. Full article

SARS-CoV-2 virus can not only damage the respiratory system but may also pose a threat to other organs, such as the heart or vessels. This review focuses on cardiovascular complications of COVID-19, including acute cardiac injury, arrhythmias, biomarkers, accompanying comorbidities and outcomes in patients diagnosed with SARS-CoV-2 infection. The research was conducted on the databases: PubMed, Springer, ScienceDirect, UpToDate, Oxford Academic, Wiley Online Library, ClinicalKey. Fifty-six publications from 1 November 2020 till 15 August 2021 were included in this study. The results show that cardiac injury is present in about 1 in 4 patients with COVID-19 disease, and it is an independent risk factor, which multiplies the death rate several times in comparison to infected patients without myocardial injury. New-onset cardiac injury occurs in nearly every 10th patient of the COVID-19-suffering population. Comorbidities (such as hypertension, cardiovascular disease and diabetes) severely deteriorate the outcome. Therefore, patients with SARS-CoV-2 infection should be carefully assessed in terms of cardiac medical history and possible cardiological complications. Full article

Background: The COVID-19 pandemic has had substantial impacts on citizens’ daily living. Concerns over mental health issues are rising. Recent studies assessing the psychosocial impact of COVID-19 on the general public revealed alarming results. Meanwhile, the impact of the COVID-19 pandemic on mental health among patients with pre-existing psychiatric disorders remained unclear. Methods: Patients diagnosed with anxiety disorders, depressive disorders, bipolar disorders, or schizophrenia were invited to complete a survey between July and October 2020. The survey collected information on subjects’ demographics, accommodation status, changes in mental health status during the COVID-19 outbreak, and the factors that affect subjects’ mental health during COVID-19. The primary outcome of this study was the change in mental health, defined by psychiatric symptom change and patient satisfaction on symptom control. The secondary outcomes were patients’ emotional status—measured by the Depression, Anxiety and Stress Scale (DASS-21)—during the COVID-19 pandemic and factors that impacted patients’ mental health during the COVID-19 pandemic. Results: Out of the 294 patients recruited, 65.0% were living in hostel while 35.0% were living in the community. The proportion of patients with ‘unsatisfied’ or ‘very unsatisfied’ mental disease control increased from 10.2% to 17.1% after the COVID-19 outbreak (p < 0.001). Under the DASS-21 questionnaire, 24.2% subjects, 32.6% subjects, and 18.9% subjects were classified as severe or extremely severe in terms of the level of depression, anxiety, and stress they experienced, respectively. Patients living in the community, patients with mood disorders, and female patients reported significantly worse control over anxiety and mood symptoms. The three major factors that affected patients’ mental health during COVID-19 were ‘reduced social activities’, ‘worries over people around getting infected’, and ‘reduced exercise’. Conclusion: Psychiatric patients in general have poorer disease control after the COVID-19 outbreak. Patients in the community appeared to be more affected than patients residing in hostels. More efforts should be directed to screening patients with pre-existing mental health disorders to enable timely interventions. Full article

Background: From the beginning of 2020, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quickly spread worldwide, becoming the main problem for the healthcare systems. Healthcare workers (HCWs) are at higher risk of infection and can be a dangerous vehicle for the spread of the virus. Furthermore, cancer patients (CPs) are a vulnerable population, with an increased risk of developing severe and lethal forms of Coronavirus Disease 19 (COVID-19). Therefore, at the National Cancer Institute of Naples, where only cancer patients are treated, a surveillance program aimed to prevent the hospital access of SARS-CoV-2 positive subjects (HCWs and CPs) was implemented. The study aims to describe the results of the monitoring activity for the SARS-CoV-2 spread among HCWs and CPs, from March 2020 to March 2021. Methods: This surveillance program included a periodic sampling through nasopharyngeal molecular swabs for SARS-CoV-2 (Real-Time Polymerase Chain Reaction, RT-PCR). CPs were submitted to the molecular test at least 48 h before hospital admission. Survival analysis and multiple logistic regression models were performed among HCWs and CPs to assess the main SARS-CoV-2 risk factors. Results: The percentages of HCWs tested with RT-PCR for the detection of SARS-CoV-2, according to the first and the second wave, were 79.7% and 91.7%, respectively, while the percentages for the CPs were 24.6% and 39.6%. SARS-CoV-2 was detected in 20 (1.7%) HCWs of the 1204 subjects tested during the first wave, and in 127 (9.2%) of 1385 subjects tested in the second wave (p < 0.001); among CPs, the prevalence of patients tested varied from 100 (4.6%) during the first wave to 168 (4.9%) during the second wave (p = 0.8). The multivariate logistic analysis provided a significant OR for nurses (OR = 2.24, 95% CI 1.23–4.08, p < 0.001) compared to research, administrative staff, and other job titles. Conclusions: Our findings show that the positivity rate between the two waves in the HCWs increased over time but not in the CPs; therefore, the importance of adopting stringent measures to contain the shock wave of SARS-CoV-2 infection in the hospital setting was essential. Among HCWs, nurses are more exposed to contagion and patients who needed continuity in oncological care for diseases other than COVID-19, such as suspected cancer. Full article

The impact of COVID-19 virus infection during pregnancy is still unclear. This systematic review and meta-analysis aimed to quantitatively pool the evidence on impact of COVID-19 infection on perinatal outcomes. Databases of Medline, Embase, and Cochrane library were searched using the keywords related to COVID-19 and perinatal outcomes from December 2019 to 30 June 2021. Observational studies comparing the perinatal outcomes of COVID-19 infection in pregnancy with a non-infected comparator were included. The screening process and quality assessment of the included studies were performed independently by two reviewers. Meta-analyses were used to pool the comparative dichotomous data on perinatal outcomes. The database search yielded 4049 results, 1254 of which were duplicates. We included a total of 21 observational studies that assessed the adverse perinatal outcomes with COVID-19 infection. The odds of maternal death (pooled OR: 7.05 [2.41−20.65]), preeclampsia (pooled OR: 1.39 [1.29−1.50]), cesarean delivery (pooled OR: 1.67 [1.29−2.15]), fetal distress (pooled OR: 1.66 [1.35−2.05]), preterm birth (pooled OR: 1.86 [1.34−2.58]), low birth weight (pooled OR: 1.69 [1.35−2.11]), stillbirth (pooled OR: 1.46 [1.16−1.85]), 5th minute Apgar score of less than 7 (pooled OR: 1.44 [1.11−1.86]) and admissions to neonatal intensive care unit (pooled OR: 2.12 [1.36−3.32]) were higher among COVID-19 infected pregnant women compared to non-infected pregnant women. Full article

There is little knowledge about how the influence of non-pharmaceutical interventions (NPIs) reduces the COVID-19 infection rate during the period of vaccine rollout. This study aimed to examine the effectiveness of NPIs on decreasing the epidemic growth of COVID-19 between before and after the vaccine rollout period among Asian countries. Our ecological study included observations from 30 Asian countries over the 20 weeks of the pre- and post-vaccination period. Data were extracted from the Oxford COVID-19 Government Response Tracker and other open databases. Longitudinal analysis was utilized to evaluate the impacts of public health responses and vaccines. The facial covering policy was the most effective intervention in the pre-vaccination period, followed by border control and testing policies. In the post-vaccination period, restrictions on gatherings and public transport closure both play a key role in reducing the epidemic growth rate. Vaccine coverage of 1–5%, 5–10%, 10–30%, and over 30% of the population was linked with an average reduction of 0.12%, 0.32%, 0.31%, and 0.59%, respectively. Our findings support the evidence that besides the vaccine increasingly contributing to pandemic control, the implementation of NPIs also plays a key role. Full article

Taking Beijing as a case, this paper conducted a survey to collect the characteristics of residents’ daily activities, including the mode of frequency and duration of travel, the type and environment of activities, and the duration and frequency of activities. We calculated the COVID-19 exposure risk of residents in different activities based on the exposure risk formula; the influencing factors of residents’ exposure risk were analyzed by regression analysis. The variance of residents’ COVID-19 exposure risk was calculated by coefficient of variation. The main conclusions are as follows: (1) There are differences in activity types of COVID-19 exposure risk, which are survival activity, daily activity and leisure activity from high to low. (2) There are differences in populations of COVID-19 exposure risk. Education level, occupation and income are the main factors affecting residents’ COVID-19 exposure risk. (3) There is internal inequity in the risk of COVID-19 exposure. The exposure risk was higher on work days than on rest days. Health inequities at work are highest on both work days and rest days. Among the different population characteristics, male, 31–40 years old, married, with a high school education, income level of 20,001–25,000 yuan, with a non-local rural hukou, rental housing, farmers, three generations or more living together have a greater degree of COVID-19 exposure risk. Full article

Objective: Along with the rapid spread of the COVID-19 pandemic around the globe, a proliferation of mass media information exposed the population to an infodemic with various implications documented worldwide. The present study analyzed Romanian healthcare practitioners’ (HCPs) appraisal of COVID-19 mass media information and governmental measures throughout 2020, ranking vaccination priorities and moral values. Methods: 97 HCP completed a cross-sectional survey with items referring to the COVID-19 pandemic in 2020. Results: Findings were consistent with other studies, indicating an overall negative appraisal of mass media information, which predicted anxiety and relaxation difficulties. Unlike other studies, our sample reported a moderate level of satisfaction with official measures in 2020, which was not related to their view on mass media information. The ranking of population categories in the vaccination order showed similarities with the governmental vaccination program in 2021. Despite placing freedom third after health and love in the hierarchy of values, HCPs showed a high tendency of limiting individual liberty for the common good. Conclusions: Results showed a dissociation between the overall negative appraisal of mass media information and the satisfaction with governmental measures in 2020. Romanian HCPs shared a secular perspective on moral values and assumed an authoritarian position. Full article

Aging is a dynamic process that can bring well-being but also physical and cognitive decline. Older adults can draw on their personal resources to help them cope and thrive through the aging process. Having personal resources to cope and ensure older adults’ well-being is important. Psychological strengths such as a sense of coherence, resilience, and coping are protective against the adversity associated with health problems such as those stemming from the COVID-19 pandemic. Our study’s purpose was to investigate the usefulness of reminiscence therapy for older women living in nursing homes during the COVID-19 pandemic. A sample composed of 29 older women was evaluated with the Purpose-in-Life Test (PIL), Sense of Coherence (SOC-13) and Brief Cope Inventory (COPE-28). Our reminiscence program consisted of 10 sessions lasting 60 min each. Reminiscence therapy is a psychological intervention for older adults to assist in remembering and interpreting the life events, feelings, and thoughts that define and give meaning to the person’s life. Reminiscence can lead to positive mental health and other elements of particular relevance to older adults. In each session, we worked on a different theme that promoted the memory of positive emotions: optimal experience, decisive moment, stresses, tensions, problems and solutions, memories of childhood, adolescence, maturity, significant people in life, sense of life, and future script. We compared an intervention group (n = 12) with a control group (n = 17) using a pre-post, single-blind design. Significant results were obtained and showed that reminiscence therapy was effective in increasing meaning of life, sense of coherence, and coping in older women. The reminiscence therapy applied yielded positive effects in older female participants living in a nursing home during COVID-19 pandemic. Full article

This study examined the self-assessment of Niigata’s and Khabarovsk’s adolescents’ health status and their willingness to be vaccinated during the COVID-19 pandemic. A self-reported questionnaire was administered to 735 boys and girls (aged 15 years) from Niigata, Japan (n = 387), and Khabarovsk, Russia (n = 394), between May and July 2021. Specifically, this questionnaire focused on COVID-19, including a self-assessment of health status, adaptation to a new lifestyle, and impressions about the COVID-19 vaccination. The self-assessment was based on a 4-point scale: “Got very bad”; “Got a little bit bad”; “Did not change”; “Got better/I don’t know”. Additionally, binomial logistic regression was conducted to determine the association between the self-assessment of health status and the factors exacerbating their responses. Based on the findings, 25.7 and 29.9% of Niigata and Khabarovsk’s adolescents, respectively, selected “Got very bad” and “Got a little bit bad” for their self-assessments, while the binomial logistic regression showed that the difficulty of adapting to a new lifestyle was a factor worsening the boys’ subjective health. However, the items could not explain the deterioration of their subjective health in girls. Moreover, 76.9% of Niigata’s adolescents were positive about the COVID-19 vaccination, compared to 35.5% of the adolescents in Khabarovsk. Full article

How does future anxiety caused by the COVID-19 pandemic relate to people’s willingness to remain vigilant and adhere to preventive measures? We examined the mediating role of message fatigue and the moderating role of autonomy satisfaction in the relationship between future anxiety due to COVID-19 and willingness to remain vigilant. A cross-sectional online survey was conducted with adults residing in the United States in June 2021 when numerous U.S. states re-opened following the CDC’s relaxed guidelines for fully vaccinated individuals. Our data showed that message fatigue mediated the relationship between future anxiety due to the pandemic and willingness to remain vigilant. The data further revealed that autonomy satisfaction significantly moderated the mediation. Namely, the role of message fatigue in the indirect relationship between future anxiety and willingness to remain vigilant was significant only among people low to moderate in autonomy satisfaction; its role in the indirect path was not significant for those high in autonomy satisfaction. Notably, independent of the mechanism involving message fatigue, future anxiety was directly and positively associated with willingness to remain vigilant regardless of the levels of autonomy satisfaction. Implications of these findings are discussed in light of psychological and behavioral responses to the current pandemic and policy directions. Full article

Background: The COVID-19 pandemic has disrupted our daily lives, which in turn has impacted health behaviors. Young people have been particularly affected. This study aimed to assess health behaviors in Austrian apprentices and high school students during the COVID-19 pandemic and whether vaccination willingness is affected by health behaviors. Methods: Two online surveys were conducted via REDCap with 1442 apprentices (female: 53.5%, male: 45.4%) from 29 March to 18 May 2021 and 563 school students (female: 79.6%, male: 18.6%) from 19 June to 2 July 2021. The two samples were matched to account for sociodemographic differences and analyses were run on the matched sample. Besides the health behaviors, namely, smoking, alcohol consumption, cannabis consumption, and exercise, health status and vaccination willingness were also assessed. Results: Health behaviors were affected by both education group and gender. Apprentices reported significantly more smoking than high school students and this difference was more pronounced in women (all p < 0.01). Alcohol consumption was higher in apprentices than school students, but only in women (p < 0.01). There was a trend for the two education groups to differ in their cannabis use as well (p = 0.05). Apprentices took part in more weekly exercise (p < 0.0001), but high school students reported better average health status (p < 0.001). When included in the same model, health behaviors did not affect vaccine willingness, but education group did, with high school students showing a higher willingness to receive the COVD-19 vaccine than apprentices. Conclusions: These findings support the argument that education type is an important factor for health behaviors, but this is also mediated by gender. Appropriate interventions for adolescents are needed to prevent adverse health behavior changes following the COVID-19 pandemic. Full article

Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, and temporary productivity loss. This research aims to calculate (1) how the pandemic affects on-the-job probability and earnings for the working population, and (2) how much productivity loss is associated with self or a family member sick with COVID-19. Based on data collected from the U.S Research and Development Survey (RANDS), this research projects the relationship between on-the-job possibility and age of the index group and calculates the employment possibilities of the index group relative to the healthy group, namely the employment ratio. The weekly loss of productivity, presented by earnings, associated with COVID-19 for groups aged 18–44 years and 45–64 years was calculated, since the 18- to 64-year-old population is an economy’s active workforce. Analytical results indicate that the older the age group, the lower the on-the-job possibility, and the higher the weekly productivity loss due to self or a family member being sick from COVID-19. For the group aged 45–64 years, the employment ratio of the index group relative to the healthy group dropped from 0.863 to 0.39, corresponding to a weekly productivity loss of 136–590 US dollars. The overall impact would be about a 9% loss in GDP. Infected or quarantined people would be confined to working in relatively isolated offices or places to allow for social distancing. Proactive health promotion in the workplace plus reactive work through telecommunication systems would reduce such losses. Such preparedness needs to be implemented early for more vulnerable workers who are of middle or old age and/or those comorbid with diabetes. Full article

In December 2019, COVID-19 was reported in Wuhan, China. Most of the studies related to the psychological impact and compliance with staying at home due to COVID-19 focused on ten days or one month after the initial “stay-at-home” phase of the COVID-19 pandemic. The early psychological impact and behavior change to COVID-19 during the Chinese Spring Festival (the start time for recommendations to stay at home) is uncertain. In this study, people from 23 provinces in China were recruited to participate in an online survey, using Credamo. Psychological impact and compliance with staying at home were evaluated by a self-designed and validated questionnaire. The results indicated that anxiety was the most often reported feeling (mean: 3.69), followed by sadness (mean: 3.63). Participants employed in foreign-owned companies were most likely to express anxiety and sadness. Overall, 61.8% of participants reported hardly going out, whereas 2.4% said they frequently went out during the initial “stay-at-home” phase of the COVID-19 pandemic. Participants with higher levels of anxiety and sadness were most likely to stay at home against the spread of COVID-19, as were female gender. This survey is an important study of the first reaction to staying at home during the initial “stay-at-home” phase coinciding with Chinese Spring Festival. Our findings identified factors associated with higher level of psychological impact and better compliance with staying at home recommendations during Chinese Spring Festival. The findings can be used to formulate precaution interventions to improve the mental health of vulnerable groups and high uptake of policy during the COVID-19 epidemic. Full article

To raise awareness about preventive measures in COVID-19 pandemic, even though fully vaccinated. Although recent trials showed high efficacy of vaccines in preventing symptomatic infections, there are some individuals experiencing symptomatic SARS-CoV-2 infection. In this case report, a fully vaccinated young dental practitioner experienced symptomatic SARS-CoV-2 infection 55 days postvaccination with BNT162b2 Pfizer vaccine with evident ageusia. Diagnostic swabs were performed and used for viral genome sequencing. The patient fully recovered 15 days after diagnosis. Loss of smell and taste, together with nasal congestion were the main reported symptoms. The use of personal protective equipment prevented spread of infection in patients and co-workers. With the increase of people being fully vaccinated, it is still necessary to follow infection preventive protocols by correctly applying personal protective equipment. Although high efficacy has been proved, some individuals may still be vulnerable to symptomatic infection and new guidelines and markers should be adopted and investigated to find out patients for whom vaccination may not determine full immunization. Full article

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients. Full article

The global spread of COVID-19 led the World Health Organization to declare a pandemic on 11 March 2020. To decelerate this spread, countries have taken strict measures that have affected the lifestyles and economies. Various studies have focused on the identification of COVID-19’s impact on the mental health of children and adolescents via traditional statistical approaches. However, a machine learning methodology must be developed to explain the main factors that contribute to the changes in the mood state of children and adolescents during the first lockdown. Therefore, in this study an explainable machine learning pipeline is presented focusing on children and adolescents in Greece, where a strict lockdown was imposed. The target group consists of children and adolescents, recruited from children and adolescent mental health services, who present mental health problems diagnosed before the pandemic. The proposed methodology imposes: (i) data collection via questionnaires; (ii) a clustering process to identify the groups of subjects with amelioration, deterioration and stability to their mood state; (iii) a feature selection process to identify the most informative features that contribute to mood state prediction; (iv) a decision-making process based on an experimental evaluation among classifiers; (v) calibration of the best-performing model; and (vi) a post hoc interpretation of the features’ impact on the best-performing model. The results showed that a blend of heterogeneous features from almost all feature categories is necessary to increase our understanding regarding the effect of the COVID-19 pandemic on the mood state of children and adolescents. Full article

Epidemic viral infections, including the outbreak of severe acute respiratory syndrome (SARS) in 2003 and SARS-CoV-2 in 2019, have brought tremendous loss to people across the nations. The aim of this study was to compare the psychological impact of the SARS-CoV-2 pandemic in 2020 and the SARS pandemic in 2003 on hospital workers. Hospital workers at a medical center in Southern Taiwan (n = 1816) were invited to complete questionnaires (SARS-CoV-2 Exposure Experience, the Impact of Event Scale, the Chinese Health Questionnaire, and the Distress Thermometer). The current data were compared to the data collected from hospital workers (n = 1257) at the same medical center during the SARS pandemic in 2003. We found the psychological impact on hospital workers during the SARS-CoV-2 pandemic was significantly lower than that during the previous SARS period. During the SARS-CoV-2 pandemic period, hospital workers with SARS experience were more accepting of the risk, felt a greater responsibility to take care of the SARS-CoV-2 patients, and were more likely to perceive the danger of becoming infected. The associated factors of psychiatric morbidity in hospital workers with SARS experience were being female, the degree of intrusion severity, and severity of psychological distress. Proper management strategies and lessons learned from the SARS experience might have led to low psychiatric morbidity during the SARS-CoV-2 pandemic. Full article

This study aims to provide an improved understanding of the local-level spatiotemporal evolution of COVID-19 spread across capital regions of South Korea during the second and third waves of the pandemic (August 2020~June 2021). To explain transmission, we rely upon the local safety level indices along with latent influences from the spatial alignment of municipalities and their serial (temporal) correlation. Utilizing a flexible hierarchical Bayesian model as an analytic operational framework, we exploit the modified BYM (BYM2) model with the Penalized Complexity (PC) priors to account for latent effects (unobserved heterogeneity). The outcome reveals that a municipality with higher population density is likely to have an elevated infection risk, whereas one with good preparedness for infectious disease tends to have a reduction in risk. Furthermore, we identify that including spatial and temporal correlations into the modeling framework significantly improves the performance and explanatory power, justifying our adoption of latent effects. Based on these findings, we present the dynamic evolution of COVID-19 across the Seoul Capital Area (SCA), which helps us verify unique patterns of disease spread as well as regions of elevated risk for further policy intervention and for supporting informed decision making for responding to infectious diseases. Full article

The COVID-19 pandemic has had a significant influence on education systems, educational environments, teachers, and students. This study aims to assess the satisfaction with, adherence to, and perspectives toward COVID-19 preventive measures among public health students in Jazan, Saudi Arabia in order to enhance their campus experience. This study utilized a cross-sectional methodology. Data were collected using convenience sampling between 2–19 November 2020; this was accomplished using an online survey administered via Google Forms. The final sample consisted of 200 participants. More than half of the participants (55.0%) were dissatisfied with the preventive measures that had been applied on campus, while 19.0% had a neutral outlook. Interestingly, female participants showed a higher level of dissatisfaction toward the preventive measures (70.6%) than male participants (43.5%). The ordinal logistic regression analysis revealed a significant correlation between the degree of satisfaction with the COVID-19 preventive measures and the participant’s gender and education level. Male students were more likely to be satisfied with the preventive measures (p < 0.029, OR = 2.199) than female students. In addition, final year students were 4.1 times more likely to be satisfied with the COVID-19 preventive measures (p < 0.004, OR = 0.242) than Year 2 students, and 6.2 times more likely to be satisfied (p ≤ 0.001, OR = 0.162) than Year 3 students. Efforts are needed to improve the students’ satisfaction with COVID-19 preventive measures. Steps are also required to ensure that the procedures and actions introduced by the college extend to all students. In addition, further research is needed to recognize and understand the participants’ experiences after moving to the new buildings, receiving COVID-19 vaccines, and returning to on campus study. Full article

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (<7 h) and sleep problems. Overall, sufficient MVPA was associated with better mental and sleep health during the COVID-19 induced nation-wide lockdown in Jordan. While further research is necessary, promoting physical activity during the lockdown could potentially improve mental and sleep health outcomes among the population. Full article

With the advent of vaccines, the world has a chance to see a real end to the COVID-19 pandemic. To make this possible, however, it is necessary that all groups of people are considered. Contexts of informal settlements and populations such as the homeless and migrants are often forgotten by vaccination campaigns. In this study, carried out as a result of a collaboration with MEDU, a non-profit association aimed at bringing healthcare to vulnerable populations, we provide important data related to the vaccination campaign carried out in the informal settlements of Rome. The objectives of this work are to (1) evaluate vaccination coverage in these contexts, (2) assess the gap with the vaccination coverage of the Italian population and try to hypothesize the causes, and (3) provide recommendations for how humanitarian associations can respond to reduce this gap. We observed important differences in vaccination coverage depending on the type of settlement. The percentage of vaccinated people in these contexts at the beginning of October range between 14.4% and 55.5%, underlining an important gap with the vaccination rate of Italy’s population, which is close to 80%. The data also show that particular attention must be paid to the transiting and irregular people as they are more at risk for a lack of access to vaccination. With this study, in which we provide recommendations that integrate MEDU’s fieldwork experience with the advice of the Framework report, we hope we can help those who work in similar contexts, to carry out a fair and effective vaccination campaign. Full article

Concern for public health has been growing with the increasing volume of cases of COVID-19 in India. To combat this pandemic, India has implemented nationwide lockdowns, and unlocking phases continue with certain restrictions in different parts of the country. The lockdown has required people to adopt social-distance measures to minimize contacts in order to reduce the risks of additional infection. Nevertheless, the lockdown has already impacted economic activities and other dimensions of the health of individuals and society. Although many countries have helped their people through advanced welfare protection networks and numerous support aids, several emerging economies face specific difficulties to adapt to the pandemic due to vulnerable communities and scarce resources. However, certain lower-income countries need more rigorous analysis to implement more effective strategies to combat COVID-19. Accordingly, the current systematic review addresses the impacts of the COVID-19 pandemic and lockdowns in India in relation to health and the economy. This work also provides further information on health inequalities, eco-nomic and social disparities in the country due to the COVID-19 pandemic and lockdowns and also contributes pragmatic suggestions for overcoming these challenges. These observations will be useful to the relevant local and national officials for improving and adopting novel strategies to face lockdown challenges Full article

The purpose of this study was to identify the mediating effects of perceived health status (PHS) and perceived organizational support (POS) in the association between emotional labor and burnout in public health nurses (PHNs). The participants were 207 PHNs convenience sampled from 30 public health centers and offices in Jeju, Korea. Data regarding emotional labor, PHS, POS, and burnout were collected between February and March 2021 using a structured questionnaire. Collected data were analyzed by Pearson’s correlation coefficient and multiple regression analysis. Burnout of PHNs was positively correlated with emotional labor (r = 0.64, p < 0.001) and negatively correlated with PHS (r = −0.51, p < 0.001) and POS (r = −0.51, p < 0.001). In the association between emotional labor and burnout, PHS (B = −1.36, p < 0.001) and POS (B = −0.42, p = 0.001) had a partial mediating effect. Reduction of burnout among PHNs requires not only effective management of emotional labor but also personal and organizational efforts to improve PHS and POS. Full article

COVID-19 has caused a global pandemic with considerable impact. Studies have examined the influence of socioeconomic status and air pollution on COVID-19 risk but in low detail. This study seeks to further elucidate the nuances of socioeconomic status, as defined by the Index of Multiple Deprivation (IMD), air pollution, and their relationship. We examined the effect of IMD and air pollution on the likelihood of testing positive for SARS-CoV-2 among 66,732 UKB participants tested for SARS-CoV-2 from 16 March 2020 through 16 March 2021. Logistic regression was performed controlling for age, sex, ancestry and IMD or air pollution in the respective models. IMD and its sub-scores were significantly associated with increased risk of testing positive for SARS-CoV-2. All particulate matter less than 2.5 μm (PM2.5), nitrogen oxide (NO_x), and nitrogen dioxide (NO₂) levels were associated with increased likelihood of testing positive for SARS-CoV-2. Measures of green space and natural environment around participants’ homes were associated with reduced likelihood of SARS-CoV-2. Socioeconomic status and air pollution have independent effects on the risk of testing positive for SARS-CoV-2. Green space and natural environment space in the proximity of people’s homes may mediate the effect of air pollution on the risk of testing positive for SARS-CoV-2. Full article

(1) Background: Knowledge of COVID-19 prevention among communities is the first step towards protective behaviors. The objective of this study was to assess COVID-19 prevention knowledge among a Middle Eastern and North African community in Houston, Texas. (2) Methods: A cross-sectional study was conducted using a validated quantitative survey; survey questions consisted of three parts: COVID-19 specific questions, general health questions, and sociodemographic questions. A multivariable logistic regression model was used to determine predictors of perception of knowledge on preventing COVID-19 spread. The outcome of interest comprised of “good/excellent” versus “average and below” knowledge. (3) Results: A total of 366 participants (66.39% males) completed the survey. A univariate analysis demonstrated significant differences in self-reported COVID-19 prevention knowledge among those with and without health insurance, different ages, level of knowledge, and perceived severity of COVID-19 infection. In the multivariate logistic regression, two predictors were identified: those in the 18–25-year-old group were more likely to have “excellent/good” knowledge on COVID-19 spread compared to the ≥40-year-old group (OR: 6.36; 95% CI: 1.38, 29.34). Those who somewhat agree with knowing how to protect themselves from COVID-19 were more likely to have “excellent/good” knowledge of preventing COVID-19 spread compared to those that neither agree nor disagree or disagree (OR: 7.74; 95% CI: 2.58, 23.26). (4) Conclusions: Younger adults reported higher knowledge of COVID-19 prevention. Full article

Following the pandemic scenario, researchers from all over the world, including Italians, have undertaken fervent research activity using the epidemiological data available on the sites of government and national and international research institutes. The objectives of our study were: (1) to analyze the load and trend of the COVID-19 pandemic in Italy, from the beginning to October 2021; (2) to analyze vaccination coverage by age groups and types of vaccines administered and check how the vaccination campaign has influenced the course of the disease and deaths; (3) to evaluate the Italian situation in the European context, comparing the incidence and mortality of Italy with respect to European countries; (4) finally, to evaluate how much vaccination coverage may have had an effect on mortality in the various European countries. Databases were structured to archive Italian and European COVID-19 data provided by Our World in Data, and data came from the Ministry of Health, to evaluate percentage of vaccines administered. The monthly trend of the cumulative incidence per 100,000 inhabitants in the period January 2020–October 2021 was evaluated. It is important to underline 3 peaks of incidence and mortality rates that occurred during the three waves of COVID-19: March–April–May 2020, October–November–December 2020, and March–April–May 2021. There is a slight increase in incidence in August 2021 and in mortality in September 2021. The three mortality rate peaks, related to the three waves of COVID-19, are always higher in Italy than in Europe, particularly in April 2020, December 2020, and March 2021. From May 2021 to October 2021, the mortality trend reversed, and it turned out to be higher in Europe than in Italy. Regarding vaccination, Italy currently has an important coverage, not only in the most fragile population, where it exceeds 90%, but also in the 12–19 age group, with percentages above 65%. The Pfizer/BioNTech vaccine was used widely in all age groups (first and second dose), with highest administration in 12–19 age groups and 80+, while the lowest was recorded in the 70–79 age group. In conclusion, these data confirm the importance of vaccination in the management of the COVID-19 pandemic. Full article

The South African health care system was hard hit by the second wave of Coronavirus disease (COVID-19), which affected nurse managers as healthcare facilities became overwhelmed due to an increased workload emanating from the overflow of admissions. Therefore, this study sought to explore and describe the nurse managers’ experiences during COVID-19 in order to identify gaps and lessons learnt. A descriptive phenomenological research approach was used to explore the experiences of ten nurse managers who were purposively selected from different units of a selected district hospital. Data was collected through telephonic unstructured individual interviews and analysed using Colaizzi’s seven steps method. The study revealed that nurse managers experienced human resource related challenges during COVID-19, worsened by the fact that vacant posts were frozen. It also emerged that there was a shortage of material resources that affected patient care. Nurse managers also indicated that COVID-19 brought a lot of administrative duties plus an additional duty of patient care. Also, nurse managers who had previously contracted COVID-19 experienced stigma and discrimination. The government needs to address resource related challenges in rural public hospitals and provide continuous support to nurse managers, particularly during a pandemic like COVID-19. Full article

For fighting the COVID-19 pandemic, countries used control measures of different severity, from “relaxed” to lockdown. Drastic lockdown measures are considered more effective but also have a negative impact on the economy. When comparing the financial value of lost lives to the losses of an economic disaster, the better option seems to be lockdown measures. We developed a new parameter, the effectiveness of control measures, calculated from the 2nd time derivative of daily case data, for 92 countries, states and provinces. We compared this parameter, and also the mortality during and after the effective phase, for countries with and without lockdowns measures by means of the Mann–Whitney test. We did not find any statistically significant difference in the effectiveness between countries with and without lockdowns (p > 0.76). There was also no significant difference in mortality during the effective phase (p > 0.1); however, a significant difference after the effective phase, with higher mortality for lockdown countries, was identified. The effectiveness correlated well with a parameter derived from the reproductive number (R² = 0.9480). The average duration of the effective phase was 17.3 ± 10.5 days. The results indicated that lockdown measures are not necessarily superior to relaxed measures, which in turn are not necessarily a recipe for failure. Relaxed measures are, however, more economy-friendly. Full article