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COVID-19 and its associated disease control measures have greatly altered everyday life. The burden of these challenges has fallen disproportionately on women. Drawing on qualitative inquiry in agrarian north India and Nepal, this research note analyzes how South Asian COVID-19 lockdowns have affected women's labor responsibilities in sometimes surprising ways. We find increased responsibilities for caregiving within the household, substantial stress in responding to food insecurity, and growing expectations to fulfill public roles in disease response measures. However, we also find that the return of male migrants and youth has, in some cases, reduced women's farming responsibilities and created opportunities for household togetherness at a time of great uncertainty. We conclude that more research is needed to examine the nuanced aspects of COVID-19's gendered labor impacts to create comprehensive policy responses to address the multiple and sometimes conflicting effects the lockdown has had on agrarian women's informal labor and well-being.
The purpose of this investigation was to identify, synthesize, and compare all the current information on the efficacy of dental masks, emphasizing their use, types, and filters to prevent the spread and infection of COVID-19 and other infectious diseases. A bibliographic search of the main scientific databases was carried out using the words “masks, COVID-19, and dentistry.” Articles without language restriction up to May 31, 2020, were obtained. The types of masks, their half-life, method to use, sterilization, and proposed alternatives for dental masks were analyzed. Most of the articles refer to the use of N95 or FFP2 respirators presented as a strategy to extend the life of the masks and limited reuse. Regarding sterilization, most of the articles presented studies using ultraviolet germicidal irradiation as the sterilization method. Regarding respirator mask half-life, we recommend prolonged use, combined with a disposable surgical mask over the respirator mask. Finally, the use of N95 or FFP2 respirators are recommended as part of personal protective equipment for dental use.
Coronavirus disease 2019 (COVID-19) pandemic is a global health emergency caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to evaluate whether technical analysis (TA) indicators, commonly used in the financial market to spot security price trend reversals, might be proficiently used also to anticipate a possible increase of SARS-Cov-2 spread.
Methods:
Analysis was performed on datasets from Italy, Iran, and Brazil. TA indicators tested were: (1) the combined use of a faster (3-d) and a slower (20-d) simple moving averages (SMA), (2) the moving average converge/divergence (MACD), and (3) the divergence in the direction of the number of new daily cases trend and the corresponding MACD histogram.
Results:
We found that the use of both fast/slow SMAs and MACD provided a reliable signal of trend inversion of SARS-Cov-2 spread. Results were consistent for all the 3 countries considered. The trend reversals signaled by the indicators were always followed by a sustained trend persistence until a new signal of reversal appeared.
Conclusions:
TA indicators tested here proved to be reliable tools to identify in the short mid-term a subsequent change of direction of viral spread trend either downward, upward, or sideward.
To investigate the knowledge, attitudes and practices (K-A-P) about food safety and nutrition in Chinese adults who were recruited to the online survey during the epidemic of corona virus disease 2019 (COVID-19).
Design:
Participants were recruited by an online snowball sampling method. An electronic questionnaire was sent to our colleagues, students, friends, other professionals and their referrals helped us recruit more participants. The questionnaire included socio-demographic information, the attention paid to COVID-19, K-A-P about food safety and nutrition. Multiple and logistic regression analyses were used to explore related factors of K-A-P.
Subjects:
Totally, 2272 participants aged 24·09 ± 9·14 years, from twenty-seven provinces, autonomous districts or municipalities, with 18·3 % male and 83·4 % with a medical background.
Results:
The total possible knowledge score was 8·0, the average score was 5·2 ± 1·6 and 4·2 % obtained 8·0. The total possible attitudes score was 8·0, the average score was 6·5 ± 1·4 and 36·1 % obtained 8·0. The total possible food safety practices score was 5·0, the average score was 3·7 ± 1·0 and 20·7 % obtained 5·0. During this public emergency, 79·4 % participants changed diet habits, including increasing vegetables, fruit and water intake and reducing sugary drinks and snacks. Gender, age, educational and professional background, disease history, the attention paid to COVID-19 and related knowledge were associated with K-A-P.
Conclusion:
There was room for the improvement of K-A-P in participants during this public health emergency and further strengthening education about food safety and nutrition is needed. Findings indicate that education should address biased or misleading information and promote nutritious food choices and safe food practices.
Remote delivery of evidence-based psychological therapies via video conference has become particularly relevant following the COVID-19 pandemic, and is likely to be an on-going method of treatment delivery post-COVID. Remotely delivered therapy could be of particular benefit for people with social anxiety disorder (SAD), who tend to avoid or delay seeking face-to-face therapy, often due to anxiety about travelling to appointments and meeting mental health professionals in person. Individual cognitive therapy for SAD (CT-SAD), based on the Clark and Wells (1995) model, is a highly effective treatment that is recommended as a first-line intervention in NICE guidance (NICE, 2013). All of the key features of face-to-face CT-SAD (including video feedback, attention training, behavioural experiments and memory-focused techniques) can be adapted for remote delivery. In this paper, we provide guidance for clinicians on how to deliver CT-SAD remotely, and suggest novel ways for therapists and patients to overcome the challenges of carrying out a range of behavioural experiments during remote treatment delivery.
Key learning aims
(1) To learn how to deliver all of the core interventions of CT-SAD remotely.
(2) To learn novel ways of carrying out behavioural experiments remotely when some in-person social situations might not be possible.
Presently, evidence guiding clinicians on the optimal approach to safely screen patients for coronavirus disease 2019 (COVID-19) to a nonemergent hospital procedure is scarce. In this report, we describe our experience in screening for SARS-CoV-2 prior to semiurgent and urgent hospital procedures.
Design:
Retrospective case series.
Setting:
A single tertiary-care medical center.
Participants:
Our study cohort included patients ≥18 years of age who had semiurgent or urgent hospital procedures or surgeries.
Methods:
Overall, 625 patients were screened for SARS-CoV-2 using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest computed tomography (CT) between March 1, 2020, and April 30, 2020.
Results:
Of the 625 patients, 520 scans (83.2%) were interpreted as normal; 1 (0.16%) had typical features of COVID-19; 18 scans (2.88%) had indeterminate features of COVID-19; and 86 (13.76%) had atypical features of COVID-19. In total, 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with a CT scan that yielded an atypical finding. Of the 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab 1 week after their initial swab. Also, 1 patient with a chest CT categorized as typical had a follow-up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. After surgery, none of the patients developed signs or symptoms suspicious of COVID-19 that would indicate the need for a repeated RT-PCR or CT scan.
Conclusion:
In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low-prevalence population.
Decontamination of N95 respirators is being used by clinicians in the face of a global shortage of these devices. Some treatments for decontamination, such as some vaporized hydrogen peroxide methods or ultraviolet methods, had no impact on respiratory performance, while other treatments resulted in substantial damage to masks.
Self-harm is a major international public health concern and is especially prevalent among prisoners. In this editorial, we explore recent trends in prisoner self-harm during the coronavirus lockdown, and consider strategies for improving the prevention and management of self-harm in prisons as we emerge from the pandemic.
The prolongation of the Ebola epidemic may have allowed some countries to prepare and respond to the coronavirus disease (COVID-19) outbreak. In Uganda, the surveillance structure built for Ebola virus disease (EVD) has become a pillar in the COVID-19 response. This testing and tracing apparatus has limited disease spread to clusters with zero mortality compared with the neighboring East African countries. As more sub-Saharan countries implement social distancing to contain the outbreak, the interventions should be phased and balanced with health risk and socioeconomic situation. However, having a decision-making matrix would better guide the response team. These initial lessons from EVD-experienced Uganda may be helpful to other countries in the region.
The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19.
Methods:
We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020.
Results:
Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death.
Conclusions:
COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.
Growing evidence showed that coronavirus disease 2019 (COVID-19) infection may present with neurological manifestations. This review aimed to determine the neurological manifestations and complications in COVID-19.
Methods:
We conducted a systematic review and meta-analysis that included cohort and case series/reports involving a population of patients confirmed with COVID-19 infection and their neurologic manifestations. We searched the following electronic databases until April 18, 2020: PubMed, Embase, Scopus, and World Health Organization database (PROSPERO registration number: CRD42020180658).
Results:
From 403 articles identified, 49 studies involving a total of 6,335 confirmed COVID-19 cases were included. The random-effects modeling analysis for each neurological symptom showed the following proportional point estimates with 95% confidence intervals: “headache” (0.12; 0.10–0.14; I2 = 77%), “dizziness” (0.08; 0.05–0.12; I2 = 82%), “headache and dizziness” (0.09; 0.06–0.13; I2 = 0%), “nausea” (0.07; 0.04–0.11; I2 = 79%), “vomiting” (0.05; 0.03–0.08; I2 = 74%), “nausea and vomiting” (0.06; 0.03–0.11; I2 = 83%), “confusion” (0.05; 0.02–0.14; I2 = 86%), and “myalgia” (0.21; 0.18–0.25; I2 = 85%). The most common neurological complication associated with COVID-19 infection was vascular disorders (n = 23); other associated conditions were encephalopathy (n = 3), encephalitis (n = 1), oculomotor nerve palsy (n = 1), isolated sudden-onset anosmia (n = 1), Guillain–Barré syndrome (n = 1), and Miller–Fisher syndrome (n = 2). Most patients with neurological complications survived (n = 14); a considerable number of patients died (n = 7); and the rest had unclear outcomes (n = 12).
Conclusion:
This review revealed that neurologic involvement may manifest in COVID-19 infection. What has initially been thought of as a primarily respiratory illness has evolved into a wide-ranging multi-organ disease.
Despite the introduction of social restrictions designed to stem the spread of COVID-19, many Indonesians have continued to attend places of worship. This poses a major public health threat, as congregational prayer involves large numbers of worshippers gathering under conditions known to enable the spread of the virus. Using a nationally representative survey, we evaluated the efficacy of messages delivered from different authorities in encouraging Indonesians to worship at home. We find no consistent evidence that public health messages change Indonesians’ attitudes toward communal prayer or their willingness to forgo communal prayer during the COVID-19 pandemic. Importantly, however, looking at well-defined subpopulations – non-Muslims and supporters of the president – we find suggestive evidence that messages were effective in increasing the likelihood of individuals to indicate a willingness to forgo communal prayer in the forthcoming week. Our results suggest that public health officials should eschew blanket messaging strategies in favor of more targeted approaches.
On March 1, 2020, the Kurdistan Region Government (KRG) announced 4 confirmed cases of coronavirus disease (COVID-19). We aimed to explore the response of the public toward the prevention principles against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Methods:
The investigators invited individuals from different geographic areas of Duhok Governorate of Iraqi Kurdistan in March 2020.
Results:
The mean age of the participants was 25.74 (16‐95 years). The mean score and prevalence of fear toward SARS-CoV-2 infection was 4.40 of 10 and 81.9%, respectively. A small percentage of participants did not minimize their exposures by reducing close contacts and transmission of respiratory droplets (14.5%) and visited public areas during the epidemic (28.7%). The study revealed that 30.8% of the participants do not use face masks or tissues when they sneeze in public areas. Most of the participants wash their hands when they suspect a possible transmission of the SARS-CoV-2 pathogen (94.6%) and clean or disinfect pathogen contamination-suspected areas at home (84.6%). The study also revealed that some participants (11.2%), due to a lower education, did not visit a medical clinic when they experienced possible symptoms of SARS-CoV-2 infection. Participants agreed with the health policies of KRG against the COVID-19 outbreak (90.8%).
Conclusions:
Some individuals do not adhere to preventive measures against SARS-CoV-2 infection.
Diagnostic testing to identify patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) plays a key role to control the coronavirus disease (COVID-19) pandemic. While several countries have implemented the use of diagnostic testing in a massive scale as a cornerstone for infection control and surveillance, other countries affected by the pandemic are hampered by its limited testing capacity. Pooled testing was first introduced in the 1940s and is now used for screening in blood banks. Testing is done by pooling multiple individual samples together. Only in the case of a positive pool test would individual samples of the pool be tested, thus substantially reducing the number of tests needed. Several studies regarding their use for SARS CoV-2 have been done in the United States, Israel, and Germany. Studies have shown that an individual positive sample can still be detected in pools of up to 32 samples, and possibly even 64 samples, provided that additional polymerase chain reaction (PCR) amplification cycles are conducted with a sensitivity of 96%. Simulation studies to determine optimal pool size and pooling techniques have also been conducted. Based on these studies, pooled testing is shown to be able to detect positive samples with sufficient accuracy and can easily be used with existing equipment and personnel for population-wide screening.
Cases of COVID-19 are rising quickly on the African continent. A critical element of any health system response to such a surge of active cases is the existence of functional emergency care systems. Yet, these systems are markedly underdeveloped in African countries. This short letter reviews the key role emergency medicine plays in epidemic disease response and actions that ministries of health can take now to shore up gaps in emergency care capacity to avoid needless death and suffering of COVID-19 patients.