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Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was one of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a “Swiss Cheese” risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from 1 August to 8 December 2020. There were 62,970 COVID-19 tests conducted with 1,435 people testing positive for a positivity rate of 2.28%. A total of 1,670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3,500 with approximately 80 of these positive (11 per day). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of one per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.
The aim of this study was to investigate the influences of sociodemographic data, mental disorder history, confusion and somatic discomfort triggered by social media on anxiety and depression symptoms among medical professionals during COVID-19 outbreak.
460 participants completed online questionnaires that included sociodemographic data, mental health disorder history, an assessment of confusion and somatic discomfort triggered by social media, and psychological disturbance. Hierarchical linear regression model was adopted to analysis the data.
The hierarchical linear regression model was able to explain 41.7% of variance in depression symptoms. Including: comorbidity with one mental disorder (B= 0.296, P < .001), confusion (B= 0.174, P < .001) and somatic discomfort (B=0.358, P<.001) triggered by social media. The hierarchical linear regression model was able to explain 41.7% of variance in anxiety symptoms, including: sex (B = -0.08, P < .005), comorbidity with one mental health disorder (B= 0.242, P < .001), confusion (B= 0.228, P < .001) and somatic discomfort (B=0.436, P<.001) triggered by social media.
These results suggest that it is important to provide adequate psychological assistance for medical professionals with mental health problems in COVID-19 to buffer the negative impact of social media.
To investigate the perceived effects of the coronavirus disease (COVID-19) pandemic lockdown measures on food availability, accessibility, dietary practices, and strategies used by participants to cope with these measures.
We conducted a cross-sectional multi-country online survey between May and July 2020. We used a study-specific questionnaire mainly based on the adaptation of questions to assess food security and coping strategies from the World Food Programme’s “Emergency Food Security Assessment” and “The Coping Strategy Index”.
The questionnaire was hosted online using Google Forms and shared using social media platforms.
A total of 1075 adult participants from 82 countries completed the questionnaire.
As a prelude to COVID-19 lockdowns, 62.7 % of the participants reported to have stockpiled food, mainly cereals (59.5% of the respondents) and legumes (48.8%). An increase in the prices of staples such as cereals and legumes, was widely reported. Price increases have been identified as an obstacle to food acquisition by 32.7% of participants. Participants reported having lesser variety (50.4%), quality (30.2%), and quantity (39.2 %) of foods, with disparities across regions. Vulnerable groups were reported to be facing some struggle to acquire adequate food, especially people with chronic diseases (20.2%), the elderly (17.3%), and children (14.5%). To cope with the situation, participants mostly relied on less preferred foods (49%), reduced portion sizes (30%), and/or reduced the number of meals (25.7%).
The COVID-19 pandemic negatively impacted food accessibility and availability, altered dietary practices and worsened the food insecurity situation, particularly in the most fragile regions.
There has been a reported increase in cases of domestic violence during the coronavirus disease (COVID-19) pandemic, however systematic research data is still unavailable. This study was conducted to find out domestic violence prevalence and coping strategies among married adults during lockdown due to COVID-19 in India.
A cross-sectional study was conducted among married men and women in the month of April 2020. Data regarding socio-demographic profile, domestic violence and coping strategies employed during lockdown was collected thorough google forms. 97.9% forms were completely filled by the respondents. Descriptive analysis was done.
Out of 94 study participants, about 7.4% (n=7) had faced domestic violence during lockdown. Out of these 7 participants, about 85.7% (n=6) reported increased frequency of domestic violence during lockdown. About half of the victims chose to ignore it (57.1%, n=4) or used yoga/meditation (42.9%, n=3) to cope.
With about 7.4% study participants facing domestic violence during lockdown, it is necessary to study its detailed epidemiology in pandemics so that interventions like helpline numbers, screening of patients during tele-consultation, etc. which can be delivered even during lockdown with the help of healthcare and frontline workers could be devised to address this problem.
To characterize and compare early coverage of COVID-19 in newspapers, television, and social media, and discuss implications for public health communication strategies that are relevant to an initial pandemic response.
Latent Dirichlet Allocation (LDA), an unsupervised topic modelling technique, analysis of 3,271 newspaper articles, 40 cable news shows transcripts, 96,000 Twitter posts, and 1,000 Reddit posts during March 4 - 12, 2020, a period chronologically early in the timeframe of the COVID-19 pandemic.
Coverage of COVID-19 clustered on topics such as epidemic, politics, and the economy, and these varied across media sources. Topics dominating news were not predominantly health-related, suggesting a limited presence of public health in news coverage in traditional and social media. Examples of misinformation were identified particularly in social media.
Public health entities should utilize communication specialists to create engaging informational content to be shared on social media sites. Public health officials should be attuned to their target audience to anticipate and prevent spread of common myths likely to exist within a population. This may help control misinformation in early stages of pandemics.
Utilisation of the Head and Neck Cancer Risk Calculator version 2 has been recommended during the coronavirus disease 2019 pandemic for the assessment of head and neck cancer referrals. As limited data were available, this study was conducted to analyse the use of the Head and Neck Cancer Risk Calculator version 2 in clinical practice.
Patients undergoing telephone triage in a two-week wait referral clinic were included. Data were collected and analysed using appropriate methods.
Sixty-four patients in the study were risk-stratified into low-risk (51.6 per cent, 33 of 64), moderate-risk (14.1 per cent, 9 of 64) and high-risk (34.4 per cent, 22 of 64) groups. Of the patients, 53.1 per cent (34 of 64) avoided an urgent hospital visit, and 96.9 per cent (62 of 64) were cancer free, while 3.1 per cent (2 of 64) were found to have a head and neck malignancy. The sensitivity, specificity, negative predictive value and accuracy were 50.00 per cent, 66.13 per cent, 99.92 per cent and 66.11 per cent, respectively.
It is reasonable to use the calculator for triaging purposes, but it must always be accompanied by a meticulous clinical thought process.
Injury patterns are closely related to changes in behavior. Pandemics and measures undertaken against them may cause changes in behavior; therefore, changes in injury patterns during the coronavirus disease 2019 (COVID-19) outbreak can be expected when compared to the parallel period in previous years.
The aim of this study was to compare injury-related hospitalization patterns during the overall national lockdown period with parallel periods of previous years.
A retrospective study was completed of all patients hospitalized from March 15 through April 30, for years 2016-2020. Data were obtained from 21 hospitals included in the national trauma registry during the study years. Clinical, demographic, and circumstantial parameters were compared amongst the years of the study.
The overall volume of injured patients significantly decreased during the lockdown period of the COVID-19 outbreak, with the greatest decrease registered for road traffic collisions (RTCs). Patients’ sex and ethnic compositions did not change, but a smaller proportion of children were hospitalized during the outbreak. Many more injuries were sustained at home during the outbreak, with proportions of injuries in all other localities significantly decreased. Injuries sustained during the COVID-19 outbreak were more severe, specifically due to an increase in severe injuries in RTCs and falls. The proportion of intensive care unit (ICU) hospitalizations did not change, however more surgeries were performed; patients stayed less days in hospital.
The lockdown period of the COVID-19 outbreak led to a significant decrease in number of patients hospitalized due to trauma as compared to parallel periods of previous years. Nevertheless, trauma remains a major health care concern even during periods of high-impact disease outbreaks, in particular due to increased proportion of severe injuries and surgeries.
The importance of zinc for human health becomes obvious during zinc deficiency. Even mild insufficiencies of zinc cause alterations in haematopoiesis and immune functions, resulting in a pro-inflammatory phenotype and a disturbed redox metabolism. Although immune system malfunction is the most obvious effect, the functions of several tissue cell types are disturbed if zinc supply is limiting. Adhesion molecules and tight junction proteins decrease while cell death increases, generating barrier dysfunction and possibly organ failure. Taken together, zinc deficiency both weakens the resistance of the human body towards pathogens and at the same time increases the danger of an overactive immune response that may cause tissue damage.
The case numbers of COVID-19 are still increasing, which is causing enormous problems for health systems and economies. There is an urgent need to reduce both the number of severe cases and the resulting deaths. While therapeutic options are still under investigation,and first vaccines have been approved, cost-effective ways to reduce the likelihood of or even prevent infection, and the transition from mild symptoms to more serious detrimental disease, are highly desirable. Nutritional supplementation might be an effective option to achieve these aims.
In this review, we discuss known zinc deficiency effects in the context of an infection with SARS-CoV-2 and its currently known pathogenic mechanisms and elaborate on how severe pre-existing zinc deficiency may pre-dispose patients to a severe progression of COVID-19. First published clinical data on the association of zinc homeostasis with COVID-19 and registered studies in progress are listed.
During the global COVID-19 pandemic, there has been guidance concerning adaptations that physical healthcare services can implement to aid containment, but there is relatively little guidance for how mental healthcare services should adapt service provision to better support staff and patients, and minimise contagion spread.
This systematic review explores service adaptations in mental health services during the COVID-19 pandemic and other contagions.
The Allied and Complementary Medicine database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Medline, PsycINFO and Web of Science were systematically searched for published studies from database inception to April 2020. Data were extracted focusing on changes to mental health services during contagion outbreaks. Data were analysed with thematic analysis.
Nineteen papers were included: six correspondence/point-of-view papers, five research papers, five reflection papers, two healthcare guideline documents and one government document. Analysis highlighted four main areas for mental health services to consider during contagion outbreaks: infection control measures to minimise contagion spread, including procedural and practical solutions across different mental health settings; service delivery, including service changes, operational planning and continuity of care; staff well-being (psychological and practical support); and information and communication.
Mental health services need to consider infection control measures and implement service changes to support continuity of care, and patient and staff well-being. Services also need to ensure they are communicating important information in a clear and accessible manner with their staff and patients, regarding service delivery, contagion symptoms, government guidelines and well-being.
China is ranked 42nd on the Global Terrorism Index (2019), a scoring system of terrorist activities. While China has a relatively low terrorism risk, events globally have wide-ranging repercussions for future attacks, putting first responders and emergency health workers at risk. This study aims to provide the epidemiological context for the past decade detailing the unique injury types responders are likely to encounter and to develop training programs utilizing these data.
The Global Terrorism Database (GTD) was searched for all attacks in China between the years 2008-2018. Attacks met inclusion criteria if they fulfilled the terrorism-related criteria as set by the GTD’s Codebook. Ambiguous events, as defined by the GTD’s Codebook, were excluded. English language grey literature was searched to ensure no events meeting these criteria were missed. A focused search of online English language newspaper articles was also performed for any terrorist events between 2008-2018.
One-hundred and eight terrorist events occurred in the study time period. Of the 108 incidents, forty-seven (43.5%) involved Explosives/Bombs/Dynamite (E/B/D) only, with an average fatality count of 2.9 and injury count of 7.5 per event. Twenty-seven (25.0%) used bladed or blunt weapons in melees with an average fatality count of 9.7 and an injury count of 8.8 per event. Five (4.6%) involved incendiary weapons with an average fatality count of 2.4 and an injury count of 7.2 per event. Two used only chemical weapons (1.8%) with no recorded deaths and an injury count of 27.0 per event. Two events had unknown weapon types (1.8%) with one recorded death and no injury count. One event used a firearm (0.9%) and led to one death and no injuries. One event used a vehicle (0.9%), which also led to one death and no recorded injuries. Twenty-three attacks used a mix of weapons (21.2%) with an average fatality count of 17.1 and an injury count of 12.0 per event.
One-hundred and eight terrorist attacks were recorded between 2008-2018 on Chinese soil using well-understood modalities. This resulted in a total of 809 recorded fatalities with 956 non-fatal injuries. The most commonly chosen methodology was E/B/D, followed by melees and the use of bladed weapons. Three events individually recorded a combined casualty toll of over 100 people.
By nature of their specialty, otolaryngologists are disproportionately exposed to coronavirus disease 2019 through aerosol-generating procedures and close proximity to the oropharynx during examination.
Our single-centre, retrospective study analysed the pertinence of guidelines produced by ENT UK to improve the investigation and management of suspected upper aerodigestive fish bone foreign bodies during the coronavirus disease 2019 pandemic.
Our results demonstrated 43.3 per cent (n = 13) low-risk cases and 56.7 per cent (n = 17) moderate-risk cases. Nine fish bones (two low risk, seven moderate risk) were found; none of these were confirmed with X-ray and three (moderate risk) required nasoendoscopy for diagnosis. One patient required rigid pharyngoscopy.
This study confirms that soft tissue neck X-ray and flexible nasoendoscopy are unnecessary in low-risk cases; however, early nasoendoscopy in higher suspicion cases is appropriate. Recommendations are made about the long-term sustainability of these guidelines, and additional measures are encouraged that relate to repeat attendances and varying prevalence of coronavirus disease 2019 in the hospital catchment area.
Health care organizations have been challenged by the coronavirus disease 2019 (COVID-19) pandemic for some time, while in January 2020, it was not immediately suspected that it would take such a global expansion. In the past, other studies have already pointed out that health care systems, and more specifically hospitals, can be a so-called “soft target” for terrorist attacks. This report has now examined whether this is also the case in the context of the COVID-19 pandemic.
During the lockdown, hospitals turned out to be the only remaining soft targets for attacks, given that the other classic targets were closed during the lockdown. On the other hand, other important factors have limited the risk of such attacks in hospitals. The main delaying and relative risk-reducing factors were the access control on temperature and wearing a mask, no visits allowed, limited consultations, and investigations.
But even then, health care systems and hospitals were prone to (cyber)terrorism, as shown by other COVID-19-related institutions, such as pharmaceuticals involved in developing vaccines and health care facilities involved in swab testing and contact tracing. Counter-terrorism medicine (CTM) and social behavioral science can reduce the likelihood and impact of terrorism, but cannot prevent (state-driven) cyberterrorism and actions of lone wolves and extremist factions.
SARS-CoV-2 has rapidly spread worldwide, threatening public health and financial and social life.
The current study's aim was to determine the prevalence of psychological distress and post-traumatic stress symptoms in the Greek population during the first COVID-19 lockdown, and to detect potential correlates.
An anonymous online survey was conducted between 10 April and 4 May 2020, to collect information regarding people's psychological functioning and COVID-19-related perceptions.
A total of 1443 individuals completed the survey; 293 (20%) reported clinically significant anxiety symptoms, 188 (12.9%) reported clinically significant depressive symptoms and 506 (36.4%) suffered from definite post-traumatic stress disorder. Anxiety symptoms were independently associated with female gender (β = 1.281, 95% CI 0.808–1.755, P < 0.001), educational level (β = −1.570, 95% CI −2.546 to −0.595, P = 0.002), perceived severity (β = −1.745, 95% CI −3.146 to −0.344, P = 0.015) and COVID-19-related worry (β = 7.633, 95% CI 6.206–9.060, P < 0.001). Depressive symptoms were strongly correlated with educational level (β = −1.298, 95% CI −2.220 to −0.377, P = 0.006), perceived severity (β = −1.331, 95% CI −2.579 to −0.082, P = 0.037) and COVID-19-related worry (β = 4.102, 95% CI 2.769–5.436, P < 0.001). Finally, post-traumatic stress symptoms were linked to female gender (β = 6.451, 95% CI 4.602–8.299, P < 0.001), educational level (β = −5.737, 95% CI −9.479 to −1.996, P = 0.003), psychiatric history (β = −4.028, 95% CI −6.274 to −1.782, P < 0.001) and COVID-19-related worry (β = 23.865, 95% CI 18.201–29.530, P < 0.001).
A significant percentage of the population reported clinically important anxiety, depressive and post-traumatic stress symptoms. Women, less-educated individuals and people with a psychiatric history appeared more vulnerable to the pandemic's psychological impact.
Concerns have emerged regarding infection transmission during flexible nasoendoscopy.
Information was gathered prospectively on flexible nasoendoscopy procedures performed between March and June 2020. Patients and healthcare workers were followed up to assess for coronavirus disease 2019 development. One-sided 97.5 per cent Poisson confidence intervals were calculated for upper limits of risk where zero events were observed.
A total of 286 patients were recruited. The most common indication for flexible nasoendoscopy was investigation of ‘red flag’ symptoms (67 per cent). Forty-seven patients (16 per cent, 95 per cent confidence interval = 13–21 per cent) had suspicious findings on flexible nasoendoscopy requiring further investigation. Twenty patients (7.1 per cent, 95 per cent confidence interval = 4.4–11 per cent) had new cancer diagnoses. Zero coronavirus disease 2019 infections were recorded in the 273 patients. No. 27 endoscopists (the doctors and nurses who carried out the procedures) were followed up.The risk of developing coronavirus disease 2019 after flexible nasoendoscopy was determined to be 0–1.3 per cent.
The risk of coronavirus disease 2019 transmission associated with performing flexible nasoendoscopy in asymptomatic patients, while using appropriate personal protective equipment, is very low. Additional data are required to confirm these findings in the setting of further disease surges.
Australia is ranked 71st on the Global Terrorism Index (GTI; 2019), a scoring system of terrorist activities. While it has a relatively low terrorist risk, events globally have wide-ranging repercussions putting first responders and emergency health workers at risk. Counter-Terrorism Medicine (CTM) is rapidly emerging as a sub-specialty needed to address these threats on the front line. This study aims to provide the epidemiological context for the past decade, detailing the unique injury types responders are likely to encounter, and to develop training programs utilizing these data.
The Global Terrorism Database (GTD) was searched for all attacks in Australia from the years 2009-2019. Attacks met inclusion criteria if they fulfilled the following terrorism-related criteria as set by the GTD. Ambiguous events were excluded when there was uncertainty as to whether the incident met all of the criteria for inclusion as a GTD terrorist incident. The grey literature was reviewed, and each event was cross-matched with reputable international and national newspaper sources online to confirm or add details regarding weapon type used, and whenever available, details of victim and perpetrator fatalities and injuries.
Thirty-seven terrorist events occurred in the study time period. Of the thirty-seven incidents, twenty-six (70.2%) involved incendiary weapons, five (13.5%) involved firearms, four (10.8%) involved melee (bladed weapon/knife) attacks, two (5.4%) were explosive/bombing/dynamite attacks, and one (2.7%) was a mixed attack using both incendiary and melee weapons. All except one firearms-related incident (four out of five) resulted in either a fatality or injury or both. Every melee incident resulted in either a fatality or injury or both.
In the decade from 2009 to 2019, terrorist attacks on Australian soil have been manageable, small-scale incidents with well-understood modalities. Eleven fatalities and fourteen injuries were sustained as a result of terrorist events during that period. Incendiary weapons were the most commonly chosen methodology, followed by firearms, bladed weapons, and explosive/bombings/dynamite attacks.
Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre.
After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019.
An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients.
Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.
Although the COVID-19 pandemic had claimed over one million lives globally by late 2020, Africa had avoided a massive outbreak. Patterson and Balogun analyze pandemic responses by the Africa Centres for Disease Control and Prevention and various states collaborating with civil society. They argue that responses display forms of agency rooted in contextually relevant expertise, pan-African solidarity, and lessons learned about health messaging and community mobilization from previous health crises. Yet collaboration has not always been harmonious, as actors have adopted various approaches in their interactions with global health institutions and civil society partnerships, and they have actively debated the use of traditional medicine as a COVID-19 treatment.
The coronavirus disease 2019 (COVID-19) pandemic has had a considerable impact on US hospitalizations, affecting processes and patient population.
We evaluated the impact of COVID-19 pandemic in 78 US hospitals on central line associated bloodstream infections (CLABSI) and catheter associated urinary tract infections (CAUTI) events 12 months pre-COVID-19 and 6 months during COVID-19 pandemic.
There were 795,022 central line-days and 817,267 urinary catheter-days over the two study periods. Compared to pre-COVID-19 period, CLABSI rates increased during the pandemic period from 0.56 to 0.85 (51.0%) per 1,000 line-days (p<0.001) and from 1.00 to 1.64 (62.9%) per 10,000 patient-days (p<0.001). Hospitals with monthly COVID-19 patients representing >10% of admissions had a NHSN device standardized infection ratio for CLABSI that was 2.38 times higher compared to those with <5% prevalence during the pandemic period (p=0.004). Coagulase-negative staphylococcus CLABSI increased by 130% from 0.07 to 0.17 events per 1,000 line-days (p<0.001), and Candida sp. by 56.9% from 0.14 to 0.21 per 1,000 line-days (p=0.01). In contrast, no significant changes were identified for CAUTI (0.86 vs. 0.77 per 1,000 catheter-days; p=0.19).
The COVID-19 pandemic was associated with substantial increases in CLABSI but not CAUTI events. Our findings underscore the importance of hardwiring processes for optimal line care, and regular feedback on performance to maintain a safe environment.
King Saud Medical City (KSMC) is a quaternary care center based in the center of the capital city, Riyadh, Kingdom of Saudi Arabia (KSA) and is one of the key Ministry of Health (MoH) facilities dedicated to the care of COVID-19 patients in the central region.
A comprehensive surge plan was promptly launched in mid-March 2020 to address the pandemic and then expanded in a phase-wise approach. Supporting the capacity of the infection prevention and control department (IPCD) was one of the main pillars of KSMC surge plan. Task force Infection Control teams have been formulated to tackle the different aspects of pandemic containment processes. The challenges and measures undertaken by the IPC team have been described.
Realizing the more prominent role of infection prevention and control staff as frontline responders to public health emergencies like COVID-19, a solid infection prevention and control system at the healthcare setting supported by qualified and sufficient manpower, a well-developed multidisciplinary team approach, electronic infrastructure and efficient supply utilization is required for effective crisis management.
Peritonsillar abscess, or quinsy, is one of the most common emergency presentations to ENT departments, and is the most common deep tissue infection of the head and neck. In the UK, junior members of the ENT team are regularly required to independently assess, diagnose and treat patients with peritonsillar aspiration or incision and drainage.
Inexperienced practitioners can stumble at several obstacles: poor access due to trismus; poor lighting; difficulty in learning the therapeutic procedure; and difficulty in accurately documenting findings and treatment.
To counter these and other difficulties, the authors describe the routine use of video endoscopy as a training tool and therapeutic adjunct in the management of quinsy.