Table of Contents
Editorial in Public Health and COVID-19
Tribute to healthcare operators threatened by the COVID-19 pandemic
Authors: Francesco CHIRICO1, Gabriella NUCERA2
1 M.D., Contract Professor, Health Service Department, State Police, Ministry of Interior, Italy. Post-Graduate Specialization of Occupational Medicine, Università Cattolica del Sacro Cuore, Roma, Italy.
2 M.D., Contract Professor, Department of Medicine, ASST Fatebenefratelli Sacco, PO Fatebenefratelli, Milan, Italy
Keywords: COVID-19; emergency; healthcare; healthcare system; public health preparadness; spirituality.
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Viewpoint in Psychology and Public Health
Health professionals and COVID-19 pandemic: Heroes in a new war?
Authors: Angelo R. PENNELLA1, Angela RAGONESE2
1 Psychologist, Psychotherapist, Lecturer in Clinical Psychology at the Specializing School in Health Psychology of the Sapienza University of Rome, Italy
2 Psychologist, Specialist in psychoanalytic psychotherapy.
The SARS-CoV-2 pandemic has forced many countries to face a serious health emergency. Together with the exponential growth of SARS-CoV-2 positive patients, cases in intensive care units and deaths, a collective definition developed in which the health was represented as a ‘war’ and doctors, and more generally health workers, as ‘heroes’. The metaphor of the war in medicine is not unusual; but the fact that many doctors have rejected the representation of themselves as heroes invites us to reflect on the meaning and possible implications of these metaphor. The article presents some psychological reflections on the sense of representing the doctor as a hero and on the connections that this representation has with biomedical and biopsychosocial models, but also with the doctor-patient relationship.
Keywords: COVID-19; healthcare workers; physician patient relationship; Physicians well-being.
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Viewpoint in Research and COVID-19
Guidance for research on the COVID-19 disease in times of pandemic
Author: Oya KALAYCIOGLU1
1 PhD, Assistant Professor, Department of Biostatistics and Medical Informatics, Bolu Abant Izzet Baysal University, Bolu, Turkey
This study is aimed at examining the manner of use of internet and phone surveys and making suggestions related to sample selection strategies during the COVID-19 outbreak. As the influence of the COVID-19 pandemic spreads worldwide, many researchers are engaged in telephone and internet surveys to assess the socioeconomic impacts of the outbreak of the disease and the emerging needs of societies during this period. However, the data collection methods requiring access to technology and the ability to use it may lead to under-representativeness of socioeconomically deprived groups. In emergency situations, although this can be a legitimate limitation, it should be reported by the researchers and optimal effort should be made to increase representativeness. In order to ensure that the population is adequately represented with a sample, the choice of survey mode and sampling strategy should be determined based on the research objectives, socio-demographic characteristics of the target population and the available resources. However, most survey research being conducted during the outbreak of COVID-19 disease lack proper justification of the sampling strategy used and neglect to address the limitations due to under-represented communities. This may consequently result in misleading and overgeneralized findings. Therefore, guidance to researchers concerning appropriate survey methods and sample selection strategies that could be used in surveys during the COVID-19 pandemic are needed. The comparison of advantages and disadvantages of different survey strategies presented in this study are expected to contribute to the methodological literature in data collection.
Keywords: COVID-19 research; data collection; research methodology; survey methods; survey sampling.
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Viewpoint in Global Public Health and COVID-19 Research
Physical activity at home during the COVID-19 lockdown in India: Need of the hour for optimum physical health and psychological resilience
Authors: Suraj CHAWLA1, Manisha KOCHER2
1 MD, Associate Professor, Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India
2 MPT, Physiotherapist, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, India.
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the most recently discovered Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2). World Health Organization (WHO) has advised certain precautions to shield uninfected people and prevent the spread of COVID-19 like frequent cleaning of hands with soap and water or alcohol-based rub, avoid touching eyes, nose and mouth with the hands, follow good respiratory hygiene and exercise physical distancing measures. The closure of gyms, fitness clubs, parks, and other public places due to lockdown and other social distancing measures, however, is challenging the physically active lifestyle, particularly for those who are not habitual to exercise at home. Regular physical activity benefits both physical and mental health. It can reduce high blood pressure, help manage overweight, improve immune regulation, reduce the risk of getting heart disease, type 2 diabetes, stroke, and various cancers- all conditions which increase vulnerability to COVID-19. In this viewpoint we overview several ways to stay active and reduce sedentary behavior while at home such as short active breaks and exercises, breaking up sitting, using online resources for being active, deep breaths, and meditation. Maintaining regular physical activity using the aforementioned measures in a safe home environment is an important strategy for physical health and emotional resilience during the coronavirus crisis.
Keywords: COVID-19; lockdown; physical activity; physical health; psychological resilience.
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Systematic Review in Medical Engineering and Infectious Diseases
A systematic review with narrative synthesis on medical robotics and laboratory automation in the control of SARS-CoV-2, Ebola and H1N1 (Swine Flu) viruses
Authors: Shantani KANNAN1, Kannan SUBBARAM2, Sheeza ALI3, Hemalatha KANNAN4
1 B.E., Department of Electronics and Communication Engineering, Kumaraguru College of Technology, Coimbatore, India
2 M.Sc., PhD, School of Medicine, The Maldives National University, Male’, Maldives
3 MBBS, MBA, MCPS, FCPS, School of Medicine, The Maldives National University, Male’, Maldives
4 M.Sc., PhD, Department of Laboratory Sciences & Pathology, Jimma University, Jimma, Ethiopia
Introduction: Medical robotics is a rapidly growing aspect of the modern health care landscape. The aim of this paper was to review the availability of robotic technology and laboratory automation in the control of SARS-CoV-2, Ebola and H1N1 (Swine Flu) viruses.
Methods: A systematic review with narrative synthesis was conducted using the following databases: MEDLINE / PubMed, SCOPUS, Web of Science, Science Direct and Google Scholar to retrieve studies regarding the use of robots and automated lab technologies, with appropriate MeSH terms and in accordance with the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines. A narrative synthesis was performed to synthesize the findings of the different studies.
Results: A total of 250 articles were selected and 30 articles were included in this systematic review. Our findings indicate that robotic technology and automated laboratories have a promising approach, while handling biosafety level – 3 & 4 (BSL-3 & 4) biological agents. In case of epidemics with high case fatality ratio (Ebola virus) or high human-to-human transmission (SARS-CoV-2), healthcare workforce are at high risk. Thus, if robots are employed in such settings, it is possible to minimize intra-hospital transmission of these infections to the highest degree.
Discussion and Conclusion: Medical robotics and lab automation may be utilized as a strategic approach in containing the spread of infectious diseases like SARS-CoV-2, Ebola and Swine Flu Pandemic (H1N1). However, in the next future, many clinical trials and further tests are needed to determine the effectiveness of this technology, in order to balance advantages and risk factors involved.
Keywords: Ebola Virus; Human Coronavirus; Infectious Disease Transmission; Lab-On-A-Chip Devices; Robot-Enhanced Procedures; Robotics.
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Mini Review in Public Health and COVID-19
SARS and MERS as learning tools for addressing the 2019-nCoV epidemic: A mini-review
Authors: Udit DAVE1, Ashwin PALANIAPPAN2
1 B.S., Georgetown University, Washington, D.C., U.S.A.
2 A.B. Candidate, Brown University, Providence, Rhode Island, U.S.A.
The novel Coronavirus (2019-nCoV), named SARS-COV-2, originating in the Wuhan district of China, has reached pandemic proportion with a death toll that is steadily rising. Coronaviruses are classified by their distinct genomic make-up and have been in the spotlight due to their ability to cause fatal epidemics across national borders. Issues such as sub-par personal hygiene, overcrowding, and mass panic exacerbated the spread of the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and Middle East Respiratory Syndrome coronavirus (MERS-CoV), serving as crucial lessons for understanding the 2019-nCoV. Heightened sanitation measures with regards to waste disposal in healthcare clinics and in areas of mass transit are also of great importance. The 2019-nCoV is a concern for many different countries and governments of all levels due to its negative effects on public morale, national economies, and health standards and outcomes. There is an immense capacity to use past approaches to SARS and MERS epidemics to influence the design of strategies to control the 2019-nCoV epidemic. The 2019-nCoV has infected more individuals than previous coronaviruses SARS and MERS. In this minireview, we evaluated the SARS and MERS epidemics to provide context to the strategies against 2019-nCoV. We further identified drawbacks in the global approach to combating SARS and MERS to inform policies to curb 2019-nCoV.
Keywords: 2019-nCoV; Coronavirus, Covid-19; epidemic; governments; MERS CoV, policies; SARS CoV.
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Narrative Review in Public Health
The relationship between bats and human coronavirus: An exploratory review
Authors: Sajal BHATTACHARYA1, Shakya SINHA2, Rina TILAK3, Sugeng Juwono MARDIHUSODO4
1 Professor (Associate), Postgraduate Department of Zoology, Asutosh College (University of Calcutta), Kolkata, West Bengal, India.
2 Master of Science student, Postgraduate Department of Zoology, Dinabandhu Andrews College (University of Calcutta), Kolkata, West Bengal, India.
3 Scientist ‘G’, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India.
4 Professor, Faculty of Public Health, University of Malahayati, Bandar Lampung, Indonesia..
Introduction: Bats are known to harbour several coronaviruses including the progenitor of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which has caused COVID-19 pandemic. The emergence of SARS-CoV-2 has unwittingly fueled widespread apprehension and fear in the general public about bats. Aim of this paper was to review human coronaviruses in bats, the possible transmission dynamics of bat-borne viruses, and the impact of deforestation and climate change on bats.
Methods: A narrative review was conducted by using electronic databases- PubMed/Medline, Google scholar, Wiley Online Library, Semantic Scholar, and medXiriv- for searching all types of peer-reviewed and not peer-reviewed articles in English language, published from 2002 to 2020. All the findings and observations in this review were listed in references and main findings were summarized in a table.
Results: Certain species of bats are being progressively acknowledged as important natural reservoirs for several groups of viruses; some of which cause epidemics. Anthropogenic activities like encroachment of wildlife habitat, deforestation, developmental activities and close encounter with wild animals, cause disturbances in ecosystem functioning. This ecological imbalance threatens the bat populations and creates selection pressure leading to random mutations in the viruses. This may eventually cause viral spillover to humans and other animal hosts due to forced proximity, leading to outbreaks of novel diseases. Although bats are considered likely reservoirs of most of the human coronaviruses causing epidemics, yet they cannot be considered as a public health threat as the transmission dynamics is influenced by human behavior/ activities.
Conclusion: The complex eco-epidemiological situation calls for a judicious approach in assessing the role of bats in nature. Bats, on their own, may not pose public health threat, however there is a need to adopt comprehensive environmental health management policies based on the principles of conservation medicine to address this likely public health threat from bats.
Keywords: Human Coronaviruses, Public health threat, Deforestation, Threatened Bat population, Ecological imbalance.
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Original Article in Public Health and COVID-19
Are women leaders significantly better at controlling the contagion during the COVID-19 pandemic?
Authors: Soumik PURKAYASTHA1, Maxwell SALVATORE1,2, Bhramar MUKHERJEE1,2*
1 Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA.
2 Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA.
Introduction: Recent media articles have suggested that women-led countries are doing better in terms of their responses to the COVID-19 pandemic. The aim of this paper is to examine an ensemble of public health metrics to assess the control of COVID-19 epidemic in women- versus men-led countries worldwide based on data available up to June 3.
Methods: We restrict our analysis to 159 countries with at least 100 cumulative reported cases of COVID-19 infections and at least 10 days of reported data as of June 3, 2020. We compared in women- versus men-led countries the trajectory of time varying reproduction number R(t) as well as most recent values of R(t) and other metrics of viral transmission such as doubling time and case-fatality rates. A two-sample bootstrap procedure-based comparison of medians and construct 95% confidence interval (95% CI) based on empirical 2.5th and 97.5th percentile of the bootstrap distributions were used.
Results: The median of the distribution of median time-varying effective reproduction number for women- and men-led countries were 0.89 and 1.14 respectively with the 95% two-sample bootstrap-based confidence interval for the difference (women – men) being -0.34 to 0.02. In terms of scale of testing, the median percentage of population tested were 3.28% (women), 1.59% (men) [95% CI -1.29% to 3.60%)] with test positive rates of 2.69% (women) and 4.94% (men) respectively.
Conclusion: It appears that though statistically not significant, countries led by women have an edge over countries led by men in terms of public health metrics for controlling the spread of the COVID-19 pandemic worldwide.
Keywords: COVID-19; leaders; public health; healthcare policy; social support; women.
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Original Article in Infectious Diseases
Ebola Virus and SARS-CoV-2: Similarities and Differences
Authors: Robert C. SIZEMORE1, Md S. ZAMAN1,2
1 Ph.D, Department of Biological Sciences, Alcorn State University, Alcorn State, MS. 39096, USA
2 Ph.D, Department of Biology, South Texas College, McAllen, TX. 78501, USA.
Ebola virus and the novel coronavirus of 2019, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) share many similarities in origin although transmission, morbidity and mortality are vastly different. In both cases the viruses are zoonotic pathogens and are thought to have originated in bats. The intermediate animals for Ebola virus include primates, antelopes and various rodents, and contact with these animals resulted in infection of humans. As of this writing, the intermediate host for SARS-CoV-2 remains a mystery although pangolins have been implicated. Ebola virus disease is spread by direct contact with body fluids and is not considered to be an airborne disease. SARS-CoV-2 is a respiratory tract infection, is highly infectious (more contagious than previous SARS-CoV and MERS-CoV, two betacoronaviruses causing the Severe Acute Respiratory Syndrome or SARS, and the Middle East Respiratory Syndrome, respectively) and is spread via airborne means. The other main difference is in regard to pathology and mortality. The Zaire Ebolavirus strain was 90% fatal and was eventually contained to small areas whereas fatality of SARS-CoV-2, as of this writing varies apparently across countries (from 2.1 % in Turkey to 12.8 % in Italy and Belgium) although the precise case fatality ratio is still unknown. The fact that most SARS-CoV-2 cases have resulted in asymptomatic or in a mild disease (COVID-19) mimicking a common cold or flu, has made it difficult to contain the infection. Infected individuals may think they have a seasonal cold, contact others and travel to new areas where the disease can spread. This has resulted in COVID-19 becoming a pandemic, which is currently going throughout the world. Therefore, a final picture for a more precise comparison between these two infections may be concluded in the next months.
Keywords: COVID-19; SARS-CoV-2; coronavirus; Ebola virus
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Original Article in Public Health and Infectious Diseases
Early measures for prevention and containment of COVID-19 in the Maldives: A descriptive analysis
Authors: Mariyam SUZANA¹, Sheena MOOSA2, Fathmath Nazla RAFEEG3, Sofoora K. USMAN4
1 PhD, The Maldives National University, Male City, Republic of Maldives
2 MBBS,PhD, The Maldives National University, Male City, Republic of Maldives
3 MBBS, MPH, Ministry of Health, Male City, Republic of Maldives. Health Protection Agency, Male City, Republic of Maldives.
4 MSc, Ministry of Health, Male City, Republic of Maldives. Health Protection Agency, Male City, Republic of Maldives.
Introduction: The Maldives attracts more than one million travelers annually placing it at a high risk of imported epidemic-prone diseases; and it has one of the most congested capital cities in the world making it a conducive environment for infectious diseases. This study describes the early measures for prevention and containment of COVID-19 that contributed to delaying the pandemic entry into the country and helped contain the first wave of the outbreak in the Maldives.
Methods: This is a descriptive study of publicly available secondary data. Social media channels, websites of stakeholder agencies, developmental and technical agencies both nationally and internationally during 1st December 2019 to 30th March 2020 were analysed.
Results: The government of Maldives initiated its first public health measures as early as January and as of March 2020, levied more than two hundred interventions to combat the outbreak of COVID-19. Unlike many countries, which imposed restrictions for weeks at a stretch, Maldives applied a strategy of gradual intensification of measures, imposed localized restrictive measures compared to a national lockdown and used multiple communication mechanisms to educate and engage the community. The public-private partnerships explored were strategic in mitigating the loss of income to the tourist industry as well as in breaking the chain of transmission. Maldives delayed the entry of the pandemic into the country by about 90 days, and maintained its testing rate at fourth highest among United Nations Small Island Developing States and highest among the South East Asian countries.
Conclusion: The management of a global pandemic in a resource constrained, tourism reliant, and import-oriented vulnerable economy requires decisive leadership, collective effort of multiple stakeholders, strategic partnerships, and a precedence for public health measures over economic considerations. Further stringent measures and stricter compliancy are needed to combat community transmission of the disease.
Keywords: COVID-19; Maldives; preventive measures; public health; Small Island Developing States.
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Original Article in Psychiatric Services and COVID-19
COVID-19 in India: Health implications and treatment needs of people who use drugs (PWUD) and patients with substance use disorders (SUD)
Author: Gautam Kr GHOSH1
1 Ph.D., PG in Management of Reproductive Child Health, Research Scientist, Virology, National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research & National Consultant, National AIDS Control Organization under Ministry of Health & Family Welfare, India.
Introduction: The COVID-19 induced lockdown in India had put large number of people who use drugs (PWUD) in panicky over their craving for substance use with supply chain disruptions. Aim of this paper was to understand the COVID-19 induced problems faced by PWUD and those with substance use disorders (SUD) in India.
Methods: A rapid qualitative research was conducted remotely from May to early June 2020, during lockdown period in India, with consent-based in-depth interviews with key stakeholders from national agencies and drug deaddiction center in East and Northern-East India.
Results: The current public health crisis raises serious additional concerns for the wellbeing of PWUD as they run the same risks of infection by COVID-19 due to underlying chronic medical conditions. During the current COVID-19 pandemic, there has been persistent lacking of treatment services for patients with substance use disorders (SUD). Those who needed treatment during lockdowns faced problems as government supported drug deaddiction centers, which stopped new admission but lately started new admission but in reduced numbers. The outpatient services of drug treatment centers (DTC) at some government hospitals could not operate. The Opioid Substitution Therapy centers, though started dispensing of methadone on biweekly and buprenorphine on seven-day refill basis, yet there remained travel related problems and reported harassment during lockdown stage.
Conclusion: Specific measures to mitigating health service needs of PWUD in India should be put in place, taking lessons from the current pandemic situation.
Keywords: Deaddiction, drug treatment centers; drugs; India; lockdown; People Who Use Drugs (PWUD); People with Substances Use Disorders (SUD); Substance Use Disorders; treatment; opioid substitution therapy.
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