COVID doi: 10.3390/covid6080138

Authors: Jyotpal Singh Payam Dehghani Rishi Thakkar Chase J. Ellingson Kevin R. Bainey G. B. John Mancini Cindy Grines Ehtisham Mahmud Shy Amlani Ross Garberich Odayme Quesada Santiago Garcia Timothy D. Henry

The COVID-19 pandemic presented a unique opportunity for researchers to use pragmatic methods to obtain information about the virus and promptly disseminate the findings for healthcare providers to utilize them. One such approach to studying patients who presented with COVID-19 and ST-Elevation Myocardial Infarction (STEMI) was the development of the North American COVID-19 STEMI (NACMI) registry. By leveraging social media and communication platforms such as WhatsApp, cardiologists across North America initiated the development of the NACMI registry within 14 days—an accomplishment which was unfathomable pre-pandemic. This was followed by ethics approval through a centralized Institutional Review Board, which led to patient consent being waived, and the use of a single coordinating center (Minneapolis Heart Institute Foundation) responsible for sites, database, and analysis. The NACMI findings were published rapidly across various media, including high-profile cardiovascular journals. Early results demonstrated an elevated mortality rate, disproportionality based on race, and angiographic differences showing unique mechanistic differences in the etiology of STEMI due to COVID-19. Additionally, NACMI provided early evidence that vaccination for COVID-19 reduced the risk of mortality in those with COVID-19 and STEMI. NACMI provided a framework for informing cardiologists early on regarding the optimal treatment of STEMI in patients with COVID-19. The lessons learned may be valuable for developing policy in future pandemics to treat patients using real-world application and routinely collected variables.

COVID doi: 10.3390/covid6080137

Authors: Domna Tichala Dimitrios Papagiannis Ourania S. Kotsiou

Due to an inadvertent omission during the submission process, an additional affiliation was not included for Domna Tichala, Dimitrios Papagiannis and Ourania S. Kotsiou in the published publication [...]

COVID doi: 10.3390/covid6080136

Authors: Marcia Liane Klauck Santos Catiele Raquel Schmidt Edna Ribeiro de Jesus Camila Xavier Dalcól Michelle Mariah Malkiewiez Gabriela Marcellino de Melo Lanzoni Darlisom Sousa Ferreira David Eduardo González Naranjo Luana Amaral Alpirez Elisiane Lorenzini

Care transition comprises integrated actions that ensure individualized, multidimensional care and became especially relevant after COVID-19 due to complications, readmissions, and fragmented healthcare delivery. The aim this study was to assess care transition care quality for post-COVID-19 patients using the Care Transition Measure (CTM-15) and its association with sociodemographic and clinical variables. This cross-sectional quantitative study included 176 post-COVID-19 patients or caregivers from a Brazilian public hospital (2020–2021). Data were collected by telephone within 30 days after discharge using a sociodemographic/clinical questionnaire and the CTM-15. The results demonstrated that care transition quality was rated as satisfactory. The highest scores were observed in health management preparation and the lowest in understanding medications. Better evaluations were associated with younger age, higher income, influenza diagnosis, and non-smoking status, whereas diabetes and chronic obstructive pulmonary disease negatively influenced care plan scores. In conclusion, care transition quality was satisfactory and influenced by sociodemographic and clinical factors, highlighting the importance of individualized discharge planning.

COVID doi: 10.3390/covid6080135

Authors: Humaira Mujeeb Steven Jones Hayley J. Lowther-Payne Fiona Lobban

The COVID-19 pandemic affected maternal mental health in the UK, increasing postpartum emotional distress. This scoping review identified forms of postpartum emotional distress (PPED) examined during the pandemic, the methodologies and assessment tools used, analytical approaches, reported limitations, future research directions, and overall findings. This review followed Arksey and O’Malley’s framework and the Joanna Briggs Institute scoping review guidelines. A comprehensive, keyword-based search strategy was applied across electronic databases, initially on 28 January 2023, and updated on 20 July 2023, and 3 September 2025. Strict inclusion criteria were used, and data from eligible studies were charted and synthesised. This review of 35 UK studies on postpartum emotional distress (PPED) during COVID-19 found a dominant focus on depression and anxiety, with other PPED forms largely neglected. Quantitative designs overwhelmingly outnumbered qualitative and mixed-method approaches. Common limitations included low sample diversity, reliance on online self-report surveys, cross-sectional designs, convenience sampling, and social-media-based recruitment. This review is the first to map research approaches used to explore postpartum emotional distress (PPED) during COVID-19 in the UK. The limitations and future research directions identified in this review highlight an urgent need for more diverse sampling, longitudinal study designs, qualitative research exploring women’s lived experience narratives of different forms of postpartum emotional distress, greater consideration of biopsychosocial factors, and evidence-based interventions.

COVID doi: 10.3390/covid6080134

Authors: Ricardo S. S. Durães Gisângela Faria de Paula Andreza C. Both Casagrande Elaine R. Neiva Cristiana C. A. Rocca Antonio P. Serafim

Background: Brazilian psychologists faced heightened occupational and emotional demands during the COVID-19 peak, yet evidence on longer-term changes in distress and self-care is limited. This repeated cross-sectional study compared psychological distress and multidimensional self-care among Brazilian psychologists at the pandemic peak (T1: April 2021; n = 578) and three years later (T2: April 2024; n = 524). Methods: Distress (DASS-21) and self-care indicators (perceived self-care, working hours, work–life balance, psychotherapy/psychiatric care) were assessed. Blockwise OLS and logistic models (M0–M3) estimated time differences; dose–response and moderation analyses used adjusted marginal means with FDR correction. Results: Anxiety and stress were lower at T2 (M3: anxiety β = −1.53; stress β = −2.08; p < 0.001), whereas depression showed no statistically significant change in fully adjusted models (β = −0.37, p = 0.456), with only a modest downward tendency evident in unadjusted and nonparametric comparisons. Clinically elevated (Moderate+) anxiety decreased robustly (OR = 0.56), while the reduction in Moderate+stress was attenuated after full adjustment (OR = 0.71, p = 0.049) and did not remain significant after FDR correction. Perceived self-care showed a dose–response association with lower distress, and stress declined most among telehealth and hybrid practitioners. Conclusions: Three years post-peak, anxiety and stress were lower, whereas depression showed no clear change in fully adjusted models, indicating heterogeneous recovery. Self-care and work conditions were key associated factors, underscoring the need for sustained workforce well-being strategies. Because the design was repeated cross-sectional, these findings reflect sample-level trends rather than within-person change.

COVID doi: 10.3390/covid6080133

Authors: Emna Mziou Aicha Hchaichi Hejer Letaief Sonia Dhaouadi Mouna Safer Rim Mhadhbi Molka Osman Khouloud Talmoudi Amenallah Zouayti Khlifi Oumaima Nawel Elmili Amine Yedess Leila Bouabid Sondes Derouiche Souha Bougatef Mohamed Kouni Chahed Nissaf Bouafif Ben Alaya

The first case of Coronavirus Disease 2019 (COVID-19) in Tunisia was reported on 2 March 2020. This study aimed to describe the epidemiological evolution of the COVID-19 pandemic in Tunisia from March 2020 to December 2022 and to assess changes in key transmission indicators across the different phases and epidemic waves. We conducted a nationwide longitudinal descriptive study based on prospectively collected surveillance data including all laboratory-confirmed COVID-19 cases reported through the national surveillance system between March 2020 and December 2022. Descriptive analyses were performed to estimate screening rates, test positivity rates, cumulative incidence rates, and the time-varying effective reproduction number (Rt). During the three-year study period, Tunisia reported a cumulative incidence of 9562.05 cases per 100,000 inhabitants. The mean daily screening rate was 38.23 tests per 100,000 inhabitants, while the average positivity rate reached 16.03%. The mean effective reproduction number was estimated at 1.14 (95% CI: 1.11–1.17). The epidemic evolved through two distinct transmission phases. The first phase, extending from 2 March to 17 August 2020, was characterized by limited community transmission mainly associated with imported cases. The second phase was marked by sustained autochthonous community transmission and comprised five epidemic waves. Between March and May 2021, genomic surveillance identified the predominance of the Alpha Variant of Concern (VOC). The fourth wave was dominated by the Delta VOC until December 2021, whereas the fifth wave, occurring in 2022, was associated with the Omicron VOC. Continuous monitoring of transmission indicators through the national surveillance system provided timely evidence to support risk assessment, guide public health decision-making, and adapt prevention and control measures throughout the different phases of the pandemic in Tunisia.

COVID doi: 10.3390/covid6080132

Authors: Giancarlo Ripabelli Angelo Salzo Roberta De Dona Antonio D’Amico Vittorio Viccione Nicandro Samprati Arturo Santagata Carmen Adesso Michela Anna Di Palma Anna Natale Romeo Flocco Manuela Tamburro

The risk of healthcare associated infections (HAIs) among hospitalized patients increased with the severity of COVID-19 disease and duration of hospitalization, especially in intensive care units (ICUs). This study retrospectively investigated HAI trends between March 2020 and December 2022 in patients with a COVID-19 diagnosis admitted to the exclusive ICU for the management of severe COVID-19 patients in the Molise region, central Italy. The clinical records of patients were anonymously coded and examined for the number of HAIs and microbiological isolations. Only infections that occurred after 48 h of ICU admission were included for descriptive, univariate and multivariate statistical analysis. Over the three-year period, 185 patients with a COVID-19 diagnosis (69.7% male, mean age 66.1 ± 10.6 years) were admitted to the hospital ICU: 50 (27.0%) in 2020, 94 (50.8%) in 2021, and 41 (22.2%) in 2022. During ICU stays, a high proportion of patients required at least one invasive device and died (97.2% and 88.1%, respectively). Death outcome was significantly associated with pre-existing comorbidities and related treatment, sex, and devices. During ICU stays, 80% received antimicrobial therapy, which was further related to death. At least one microbiological HAI was detected in 103 (55.9%) patients (76.6% male, mean age 65.4 ± 9.6 years). HAI incidence differed by year (p < 0.001), occurring in 36 (35.0%) patients in 2020, 54 (52.4%) in 2021, and 13 (12.6%) in 2022, respectively, and 80.6%, 96.0%, and 92.3% of patients died. A total of 268 isolations were observed: 99 (36.9%), 139 (51.9%) and 30 (11.2) in 2020, 2021 and 2022, respectively, and were mostly fungi in 2020 and 2022 (46.5% and 36.7%, respectively), while Gram-negative bacteria predominated in 2021 (36.7%). The study revealed higher HAI rates among patients in 2021 according to the increasing number of COVID-19 cases and related hospitalizations due to the Alpha variant at the local level, but also reflected the national epidemiology, while the decline in 2022 could be likely associated with the pandemic evolution and improvements in the management of COVID-19 patients. These findings further underline a high rate of lethality, more likely attributed to severe COVID-19 in patients with advanced age and underlying diseases, to which HAI onset could have undoubtedly contributed. The study provides useful epidemiological data regarding HAIs among critically ill COVID-19 patients during different phases of the pandemic across three years.

COVID doi: 10.3390/covid6080131

Authors: Elena Moreno-Guillamont Carmen I. Sáez-Lleó María Auxiliadora Dea-Ayuela Jose M. Soriano

The COVID-19 pandemic produced a severe and heterogeneous burden across age groups, territories and epidemic phases in Spain. Older adults experienced disproportionately high rates of hospitalization, intensive care unit (ICU) admission and death, particularly during the early pandemic waves when vaccination was unavailable. However, the relationship between surveillance-confirmed cases and severe outcomes changed substantially over time, a phenomenon termed epidemiological decoupling. This study developed and applied a novel Older-adult COVID-19 Severity Decoupling Index (O-CSDI) to weekly COVID-19 surveillance data from the 17 Spanish autonomous communities and the two autonomous cities of Ceuta and Melilla. The integrated dataset covered January 2020 to July 2023 and comprised 3496 autonomous community–week observations and 143 variables obtained from four open-access surveillance sources: ISCIII-RENAVE, Datadista/Ministerio de Sanidad, Our World in Data and the MoMo excess mortality system. However, the primary incidence- and ratio-based O-CSDI analyses were restricted to March 2020–March 2022 because open-access individual event counts were no longer structurally comparable after the transition to reduced surveillance. Data from later periods were retained only for contextual vaccination and MoMo mortality indicators. The O-CSDI quantifies the degree to which reported COVID-19 incidence became disconnected from hospitalization, ICU admission and mortality in adults aged 60–69, 70–79 and ≥80 years. The primary version of the index was based on the death-to-case ratio, while complementary versions examined hospitalization-to-case, ICU-to-hospitalization and death-to-hospitalization transitions. Results showed progressive but heterogeneous decoupling across phases, territorial units and age strata, with the strongest decoupling observed during the Omicron BA.1/BA.2 period and the highest residual mortality burden in adults aged ≥80 years. All results were interpreted as ecological, descriptive indicators rather than individual-level risks or causal estimates. These findings provide a reproducible epidemiological tool for retrospective pandemic evaluation and preparedness in ageing populations.

COVID doi: 10.3390/covid6070130

Authors: Nawaf M. Alshabibi

The COVID-19 pandemic has caused unprecedented upheaval to the worldwide transportation infrastructure and as such, has redefined trends in urban mobility. In the current research, the authors plan to compare six metropolitan areas, including Houston (Texas) and Chicago (Illinois), Singapore, Dubai (United Arab Emirates), Calgary (Canada), and Cairo (Egypt), to assess the effects of the pandemic on transit ridership during the period of 2018 to 2022. The monthly data provided by the official transit agencies was analysed using paired t-tests and correlation statistics to measure the change in the ridership and how they are related to population, urban area, and network length. The results are consistent, and the effects are a three-stage course shock, stabilization, and recovery, but as the rates of recovery are different to the governance, economic structure, and technological preparation. Digitally developed, high-income metropolises like Singapore and Dubai were a bit faster in recovery, and those that relied on cars like Chicago and Calgary showed prolonged declines. Cairo also exhibited resilience driven by necessity and did not decline because of institutional adaptation, but rather because of economic dependence. The paper suggests a three-part model of resilience, including governance, technology, and necessity, that explains these differences and how mobility systems can be changed in response to crises. These findings have both theoretical and policy implications for designing adaptive, equitable, and technology-enhanced transportation planning in the post-pandemic age.

COVID doi: 10.3390/covid6070129

Authors: Alexandra Isabelle D. Ang Alexandra P. Lee Junie B. Billones Lyre Anni E. Murao Maria Constancia O. Carrillo Stephani Joy Y. Macalino

RNA-dependent RNA-polymerase (RdRp), one of the key enzymes in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) life cycle, is a recognized druggable target for Coronavirus disease 19 (COVID-19) treatment. Its inhibition has been associated with reduced viral loads in infected individuals. A library of 1562 Philippine Natural Compounds was screened in silico for potential SARS-CoV-2 anti-RdRp activity using a high-throughput virtual screening (VS) approach. Molecular docking experiments and in silico absorption, distribution, metabolism, and excretion (ADME) predictions were used to determine compounds with potential inhibitory capabilities against RdRp. The top three compounds, Vitelignin A (VIT), Vitexoside (VIX), and Cannabifolin C (CAN), were subjected to molecular dynamics (MD) simulations in complex with RdRp, confirming the formation of stable protein-ligand complexes. Overall, these results suggest promising inhibitory capabilities of these three compounds against SARS-CoV-2 RdRp. Their shared presence in extracts of Vitex negundo, a Philippine medicinal plant, warrants further in vitro and in vivo investigation regarding the anti-SARS-CoV-2 activity of its extracts and active components.

COVID doi: 10.3390/covid6070128

Authors: Erhan Özmen Süleyman Kaan Yalçin

The COVID-19 pandemic transformed online and distance learning from a supplementary educational option into a central component of education systems, bringing anxiety, stress, and psychological well-being to the forefront of digital learning research. This study traces the two-decade evolution of research on anxiety and stress in online and distance learning between 2005 and February 2026 and examines the thematic reorientation associated with the COVID-19 period. Bibliometric mapping of 243 Web of Science (WoS) records was used to identify publication trends, intellectual structures, international collaboration patterns, and thematic developments. Piecewise analysis indicated a significant post-2020 break in annual scientific output, with the growth rate increasing nearly eightfold (p = 0.0015). Thematic evolution showed that pre-pandemic studies mainly focused on technology acceptance, computer anxiety, and learner adaptation, whereas pandemic and post-pandemic research shifted toward mental health, psychological well-being, social isolation, technostress, and resilience. China and the United States dominated scientific production, while Australia and Saudi Arabia showed notable mobility in collaboration networks. Overall, the findings suggest that the COVID-19 period was associated with a field-level reorientation toward an interdisciplinary psychosocial agenda for future online education.

COVID doi: 10.3390/covid6070127

Authors: Diane Price Banks Marissa Claudio Sasha Vergez Nadine Etienne

This study investigated the perceptions and practices of disinfectant use among students at the City University of New York (CUNY) before, during, and after the peak of the COVID-19 pandemic, with a focus on behaviors observed following a controversial statement made by President Donald Trump in April 2020 suggesting the potential use of disinfectants as a treatment for a SARS-CoV-2 infection. Utilizing an online survey of 441 CUNY students, data was collected on cleaning and disinfection behaviors during four distinct periods: pre-pandemic (January–February 2020), during the pandemic’s height (March–April 2020), after the pandemic’s height (June–August 2020), and following the aforementioned presidential statement. Data patterns illustrate an increase in cleaning frequency and disinfectant use during the peak of the pandemic, followed by a notable decrease after the presidential statement. The data also illustrated potentially dangerous practices, such as misting the body with cleaning sprays and using household cleaners on bare skin, though these behaviors generally decreased after the peak of the pandemic. The study highlights the impact of public health communication and the role of misinformation in shaping hygiene practices during a crisis. It underscores the need for clear, evidence-based messaging to promote safe and effective disinfectant use and to counter misinformation that may lead to harmful behaviors. This novel research contributes to the understanding of how a specific student population responded to the pandemic and provides insights for future public health interventions.

COVID doi: 10.3390/covid6070126

Authors: Nurah Alamro Turki M. Alhakbani Abdullah AlDhuwaihy Abdulrahman AlOmar

Background: Public acceptance of vaccines during emerging infectious disease outbreaks is influenced by perceptions of safety, accessibility, and cost. Understanding these determinants during the early phase of a pandemic is important for informing vaccination policy and communication strategies. This study examined the role of vaccine cost and safety perceptions in shaping COVID-19 vaccination intention among adults in Saudi Arabia prior to national vaccine rollout. Methods: A cross-sectional electronic survey was conducted among adults residing in Saudi Arabia between August and September 2020. Participants were recruited through online distribution using social media and electronic communication channels. The questionnaire assessed socio-demographic characteristics, knowledge and perceptions regarding COVID-19, and intention to receive COVID-19 vaccination under five hypothetical scenarios reflecting vaccine cost and the availability of scientific safety and efficacy evidence. Multivariable logistic regression analyses were performed to identify factors associated with vaccination intention. Results: A total of 1293 respondents completed the survey. When vaccination was offered free of charge, 57.5% of participants reported that they would likely receive the vaccine. Vaccination intention declined as the hypothetical vaccine price increased, reaching 38.7% when the cost exceeded 100 SAR. Intention was lowest when vaccination was presented under conditions in which safety and efficacy evidence had not yet been confirmed. Age, gender, educational attainment, and prior seasonal influenza vaccination were associated with COVID-19 vaccination intention across several scenarios. Conclusions: Perceived vaccine affordability and confidence in scientific safety and efficacy evidence were important factors associated with COVID-19 vaccination intention during the early phase of the pandemic in Saudi Arabia. Providing vaccination without direct cost to recipients and communicating safety and efficacy evidence transparently may support public confidence and vaccine acceptance during future large-scale immunization campaigns. These findings should be interpreted as an early-pandemic baseline and should not be extrapolated to current post-rollout attitudes.

COVID doi: 10.3390/covid6070125

Authors: Marilena Mousoulidou Nektarios-Alexandros Damianou Andri Christodoulou Loukia Taxitari Konstantina Zamba

Background: The COVID-19 pandemic underscored the importance of understanding the psychological factors associated with engagement in recommended health behaviours. This study examines how decision regret and conspiracy mentality relate to vaccination engagement and protective health behaviours during the later stages of the COVID-19 pandemic in Cyprus. Methods: A total of 325 Greek-speaking adults completed an online questionnaire that included demographic questions, the Decision Regret Scale (DRS), the Conspiracy Mentality Questionnaire (CMQ), and a COVID-19 Preventive Behaviours Questionnaire developed by the authors. Results: The findings showed that: (a) greater vaccination engagement and protective health behaviours were associated with lower levels of decision regret; and (b) conspiracy mentality was associated with vaccination engagement but not with protective health behaviours. Conclusions: The findings highlight the potential relevance of emotional processes such as decision regret and belief-related factors, such as conspiracy mentality, in relation to engagement with recommended health behaviours. These findings may help inform public health communication strategies aimed at supporting engagement in recommended health behaviours during future health crises.

COVID doi: 10.3390/covid6070124

Authors: Sofia Teodora Muntean Andreea-Raluca Cozac-Szoke Andreea Cătălina Tinca Diana Maria Chiorean Adrian Horațiu Sabău Iuliu Gabriel Cocuz Raluca Niculescu Claudia Raluca Mariean Nadja Emily Pop Ovidiu Simion Cotoi Anca Ileana Sin

Background: Persistent cardiovascular and multisystem manifestations remain an important concern following hospitalization for coronavirus disease 2019 (COVID-19). However, the spectrum of newly identified conditions during follow-up and their relationship with acute disease severity remain incompletely characterized. This study aimed to describe cardiovascular and multisystem diagnoses, identified during short-term and long-term follow-up and to evaluate the association between acute-phase clinical characteristics, biomarkers, and subsequent outcomes. Methods: We conducted a retrospective observational cohort study including 762 adults hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between January 2021 and December 2022. Follow-up data were obtained from patients who re-presented to the same hospital during short-term follow-up (mean 4.33 months; n = 130) or long-term follow-up (mean 2.06 years; n = 186). Newly documented cardiovascular and non-cardiovascular diagnoses recorded during routine clinical care were analyzed separately for each follow-up cohort. Multivariable logistic regression was used to identify predictors of in-hospital mortality and cardiovascular outcomes. Results: At least one newly documented diagnosis was identified in 120/130 patients (92.3%) during short-term follow-up and in 175/186 patients (94.1%) during long-term follow-up. Cardiovascular diagnoses were identified in 32.3% and 45.2% of patients attending short-term and long-term follow-up, respectively. Hypertension and atherosclerosis were the most frequent cardiovascular diagnoses during short-term follow-up, whereas heart failure and ischemic heart disease predominated among patients attending long-term follow-up. Pulmonary fibrosis was the most common non-cardiovascular diagnosis at both follow-up periods. Elevated D-dimer and fibrinogen levels during acute COVID-19 were independently associated with in-hospital mortality, whereas acute-phase NT-proBNP was not independently associated with cardiovascular diagnoses identified during follow-up. Conclusions: Patients who re-presented for clinical evaluation after hospitalization for COVID-19 exhibited a substantial burden of newly documented cardiovascular and multisystem diagnoses. Given the retrospective design, independent follow-up cohorts, and absence of a non-COVID control group, these findings should be interpreted as observational post-hospitalization data rather than evidence of causal or progressive post-COVID-19 disease. Prospective controlled longitudinal studies are needed to better define the long-term health consequences of SARS-CoV-2 infection.

COVID doi: 10.3390/covid6070123

Authors: Katerina Papavasileiou Verónica Marín María José Noguera-Marín

The present study takes place in the context of the COVID-19 pandemic and the Greek economic crisis, in which the health systems reached their limit and the physical and psychological exhaustion of professionals increased, testing supportive leadership in hospitals. An ex post facto, descriptive, and correlational study was designed, with non-probabilistic sampling, applied to 741 health professionals from public and private hospitals located in Attica and Piraeus. An 18-item ad hoc questionnaire was used, validated through an exploratory factor analysis (KMO = 0.805; 4 dimensions) and with a high reliability (α = 0.87). The staff showed a moderately positive assessment of the leadership and the supervisor dynamics, but a low enjoyment of work during the crisis. The hypothesis of generalized stress was discarded, with differences found according to gender (more conflict and less recognition perceived by women) and age (more conflicts between the supervisors and younger staff), without important differences according to level of education or work position. It can be concluded that support, psychological capital, and work relations, appeared as relatively independent constructs, modulated by organizational and personal factors, which underlines the need for specific interventions oriented towards the well-being and recognition of health professionals in contexts of crisis.

COVID doi: 10.3390/covid6070122

Authors: Caitlin Slomp Anna MacLellan John R. Best Zainab Naqqash Boyee Lin Cynthia Lu Mizuki Kubota Zahra Ofoghi Hasina Samji S. Evelyn Stewart

Canadian youth experienced profound impacts to mental health (MH) support throughout the COVID-19 pandemic. Given the risk for long-term negative outcomes from unmet MH needs, it is critical to understand access barriers. The purpose of this study was to explore the longitudinal data and personal narratives on MH challenges, needs and access barriers. The Personal Impacts of COVID-19 Survey was administered to parents regarding their youth at baseline (November 2020–July 2021) and follow-up (November 2021–October 2022). Semi-structured interviews of selected youth and parents were conducted. Quantitative data from 507 baseline surveys, 177 follow-up surveys and qualitative data from 35 interviews were included in the study. A modified explanatory sequential/nested mixed methods design was used to analyze the data. Results showed that the use of MH supports among youth increased between timepoints, although 20% had persisting unmet needs for MH supports at follow-up. Youth described waitlist barriers and difficulties finding the “right” therapist, and parents described significant difficulties navigating the MH system that profoundly impacted their families’ ability to access care and mitigate negative MH outcomes. Increased clinician availability, school MH supports, parental education, and tools for navigating the MH system are needed to better support families.

COVID doi: 10.3390/covid6070121

Authors: Salvador E. Ayala-Raggi Rafael Alejandro Cruz-Ovando Lauro Reyes-Cocoletzi Aldrin Barreto-Flores

This paper presents an automatic classification system for pulmonary diseases in chest X-rays based on geometric normalization. The proposed method consists of three main modules. Module 1: A landmark detector: A ResNet-18 convolutional neural network with coordinate attention mechanism is trained to predict 15 landmarks defining the lung contour, achieving a mean error of 3.61 pixels (median 3.07 pixels) through an ensemble of four models with test-time augmentation. Module 2: Geometric normalizer: a set of landmarks surrounding the lung region is used to geometrically normalize each image. This normalization involves: Generalized Procrustes Analysis used once to obtain a standard lung shape, Delaunay triangulation to build a deformation mesh, and a piecewise affine transformation (warping) to map the original lung region to a standardized region. This process eliminates variations in position, scale, and orientation in the original set. Module 3: Classifier: normalized images are classified into three categories (COVID-19, Viral Pneumonia, and Normal) using a ResNet-18 classifier with transfer learning and a contrast adjustment (using the SAHS (Statistical Asymmetrical Histogram Stretching) method). The classifier was evaluated through five-fold cross-validation on the COVID-19 Radiography Database, demonstrating high stability with 98.60 ± 0.26% accuracy, and 98.00% F1-Macro, confirming the robustness of the approach. Although the classifier trained with original images reached a higher accuracy than using normalized images, Gradient-weighted Class Activation Mapping (Grad-CAM) analysis and the cropping experiment suggest that this advantage is partly driven by acquisition artifacts rather than lung pathology. In contrast, geometrically normalized images outperform their non-aligned artifact-masked/cropped counterparts: 98.60% vs. 96.24% on the COVID-19 Radiography Database and 94.67% vs. 94.17% on a balanced adult–pediatric mixed dataset including pediatric cases from the Kermany dataset, suggesting that anatomical alignment can yield a more reliable and artifact-resistant representation for pulmonary disease recognition.

COVID doi: 10.3390/covid6070120

Authors: Liya Vajdi Dmitriy Klyuyev Olga Ponamareva Zeine Kulbayeva Ahmadreza Vajdi Bo Hu

Background: Long COVID is a heterogeneous post-viral condition in which persistent neurological, autonomic, cognitive, and psychometric symptoms often occur without clear isolated biomarker abnormalities. This mismatch suggests that disease persistence may be driven not only by changes in individual markers, but by longitudinal reorganization of biological and clinical interactions. Materials and Methods: This observational longitudinal study evaluated patients with persistent symptoms after confirmed SARS-CoV-2 infection at 3 and 6 months. Clinical assessment included neurological examination, Hospital Anxiety and Depression Scale, Beck Depression Inventory, and COMPASS-31. Biomarkers representing hypoxia signaling, oxidative/redox stress, endothelial and renin–angiotensin system activity, glycation-related processes, and complement regulation were analyzed. Correlation analysis, association-level biomarker–clinical network modeling, and complementary Graphical LASSO-based sparse network estimation were used to compare network density, community organization, centrality, and edge rewiring between time points. Results: Conventional paired analysis identified HIF-1α as the only continuous variable with a statistically significant longitudinal change (Wilcoxon statistic = 610.0, p=0.000350), whereas association-level network analysis revealed a broader systems-level signal. The association-level biomarker–clinical network preserved a similar global size at 3 and 6 months, with 16 nodes, 27 versus 26 edges, and densities of 0.225 versus 0.217. However, this apparent stability concealed substantial rewiring: 19 edges were shared, 8 were lost, and 7 emerged. Complementary Graphical LASSO analysis with 1000 bootstrap resamples supported this pattern by identifying a conservative sparse conditional-dependency core, including seven shared conditional-dependency edges across time points and selective weakening of four early conditional dependencies. The C3–C4 relationship reversed from negative to positive correlation (r=−0.618 to r=0.618), indicating marked remodeling of complement-associated regulation. A psychometric–autonomic module involving Beck, HADS I, HADS II, and COMPASS-31 remained stable across both assessments. Conclusions: Long COVID progression was characterized by dynamic remodeling of immune, endothelial/RAS, oxidative-redox, hypoxia-related, autonomic, and psychometric interactions. Longitudinal network analysis identified a systems-level interaction structure that was not captured by isolated biomarker comparisons alone and that was further supported by complementary sparse conditional-dependency analysis.

COVID doi: 10.3390/covid6070119

Authors: Andres González-Zapata Andrés Arias-Sánchez Roberto Henríquez Katlheen Velez Leonardo Escobar Andres Rojas-Gulloso Emmanuel Eroume A Egom

During the SARS-CoV-2 pandemic, healthcare systems faced an increased burden of secondary infections, including those caused by Candida auris, an emerging multidrug-resistant pathogen associated with hospital outbreaks worldwide. We aimed to describe the clinical and microbiological characteristics of a hospital outbreak of Candida auris fungemia in patients with COVID-19 in a tertiary care center. This retrospective observational study included 14 patients diagnosed between November 2020 and April 2021. Infection was initially identified using VITEK2® and confirmed using MALDI-TOF MS, with antifungal susceptibility determined using broth microdilution. All patients developed fungemia, were mechanically ventilated, and had central venous access and prolonged hospital stays; 64.2% had comorbidities. Resistance frequencies based on CDC tentative MIC thresholds were observed for fluconazole (64.2%) and amphotericin B (71.4%). In-hospital mortality was 50%; exploratory analyses of factors associated with mortality should be interpreted cautiously given the small sample size. These findings highlight the significant clinical impact of Candida auris in critically ill COVID-19 patients, particularly in the context of invasive care and antimicrobial resistance. The outbreak underscores the importance of early identification, appropriate antifungal therapy, and strict infection prevention and control measures. Further studies are needed to better define risk factors and optimize management strategies in similar settings.

COVID doi: 10.3390/covid6070118

Authors: Adam B. Smith Philip G. Conaghan Christine Comer Manoj Sivan Sarah R. Kingsbury

Background: Post-COVID-19 syndrome or Long COVID (LC) is a multi-system condition characterised by persistent symptoms beyond three months following SARS-CoV-2 infection. Pain, particularly musculoskeletal and neuropathic pain, is commonly reported and may substantially affect functioning and health-related quality of life (HRQoL). However, there is limited detailed characterisation of pain phenotypes and their differential impact on outcomes in LC. This study aimed to (i) characterise pain associated with LC, (ii) identify factors associated with pain type and severity, and (iii) examine its impact on HRQoL, physical activity, and work. Methods: A cross-sectional survey was conducted among adults with clinician-diagnosed or self-reported LC who reported current or previous joint, muscle, or nerve pain. Participants completed validated patient-reported outcome measures including the C19-YRS, Nordic Musculoskeletal Questionnaire, Pain Detect Questionnaire (PD-Q), Musculoskeletal Health Questionnaire, and EQ-5D-5L. Participants were classified into neuropathic, nociceptive, or ambiguous pain groups based on PD-Q scores. Descriptive analyses, group comparisons, and backward stepwise ordinary least squares regression were used to examine factors associated with overall pain (PD-Q Total). Results: Among 198 participants (73% female; mean age 52 ± 12.7 years; mean LC duration 2.4 years), 96% reported new or worsened pain following COVID-19 infection, with muscle pain (87%), joint pain (84%), and nerve pain (66%) most frequently reported. PD-Q scores suggestive of neuropathic pain were identified in 28% of participants and were associated with significantly greater pain intensity, symptom burden, functional impairment, and lower HRQoL (p < 0.05). These participants reported higher average pain scores across all body regions and greater radiating pain (76%) compared to other groups. Functional disability and anxiety were significant factors associated with pain severity. Conclusions: Pain is highly prevalent in LC, with neuropathic pain representing a distinct and more severe phenotype associated with substantial functional and quality-of-life impacts. This study provides novel comparative evidence on pain phenotypes and their differential burden, highlighting the need for targeted pain assessment and management strategies in LC.

COVID doi: 10.3390/covid6070117

Authors: Joseph Amazuwa Chirwa Emmanuel George Yusufu Lloyd George Banda

While conventional theories posit that stronger institutions buffer economies against crises, the COVID-19 pandemic presents a puzzle: despite substantial variation in institutional capacity, the global economic contraction of 2020 was both severe and widespread. Motivated by this puzzle, we constructed a global panel dataset from 2014 to 2024 and employed two-way fixed-effect estimation with Driscoll–Kraay robust standard errors to examine the differential role of state capacity across COVID-19 crisis phases. The results confirm that the shock caused by the pandemic reduced GDP per capita growth across countries, with the Americas experiencing disproportionately deeper contractions and stronger rebounds relative to other regions. Most importantly, the findings reveal a temporal asymmetry in institutional effectiveness: our constructed composite resource-based measure of state capacity does not mitigate the initial economic contraction but exerts a positive, statistically significant effect on post-pandemic recovery. Unsurprisingly, model re-estimation with the conventional perception-based measure of state capacity fails to replicate this dynamic, underscoring the importance of measurement strategy in institutional research. These results challenge the assumption that institutions uniformly buffer shocks, demonstrating instead that state capacity is more consequential for recovery than crisis prevention.

COVID doi: 10.3390/covid6070116

Authors: Mª Pilar Rodríguez-Pérez Sandra León-Herrera Raquel Gómez-Bravo Elisabet Huertas-Hoyas Sara García-Bravo Pilar Rodríguez-Ledo Cristina García-Bravo

Post-COVID condition is frequently associated with persistent fatigue, reduced functional capacity, and loss of independence in activities of daily living. Exercise intolerance and post-exertional symptom exacerbation limit participation in conventional rehabilitation programs, highlighting the need for safe and scalable home-based interventions. The REACT-COVID project aims to evaluate the feasibility, safety, and potential effects of a home-based intervention combining whole-body electromyostimulation (WB-EMS) with functional activities of daily living in individuals with post-COVID condition. This study will be a randomized, placebo-controlled, participant-blinded pilot trial including 30 participants allocated to either an experimental group receiving active WB-EMS or a control group receiving sham stimulation over a 12-week period. The primary aim is to assess feasibility, safety, and acceptability. As exploratory clinical outcomes, fatigue severity (Chalder Fatigue Questionnaire, CFQ-11) and functional capacity (Six-Minute Walk Test, 6 MWT) will also be evaluated. Secondary outcomes include handgrip strength and independence in activities of daily living (ADLQ). Assessments will be conducted at baseline (week 0), post-intervention (week 12), and three-month follow-up (week 24). This intervention is designed to provide a low-mechanical-load, accessible alternative for individuals unable to tolerate conventional exercise programs. This study’s findings will inform larger multicenter trials and contribute to scalable rehabilitation models for post-COVID care. Trial registration number: ClinicalTrials.gov (NCT07312357).

COVID doi: 10.3390/covid6070115

Authors: María Teresa Hernández-Galindo Adriana González-Hernández Cruz Vargas-De-León

Background: The COVID-19 pandemic was accompanied by an infodemic that promoted the use of so-called “miracle products” lacking scientific evidence, posing significant public health risks. Despite increasing concern, evidence on effective educational strategies to counteract this misinformation remains limited, particularly in Latin America. Methods: A quasi-experimental pre–post study without a control group was conducted among university students in Mexico City between February and June 2021. Participants were recruited via Facebook using a snowball sampling approach. A validated nine-item questionnaire assessed knowledge about miracle products before and after exposure to an educational video intervention. Paired statistical analyses were performed to evaluate changes in knowledge. Results: A total of 157 participants completed the pre-test, and 103 completed the post-test. The intervention resulted in a significant increase in knowledge scores, from a mean of 5.98 (SD = 1.73) to 9.05 (SD = 1.54) (p < 0.001). Significant improvements were observed in eight of nine items, with the largest increases in knowledge related to high-risk substances and reporting mechanisms. No significant baseline differences were found between participants who completed and those who did not complete the post-test. Conclusions: The video-based educational intervention was effective in improving knowledge about miracle products during COVID-19. These findings support the use of digital health education strategies as scalable tools to combat misinformation, particularly in resource-constrained settings. However, further research using controlled designs is needed to assess long-term effects and behavioral outcomes.

COVID doi: 10.3390/covid6070114

Authors: Lateef Olalekan Bello Dorah Dubihlela

The COVID-19 pandemic prompted the introduction of South Africa’s Social Relief of Distress (SRD) grant to mitigate income shocks among individuals excluded from existing social programs. This study utilizes a three-year national representative dataset from the General Household Survey and applies a fixed effects regression framework to estimate the association between COVID-19 SRD grants and unemployment. The findings indicate a positive and statistically significant association between grant receipt and unemployment. Specifically, the results suggest that grant recipients are approximately 27–32% more likely to be unemployed than non-recipients. The findings suggest that while the grant provided necessary initial financial relief, in the absence of complementary labour market interventions, income support alone may be insufficient to address unemployment. The study concludes by recommending the coordination of temporary income relief integrated with active labour market policies to promote sustainable employment outcomes.

COVID doi: 10.3390/covid6070113

Authors: Da-In Park

Background: During the recent COVID-19 pandemic, nursing students faced heightened infection risks during clinical practicum while managing significant psychological demands. However, factors predicting the preventive practices of future healthcare professionals remain poorly understood. Methods: This cross-sectional study examined 261 nursing students on COVID-19 knowledge, attitudes, practices, psychological distress, self-efficacy, and resilience during the fourth wave of the COVID-19 pandemic in South Korea. Grounded in the Knowledge–Attitudes–Practice (KAP) framework, hierarchical multiple regression analysis was conducted to identify predictors of preventive practice behaviors. Results: Depressive symptoms (β = 0.27, p = 0.023) and resilience (β = 0.29, p < 0.001) were significantly positive predictors of COVID-19 preventive practice. Conclusions: Resilience emerged as the strongest predictor of COVID-19 preventive practice among nursing students, highlighting the importance of psychological resources in sustaining infection prevention behaviors. Nursing education programs should incorporate resilience-building strategies to strengthen pandemic preparedness and clinical readiness among future healthcare professionals.

COVID doi: 10.3390/covid6070112

Authors: Vera Beca Fatjon Balla Daniela Nakuci Zahide Sulejmani Marsilda Danaka Enver Roshi Eliona Demaliaj

Background: SARS-CoV-2 infection during pregnancy has been associated with adverse maternal and neonatal outcomes, particularly in severe disease. However, evidence stratified by disease severity from Southeastern Europe remains limited. The aim of this study was to compare obstetric and neonatal outcomes between mild and severe COVID-19 among pregnant women managed in tertiary maternity hospitals in Tirana, Albania. Methods: A retrospective multicenter observational study was conducted between January 2020 and December 2022 in the two main tertiary maternity hospitals in Tirana. Pregnant or postpartum women with RT-PCR-confirmed SARS-CoV-2 infection were included. COVID-19 cases were classified as mild or severe according to clinical presentation and oxygen saturation. Maternal, obstetric, and neonatal outcomes were analyzed and multivariable logistic regression was used to evaluate associations between disease severity and selected outcomes. Results: A total of 270 pregnant women were included, of whom 212 (78.5%) had mild COVID-19 and 58 (21.5%) severe disease. The mean maternal age was 29.4 years and most infections occurred during the third trimester (80.8%). Severe COVID-19 was associated with significantly higher odds of NICU admission (aOR 2.87, 95% CI 1.36–6.05), Apgar score < 7 at 5 min (aOR 8.39, 95% CI 1.49–47.35), low birth weight (aOR 2.53, 95% CI 1.06–6.03), and emergency cesarean section (aOR 8.10, 95% CI 2.64–24.86). Maternal age, obesity, parity, and comorbidities were not significantly associated with the examined outcomes. Conclusions: Severe COVID-19 during pregnancy was associated with poorer neonatal condition at birth and increased obstetric intervention, highlighting the importance of close monitoring and coordinated obstetric–neonatal management in pregnancies complicated by severe SARS-CoV-2 infection.

COVID doi: 10.3390/covid6070111

Authors: Sadia Z. Shah Parthkumar Satashia Shahin Isha Patrick Johnson Katie Kunze Abdul Moiz Khan Jorge Sinclair Rose Mary Attieh Anirban Bhattacharyya Ricardo Diaz Millian Michael Anthony Edwards Rickey E. Carter Leigh Spiecher Pablo Moreno Franco Devang Sanghavi Hani M. Wadei

The Omicron variant of SARS-CoV-2 is associated with milder symptoms and lower hospitalization and mortality rates than Delta variants, although the impact of Omicron on immunocompromised patients, especially solid organ transplant (SOT) recipients, is still unclear. This study compares the hospitalization rate and outcomes between immunocompromised, immunocompetent, and SOT patients during the Delta and Omicron periods. We included adult patients who tested positive for SARS-CoV-2 on PCR or nasopharyngeal antigen test between 26 June 2021 to 8 September 2022, at our institution. A total of 12,401 COVID-19 patients were included, of which 11,055 were immunocompetent, and 1346 were immunocompromised (375 SOT recipients). Throughout the Delta and Omicron outbreaks, immunocompromised patients exhibited higher comorbidities and 30-day hospitalizations, but rates of mechanical ventilation and ICU-level care were like immunocompetent patients. During the Omicron wave, immunocompromised patients had higher unadjusted relative risk estimates (RR = 2.37, 95% CI 1.96–2.87, p < 0.05) than Delta (RR = 1.58, 95% CI 1.24–2.01, p < 0.05), with higher adjusted relative risk for hospitalization in Omicron (RR = 1.50, 95% CI 1.10–2.03, p = 0.01). Analyses show increased hospitalization risk in immunocompromised during the Omicron wave compared to the Delta wave, with no significant difference in hospitalization outcomes. The relative risk of hospitalization for SOT patients was higher in both waves.

COVID doi: 10.3390/covid6070110

Authors: José Ángel Hernández-Mariano Tania Alí Sánchez-Torres Antonio Gutiérrez-Ramírez Alejandra Valdivia-Flores Erika Gómez-Zamora Ricardo Castrejón-Salgado Marco Antonio León-Mazón Agustina Rosas-Baruch María G. Ortiz-López

Background: COVID-19 during pregnancy has been associated with various obstetric complications; however, epidemiological evidence regarding its relationship with hypertensive disorders of pregnancy (HDP) and preterm birth remains inconclusive. Therefore, we aimed to evaluate the association between COVID-19 during pregnancy and the risk of HDP and preterm birth among Mexican pregnant women. Methods: We conducted a retrospective cohort study based on a review of 3710 medical records of women treated at a tertiary hospital between 2020 and 2023. COVID-19 was diagnosed by real-time reverse transcription polymerase chain reaction (RT-PCR) assay. We estimated adjusted risk ratios (aRRs) using robust Poisson regression models, controlling for potential confounders. Results: The COVID-19 rate was 2.5%. We observed that women with COVID-19 had a higher risk of HDP (aRR = 1.59; 95% CI = 1.07–2.36). When HDP subgroups were analyzed separately, COVID-19 was associated with an increased risk of preeclampsia (aRR = 2.04; 95% CI = 1.34–4.20) and preterm birth (aRR = 1.50; 95% CI = 1.02–2.19). The association with gestational hypertension lost statistical significance after adjustment. Conclusions: Our findings suggest that COVID-19 during pregnancy may be associated with hypertensive disorders of pregnancy and preterm birth. However, the observed association with preeclampsia should be interpreted cautiously because diagnostic overlap between severe COVID-19 and preeclampsia cannot be excluded.

COVID doi: 10.3390/covid6070109

Authors: Elena Moreno-Guillamont Carmen I. Sáez-Lleó María Auxiliadora Dea-Ayuela Jose M. Soriano

Background/Objectives: The health status of institutionalized older adults is determined by the interaction of functional, cognitive, nutritional, anthropometric, and biochemical factors, which may not be adequately captured through single-domain assessments. Within the framework of the VIVA Project (Vulnerability Index: Valencia institutionalized Adults), this study aimed to characterize institutionalized older adults during the COVID-19 pandemic using an integrated multidimensional approach and to explore clinically interpretable vulnerability profiles. Methods: This cross-sectional study included 124 residents from 10 nursing homes of Valencia, Spain. Data were obtained from institutional records and included age, sex, body mass index (BMI), Barthel Index, Mini-Examination of Cognition (MEC), Tinetti scale, Mini Nutritional Assessment-Short Form (MNA-SF), and biochemical markers related to protein status, lipid metabolism, micronutrient availability, and renal function. An exploratory VIVA multidimensional index was constructed from nine standardized variables, and k-means clustering was applied to these variables rather than to a single summed score to identify residents’ phenotypes. An exploratory logistic regression model was used to assess the internal discrimination of the high-vulnerability phenotype. Results: The cohort showed marked heterogeneity across functional, cognitive, nutritional, anthropometric, and biochemical domains. Cluster analysis identified three clinically interpretable phenotypes ranging from lower to higher vulnerability. Functional impairment, particularly the Barthel Index and Tinetti score, was the main driver of separation between phenotypes, while biochemical markers contributed to refining profile discrimination. The exploratory logistic regression model showed high internal discrimination for the high-vulnerability phenotype, supporting the internal coherence of the integrated framework. Conclusions: An integrated multidimensional framework may be useful for characterizing vulnerability among institutionalized older adults and supporting risk stratification in long-term care settings. The logistic regression findings, including the high AUC, should be interpreted only as evidence of internal discrimination and internal coherence of the exploratory construct, not as evidence of external validity, reproducibility, diagnostic accuracy, or future predictive utility.

COVID doi: 10.3390/covid6070108

Authors: Xhevat Jakupi Norma P. Tavakoli Malësore Zogaj Thaqi Gylden Kreka Agnesa Blakaj Nazmi Mehmeti Rina Hoxha Sanije Gashi Arsim Kurti Berna Ibrahimi Arlinda Jakupi Rubik Hajdari Besfort Kryeziu Isme Humolli Donjeta Pllana Hajdari

Introduction: From 12 March 2020, when the first cases of COVID-19 were registered in Kosovo, to 9 March 2023, there were a total of 273,310 reported cases of COVID-19 and 3211 reported deaths in Kosovo (CFR: 1.17%). Health care workers (HCWs) have been at a higher risk of contracting SARS-CoV-2 infection; nevertheless, data on seroprevalence of SARS-CoV-2 antibodies among HCWs in Kosovo are very limited. Methodology: A cross-sectional serology study with 1654 healthcare professionals throughout Kosovo was conducted to determine the presence of antibodies against the spike antigen of SARS-CoV-2. In addition, a structured questionnaire was administered to study participants to obtain basic demographic data, and information on prior infection and COVID-19 vaccination status. Results: Antibodies against the spike antigen of SARS-CoV-2 were detected in almost all (99.8%) HCWs that participated in the study. The average antibody titer was 8030.8 AU/mL in women and 9533.7 AU/mL in men. Sixty-four percent of HCWs in this study reported prior infection with SARS-CoV-2, 6% of whom were hospitalized. Over 98% of study participants had received SARS-CoV-2 vaccination. Conclusions: Almost all HCWs participating in the study had antibodies against the spike antigen of SARS-CoV-2. This is most probably the result of the high COVID-19 vaccination rate in Kosovo as well as infection with SARS-CoV-2.

COVID doi: 10.3390/covid6070107

Authors: Gerusa Luciana Gomes Magalhães Marcia Regina Eches Perugini Marsileni Pelisson Fernanda Esposito Evelyn Poliana Candido Julia da Silva Pimenta Nilton Lincopan Eliana Carolina Vespero

Introduction: Several Enterobacterales species harboring New Delhi metallo-β-lactamase (NDM-1) have been reported worldwide. Among them is Providencia stuartii (P. stuartii), an emerging pathogen in nosocomial infections. Objective: This study aimed to perform the clinical and genomic characterization of NDM-1-producing P. stuartii isolates recovered from hospitalized patients during the COVID-19 pandemic in Southern Brazil. Materials and Methods: A retrospective observational study was conducted between April and September 2021 at a Brazilian teaching hospital. Fifty P. stuartii isolates were identified, and carbapenem-resistant isolates underwent phenotypic and molecular characterization. Genetic relatedness was assessed by Enterobacterial Repetitive Intergenic Consensus PCR (ERIC-PCR), and selected isolates were subjected to whole-genome sequencing using the Illumina NextSeq platform to determine sequence types, resistance genes, virulence determinants, and plasmid content. Statistical analyses were performed using SPSS version 20.0. Results: Among the 50 isolates, 21 (42%) harbored the blaNDM-1 gene. Most isolates were recovered from tracheal aspirates (57.2%), followed by blood (23.8%), urine (9.5%), and skin and soft tissue samples (9.5%). Significant associations were observed between NDM-1-producing isolates and SARS-CoV-2 infection (p = 0.013), central venous catheter use (p = 0.012), mechanical ventilation (p = 0.006), hemodialysis (p = 0.033), previous antimicrobial exposure, and mortality (p = 0.021). Genomic analysis revealed the presence of blaNDM-1, blaOXA-1, and multiple resistance determinants associated with aminoglycosides, fluoroquinolones, macrolides, tetracyclines, and folate pathway inhibitors. ERIC-PCR demonstrated low genetic variability among isolates, suggesting possible clonal dissemination within the hospital environment. Conclusions: This study reports the emergence of NDM-1-producing P. stuartii during the COVID-19 pandemic in a Brazilian teaching hospital. The low genetic variability among isolates and the multidrug-resistant profile highlight the potential for nosocomial dissemination and reinforce the importance of genomic surveillance and infection control strategies.

COVID doi: 10.3390/covid6060106

Authors: Gulomjon Kholov Nilufar Akhmedova Ulugbek Ochilov Gulruh Khayrullayeva Otabek Yuldashev

Background: Endothelial dysfunction and renal injury are emerging as a common feature of long COVID, especially in those with hypertension. It is not yet well characterised whether SARS-CoV-2 infection exacerbates podocyte dysfunction, fibrotic signalling and renal hemodynamic remodelling, over and above the effects of hypertension alone and there are no reliable early biomarkers in this population. Methods: We conducted a comparative cross-sectional study with prospective 6-month treatment response follow-up in 120 adult patients (aged 30–60 years) with essential hypertension (Stage I, II or III; n = 40 per stage), at Bukhara Regional Multidisciplinary Hospital. Each stage subgroup was further divided into post-COVID (3–6 months after recovery; n = 20) and non-COVID (n = 20) strata. Patients with diabetes, known chronic kidney disease, previous myocardial infarction or stroke and other major comorbidities were excluded. Serum cystatin-C, creatinine, aldosterone, TGF-β1 and VEGF-A; urinary nephrin and microalbumin; cystatin-C-derived eGFR (CKD-EPI) and oral protein-loaded renal functional reserve (RFR); and renal Doppler indices (Vps, Ved, RI, PI) of the main, segmental and interlobar arteries were assessed before and after 6 months of guideline-based renin–angiotensin–aldosterone system (RAAS) blockade (enalapril 5–10 mg or azilsartan 40–80 mg, ±eplerenone). Comparisons were made by Student’s t-test—associations by Pearson correlation. Results: At baseline, post-COVID hypertensive patients exhibited consistently higher endothelial–podocyte injury markers than non-COVID counterparts. Urinary nephrin was elevated across all stages (Stage I: 126.5 ± 9.1 vs. 91.9 ± 8.3 pg/mL, p < 0.01; Stage III: 203.3 ± 11.2 vs. 164.5 ± 9.7 pg/mL, p < 0.05), as were VEGF-A (Stage III: 286.1 ± 16.4 vs. 223.2 ± 12.6 pg/mL, p < 0.01) and TGF-β1 (Stage III: 186.4 ± 10.1 pg/mL, 1.3-fold higher; p < 0.01). The detection of microalbuminuria was 100% in Stage III post-COVID patients and 85% in non-COVID controls. The post-COVID groups had selective loss of renal functional reserve (7.8 ± 1.1% in Stage III compared to 12.5 ± 1.6% in non-COVID controls, p < 0.001). Nephrinuria correlated strongly with RFR (r = −0.824, p < 0.001), eGFR (r = −0.797, p < 0.001) and aldosterone (r = 0.613, p < 0.001). Six months of RAAS blockade reduced nephrinuria, microalbuminuria and TGF-β1 in both arms but the magnitude of biomarker reduction appeared smaller in the post-COVID group, particularly in Stage III. Conclusions: Long COVID appears to be associated with persistent endothelial dysfunction and podocyte injury in hypertensive patients. These results indicate that nephrinuria, VEGF-A, TGF-β1 and renal functional reserve are potential exploratory markers of endothelial and renal abnormalities in hypertensive patients following COVID-19. Before clinical utility can be determined, larger studies with multivariable modelling, diagnostic-performance analyses and correction for multiple testing are needed. The differences in biomarker response between groups observed in this study need to be confirmed in larger prospective studies with multivariable modelling and formal interaction analyses.

COVID doi: 10.3390/covid6060105

Authors: Gunter Wolf

The German author Hans Erich Nossack (1901–1977) wrote the novel “On Call: A Report on the Epidemic” four years before his death. This fascinating novel has yet to be translated into English. It depicts a bleak future in which a mysterious global epidemic erupts. The focus is on an unnamed first-person narrator, a chemist in a so-called on-call unit. His task is to recover the numerous bodies left behind by the epidemic. In a matter-of-fact, almost emotionless tone, he reconstructs the course of the catastrophe in retrospect. The disease is an anomaly: it is a kind of ‘suicide epidemic’ in which people apparently die or take their own lives for no apparent reason. The reasons for this remain unclear, intensifying uncertainty and a sense of helplessness within society. The novel describes in great detail fundamental changes in individual psychology and global society, revealing striking parallels nearly 50 years later during the worldwide COVID-19 pandemic. This paper seeks to compare the suicide pandemic described in the novel with today’s COVID-19 pandemic. To the best of my knowledge, this association has not been previously described. Similarities between the novel and the pandemic will be analysed. Nevertheless, there are also fundamental differences between the novel’s plot and the COVID-19 pandemic. In addition, some basic information about the author Nossack (a rather complex personality), likely not well-known to non-German-speaking readers, will be provided. The goal of this contribution is to familiarise non-German-speaking readers with this novel and its author. Finally, I will briefly mention Aaron Antonovsky’s concept of salutogenesis, which focuses on building resilience, resources, and supportive environments to manage disease. Nossack’s “Bereitschaftsdienst” anticipates key questions in salutogenesis—particularly the importance of finding meaning, comprehensibility, and coping strategies in the face of existential threats—but explores them within a far darker and more sceptical framework.

COVID doi: 10.3390/covid6060104

Authors: Sajjad Hussain Muhammad Mubeen Saeed Ahmad Qaisrani Shah Fahad Muhammad Suffian Muhammad Tahir Hafiz Muhammad Rashad Javeed Wajid Nasim

The world has already been facing food, nutrition, and security challenges for the last few decades. The coronavirus 2019, COVID-19, has a significant impact on food security and agriculture, such as affecting food demand and the food supply chain, with the greatest consequences on the most vulnerable population. This review provides a comprehensive overview of the effects of COVID-19 on global agriculture and food security, drawing on recent scientific publications, institutional reports, and policy documents from 2020 to 2026. The review examines the impact of the pandemic on cropping patterns, fruit and vegetable harvests, availability of farm inputs, connectivity of the agricultural system, food supply chains, food demand, and labor availability. Vegetable and fruit markets were most affected due to the spread of COVID-19. Due to the closing of markets and restaurants, produce distributors and farmers were required to transfer supplies entirely from the food production to the marketplace. These effects are additionally being felt in agriculture and food security. Almost 55% of researchers indicated that COVID-19 has the most impact on agriculture and its complete harvest during the season, and an additional 45% stated that COVID-19 has adversely affected food security. However, food has slowed down well to date in numerous nations. The spread of COVID-19 is beginning to disrupt the supply of agricultural products and food to consumers and the marketplace across and within borders. The different spring crops, such as sunflower, canola, maize, barley, spring wheat, and various field vegetables, cannot be grown during COVID-19. Consequently, COVID-19 has had a binding effect on the food supply chain and agriculture due to the disruption, which the government should have addressed promptly.

COVID doi: 10.3390/covid6060103

Authors: Heru Wijono Fauna Herawati Abdul Kadir Jaelani Stefani Kartika Octavia Dewi Ramdani Nur Palestin Ayumuyas Azminah Kevin Kantono Rika Yulia

This study analyses the pharmacological profiles of medications administered to critically ill COVID-19 patients to evaluate their efficacy regarding recovery rates and duration of hospitalization. The results demonstrate a significant difference in clinical outcomes. While the administration of Ceftazidime, Ceftriaxone, and Oseltamivir was associated with negative survival trends, Dexamethasone and Favipiravir were associated with a fourfold higher probability of survival in severe cases. Notably, no pharmacological intervention significantly reduced the length of hospital stay; instead, recovery duration was primarily influenced by comorbidities such as obesity, cardiovascular disease, and diabetes. Furthermore, age and preexisting physiological conditions remained primary predictors of mortality. Observational analysis in our study for drug repurposing identified Amikacin, Remdesivir, and Rivaroxaban as potential therapeutic candidates. However, Dexamethasone was identified as the most effective treatment for recovery, likely due to a molecular structure with high potential binding affinity to the SARS-CoV-2 virus. These findings suggest that while specific repurposed drugs offer measurable benefits, patient history remains a critical determinant of outcomes, highlighting the necessity for further research to refine therapies against emerging viral pathogens.

COVID doi: 10.3390/covid6060102

Authors: Jesus Alonso-Carrillo Cristina de la Calle Pilar Parra Maria Ruiz Rodriguez Estibaliz Arrieta Ortubay Ana Roca Mario Diaz Santiañez Antonio Lalueza Rocio Garcia-Garcia Carlos Lumbreras Bermejo Maria Ruiz-Ruigomez

Objective: Long COVID (LC) has been defined as a chronic condition that occurs after SARS-CoV-2 infection and persists for more than 3 months. Dyspnea is the most common and disabling symptom with several mechanisms identified. The pathophysiology of post-COVID dyspnea is unknown. The aim of this study is to analyze the clinical profile of patients presenting with dyspnea in the context of LC and to assess its possible relation with complementary diagnostic tests. Material and Methods: This is a retrospective cohort study including adult patients diagnosed with LC attending a post-COVID outpatient clinic. Dyspnea was assessed using mMRC and Borg scales. Complementary tests included chest imaging, pulmonary function tests (PFTs) and a six-minute walk test (6MWT). These assessments were performed at several time points throughout follow-up (3, 6, and 12 months). Results: Eighty patients diagnosed with LC were included, the mean age was 60.0 ± 14.4 and 43 (54.8%) were female. Most patients were hospitalized during acute infection (97.5%) and 25 patients experienced respiratory failure. During the follow-up, chest X-rays showed persistent abnormalities in 67.5% of patients, and 6MWT was pathological in 61.3% at 277 days (IQR 176–326) after acute infection. No significant differences were observed in the prevalence of ventilatory failure across dyspnea severity categories. Reduced DLCO was observed in 20% of patients, while obstructive or restrictive patterns were infrequent. Through three follow-up visits, pulmonary function and exercise capacity remained stable, with modest improvements in DLCO and exercise-induced desaturation (p = 0.005). In multivariable analysis, obesity (adjusted OR 7.88; p = 0.023) and lower DLCO (p = 0.049) were independent predictors of more severe dyspnea, highlighting the role of non-pulmonary factors in Long COVID. Conclusions: This study describes the clinical and functional profile of a cohort of patients with LC. Although abnormal findings were frequent, only impaired DLCO and obesity were independently associated with dyspnea severity, while imaging and six-minute walk test abnormalities showed no consistent association with symptom intensity, supporting a multifactorial origin of post-COVID dyspnea.

COVID doi: 10.3390/covid6060101

Authors: Pablo del Pozo-Herce Eva García Carpintero-Blas Antonio Martínez-Sabater Elena Chover-Sierra Iván Santolalla-Arnedo Regina Ruiz de Viñaspre-Hernández Vicente Gea-Caballero Teresa Sufrate-Sorzano Michał Czapla Raquel Maria Martinez-Pascual Raúl Juárez-Vela Alberto Tovar-Reinoso

The COVID-19 pandemic placed unprecedented pressure on healthcare systems and frontline professionals, particularly nurses, highlighting the importance of understanding their emotional experiences and coping strategies. This study aimed to explore the emotional experiences and coping strategies of nursing professionals during the first wave of the COVID-19 pandemic in a Spanish regional healthcare setting. A qualitative descriptive phenomenological study was conducted in 2020. Data were collected through semi-structured interviews and written narratives from 36 nursing professionals working in the Riojan Health Service. Three main themes emerged: perceived emotions, stressors, and coping strategies. Nurses reported intense feelings of fear, uncertainty, and frustration, which negatively impacted their mental health and hindered emotional regulation and decision-making. Key stressors included high workload, lack of resources, constant exposure to risk, and rapidly changing clinical situations. Despite these challenges, participants described various coping strategies, such as peer support, professional commitment, and adaptive emotional responses, which helped them manage the situation. The findings describe the emotional impact experienced by nursing professionals during the first months of the COVID-19 pandemic and identify coping strategies used in a specific regional healthcare context in Spain.

COVID doi: 10.3390/covid6060100

Authors: Kauane Vieira de Oliveira Luana dos Santos Andrade Davi Vantini Laércio da Silva Paiva Fernando Luiz Affonso Fonseca Rosangela Filipini

Background: Home care (HC) has expanded globally, offering individualized care and reducing hospital demand, but the role of the family caregiver imposes a significant physical and emotional burden, particularly during health crises like coronavirus disease 2019 (COVID-19). This study aimed to analyze the performance and quality of life perspectives of family caregivers during the pandemic. Methods: A cross-sectional, descriptive and quantitative study was conducted with 101 family caregivers from the Better at Home Program in Santo André, Brazil, between February and March 2021. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) instrument was used to assess quality of life, and the Barthel Index was used to evaluate the degree of patient dependence. Results: The sample showed a predominance of women (mean age 56 years, SD = 12.541; 13.9% aged 20–40 years, 41.4% aged 43–59 years, 44.7% aged 60–84 years) convenience sample, with low education and family income up to two minimum wages. Most caregivers were fully dedicated to patients with high dependence (89.1% in total or severe dependence, mainly due to neurological disorders). Overall quality of life was classified as “needing to improve” or “regular” in 61.4% of cases, with the pandemic intensifying perceived difficulties and negatively impacting all quality of life domains. A high prevalence of untreated chronic diseases and low COVID-19 vaccination rates were concerning findings. Conclusions: Family caregivers represent a vulnerable population requiring public policies and integrated support strategies, including quality of life assessment, psychological support, financial assistance, and respite care to ensure continuity of humanized, quality care.

COVID doi: 10.3390/covid6060099

Authors: Morgana Maciél Oliveira Yuri Clemente Andrade Sokolovicz Marieli Friedrich Loreto Gilson Zeni Tales A. C. Goulart Patrick Teixeira Campos Isabella Burchardt Ferreira Carlos Serpa Otávio Augusto Chaves Davi Fernando Back

Research on oxazolones, particularly 4-alkynyloxazolones, has garnered increasing interest due to the presence of an alkynyl group, which facilitates molecular conjugation and enables diverse chemical modifications. In this study, three representative 4-alkynyloxazolone derivatives (L1–L3) were synthesized and structurally characterized through single-crystal X-ray diffraction and computational analysis to obtain a reliable structure of L1–L3 to subsequently predict in silico interactions with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike glycoprotein. The crystallographic results revealed high molecular planarity and multifurcated hydrogen bonding. Considering the obtained crystallographic structure, theoretical descriptors such as HOMO–LUMO energy gaps and electrostatic potential maps indicated that these compounds exhibit favorable electronic reactivity, particularly for L3, with favorable drug-like predictions. The lack of methoxy groups in L2 and L3 makes these compounds have lower predicted toxicity parameters than L1. Molecular docking calculations targeting SARS-CoV-2 spike glycoprotein in three different feasible conformations in a biological matrix, i.e., three receptor-binding domains (RBD) in down conformation, two RBD in down and one in up conformation, as well as RBD bound to the human receptor angiotensin-converting enzyme 2 (ACE2), suggested strong binding affinities and specific interactions with the RBD moiety, mainly in the up conformation. Overall, this work integrates crystallographic and computational approaches to establish the structural and in silico evaluation of spike-binding properties of early substituted 4-alkynyloxazolones, suggesting L3 as a candidate for future in vitro antiviral assays.

COVID doi: 10.3390/covid6060098

Authors: Lambros Tsourgiannis Vasilios Zoumpoulidis George Drosatos Stavros Valsamidis

This study identifies the factors that influence the use of the Airbnb platform by Generation Z and Y in Greece, classifies them into groups according to their attitudes, and profiles the tourists of each generation according to their preferences regarding Airbnb bookings. The researchers conducted a primary survey using a sample of 576 citizens. Factor analysis was conducted initially to identify the main factors that affect each generation in using Airbnb after the COVID-19 pandemic. Cluster analysis was performed to classify each generation into groups. Quadratic discriminant analysis was conducted in the third phase to check cluster predictability. Non-parametric tests, including the chi-square test, were performed to profile tourists of each generation according to their preferences regarding Airbnb bookings. The results of this study indicate that people of Generations Z and Y preferred to use Airbnb accommodations even after the COVID-19 pandemic. The fact that Airbnb is safer than a conventional hotel due to COVID-19, the easy booking process and access to house amenities, as well as other marketing issues, affects most people of Generation Z and Y. This market segmentation study is quite essential in the tourism industry, especially in a country where tourism is of great importance to its economy. It highlights the impact of the pandemic on decisions and attitudes regarding the use of Airbnb.

COVID doi: 10.3390/covid6060097

Authors: Evangelia Kartsoni Nikolaos Bakalis George Markakis Sanna Ruhalahti Michail Zografakis-Sfakianakis Evridiki Patelarou Athina Patelarou

This study aimed to investigate the factors that predict the acceptance of distance learning among undergraduate nursing students during the COVID-19 pandemic and to examine Please check if the Citation part is missing the implications of these findings for nursing education in the post-pandemic era. A cross-sectional study was conducted in Greece with a convenience sample of undergraduate nursing students from the Hellenic Mediterranean University and the University of Patras. Data were collected between December 2020 and January 2021 using an online questionnaire. Statistical analysis was performed using IBM SPSS version 21.0. A total of 378 undergraduate nursing students (mean age: 22 years) participated in this study. The regression model predicting students’ attitudes toward distance learning (ATel) was statistically significant and explained 18.3% of the variance in ATel scores (R2 = 0.183, adjusted R2 = 0.158). Among the psychological and experiential factors, future career concerns (β = 0.237, p < 0.001), emotional distress related to social isolation (β = 0.186, p = 0.001), and perceived difficulties in group work (β = 0.140, p = 0.013) were revealed as significant predictors of the students’ attitudes toward distance learning. In contrast, digital readiness, flexibility, and perceived effectiveness of distance learning were not revealed as statistically significant predictors in the multivariate model but were positively associated with students’ attitudes. Demographic characteristics were not identified as statistically significant predictors of ATel scores. Psychosocial factors were significantly associated with nursing undergraduate students’ attitudes toward distance learning, underscoring the importance of incorporating blended learning in higher education in the post-pandemic era to secure group interaction, effective collaboration, and students’ well-being.

COVID doi: 10.3390/covid6060096

Authors: Toni Valković Sandra Bašić-Kinda Aron Grubešić Marija Stanić Damić Ozren Jakšić Stefan Mrđenović Sabina Novaković-Coha Dominik Lozić Mirta Mikulić Ranka Serventi Seiwerth Dino Dujmović Barbara Dreta Gordana Pavliša Marino Narančić Ida Hude-Dragičević Igor Aurer

During the pre-Omicron phases of the COVID-19 pandemic, patients with hematological neoplasms were characterized by very high morbidity and mortality rates. Remdesivir, a viral RNA-polymerase inhibitor, interferes with key SARS-CoV-2 enzymes, preventing the virus from multiplying. The use of convalescent plasma (CP) in treating patients with COVID-19 has been shown to be beneficial in patients with an impaired humoral response to infection, including most of those on active treatment for hematologic malignancies. This retrospective, non-interventional study was performed using the Croatian Cooperative Group for Hematological Diseases database of patients with hematological malignancies infected with SARS-CoV-2. Patients treated with remdesivir and/or CP were matched to those untreated according to age, disease type, and antineoplastic therapy. We identified 119 patients treated with remdesivir and/or CP fulfilling entry criteria and matched 116 according to our established criteria to one of the 374 untreated patients. Treatment significantly reduced COVID-19 mortality. The beneficial effect of antiviral therapy was limited to those who started antiviral treatment within 7 days of the onset of symptoms. Due to the exclusive enrolment of hematological patients with COVID-19, our study provides unique insights into the benefits of early application of both antiviral and CP therapy. It emphasizes the need for early administration before the infection has transformed into the hyperinflammatory phase.

COVID doi: 10.3390/covid6060095

Authors: Madalina Maria Diac Andrei Scripcaru Nona Girlescu Marin Fotache Bogdan Malinescu Daniel Tabian Sofia Mihaela David Laura Riscanu Diana Bulgaru Iliescu

Introduction: The global spread of the SARS-CoV-2 pandemic led to a serious health, social and economic global crisis. This pandemic was and remains the most important health emergency worldwide, for which all professionals have been called to provide diagnosis and treatment support. Despite early concerns about safety, forensic medicine has contributed to a better understanding of the pathological mechanisms involved. Objective: This study aims to describe and analyze the postmortem pathological findings in confirmed SARS-CoV-2 cases, emphasizing the contribution of forensic autopsies to elucidating the mechanisms of death and associated comorbidities. Methods: A retrospective study was conducted on 279 autopsies between 2020 and 2022. Demographic, clinical, and pathological data were collected and statistically analyzed. Results: Following the descriptive analysis of the cases included in the study, as well as the analysis of the relevant scientific literature, the major impact of the COVID-19 pandemic was highlighted in terms of the death mechanisms involved, occurring consequences and induced changes. Conclusions: Autopsies remain the essential tools for investigating COVID-19-related deaths. The findings confirm that SARS-CoV-2 primarily affects the pulmonary and cardiovascular systems. However, the overlap between “death from” and “death with” COVID-19 highlights the need for standardized postmortem diagnostic criteria and comprehensive clinical–pathological correlation.

COVID doi: 10.3390/covid6060094

Authors: Karoline Brizola de de Souza Eduarda de Lemos Wyse Raif Gregorio Nasre Nasser Ana Paula Veber Ana Luiza Muccillo-Baisch Bruno Dutra Arbo Flávio Manoel Rodrigues da Silva Júnior Mariana Appel Hort

Alcohol is one of the most commonly consumed psychoactive substances worldwide, with university students representing a subgroup characterized by elevated consumption rates. The COVID-19 pandemic triggered significant behavioral shifts across the general population, with students particularly vulnerable to its psychosocial impacts. In this context, the present study aimed to assess alcohol consumption patterns among university students and to examine the influence of the early stages of the COVID-19 pandemic on these behaviors. A cross-sectional study was conducted between July and November 2020 using a structured, self-administered online questionnaire. Alcohol consumption was assessed through self-reported measures of use (yes/no), frequency of intake (e.g., weekly consumption), and perceived changes in consumption compared to the pre-pandemic period. The instrument also collected data on sociodemographic characteristics, health status, and COVID-19 diagnosis. A total of 1553 valid questionnaires (i.e., fully completed responses meeting inclusion criteria) were analyzed. The prevalence of self-reported alcohol consumption was 99.93%, reflecting the inclusion of individuals with any level of consumption (including occasional use). Weekly consumption was the most frequently reported pattern. Regarding changes during the pandemic, 248 students reported an increase in alcohol intake, which was considered the main outcome of the study. Students reporting a perceived decline in overall health were less likely to report increased consumption, whereas those with a confirmed COVID-19 diagnosis were more likely to report increased use. The findings reveal a high prevalence of alcohol consumption among university students and suggest that periods marked by abrupt behavioral and routine changes, such as the COVID-19 pandemic, may significantly influence substance use patterns within this population.

COVID doi: 10.3390/covid6060093

Authors: Viridiana Del Carmen-Niño Ricardo Herrera-Navarrete José Angel Vences-Martínez Mirella Saldaña-Almazán Karla Rosalba Anzaldúa-Soulé Miguel Angel Lorenzo-Santiago

Solid waste management (SWM) is a major global challenge for environmental sustainability and public health. This study analyzed SWM perceptions and practices before and during the COVID-19 pandemic in Playa Boca Chica, Tecpan de Galeana, Guerrero, Mexico, using a descriptive and quantitative approach. Data was collected from 60 households between September and October 2022 and analyzed using SPSS statistical software version 26; reliability was confirmed with Cronbach’s Alpha; and the generation-associated greenhouse gas (GHG) emissions were estimated using the SWM-GHG climate calculator. This study explored socio-environmental dynamics in informal coastal settlements through a case study in the Global South. The results showed that waste generation remained stable during the pandemic (3.25 kg/day; p = 0.116), suggesting a pattern of behavioral rigidity in which entrenched waste management practices persisted despite the global health crisis, likely due to the absence of structural environmental interventions and policy-driven behavioral incentives. The climate calculator estimated GHG emissions of 92 and 99 tons of CO2-eq/year before and during the pandemic, respectively. Residents highlighted the need for improved infrastructure, recycling, and composting, while 97% emphasized environmental education and waste separation. The absence of a local waste management policy contributes to persistent emissions, underscoring the need for integrated and sustainable SWM strategies.

COVID doi: 10.3390/covid6060092

Authors: Imane Dalichaouche Meriem Hamouda Djamel Zoughailech Aicha Eutamene Nousseiba Abed El Batoul Ahmed Rais Malak Fertaki

The COVID-19 pandemic disrupted education worldwide, including in Algeria. This study assessed knowledge, attitudes, and practices (KAP) related to COVID-19 among biology students at the University of Constantine 1, Algeria, in 2021, aiming to inform university-based prevention strategies and future epidemic preparedness. Methods: A cross-sectional study was conducted from April to May 2021 among 300 students using a structured self-administered questionnaire. Sociodemographic data and KAP scores were collected and categorized as low, moderate, or high. Associations between KAP and demographic variables were analyzed. Results: Among participants, 86% were female, with a mean age of 22 ± 2 years. About 32% reported previous COVID-19 infection, and 59% had an infected family member. The mean knowledge score was 4.71 ± 0.94 (0–6), indicating high knowledge. The mean attitude score was 5.59 ± 1.91 (0–10), reflecting moderately positive attitudes, and the mean practice score was 8.92 ± 2.26 (0–12), indicating moderate adherence. No significant correlations were observed between knowledge, attitudes, and practices. Students showed good knowledge of COVID-19, but attitudes and practices were moderate, highlighting a gap between knowledge and behavior. Targeted university-based health education and behavioral interventions are needed to improve preventive adherence and epidemic preparedness.

COVID doi: 10.3390/covid6060091

Authors: Paskalis Gunawan Siti Setiawati Gurmeet Singh Ikhwan Rinaldi

Objectives: This study aimed to estimate the prevalence of Post-COVID-19 Syndrome among older adults in Indonesia, using time-based definitions of symptoms persisting beyond >4 weeks, >8 weeks, and >12 weeks. Methods: A retrospective cohort study was conducted among 329 older patients (≥60 years) hospitalized with COVID-19 in two tertiary hospitals in Jakarta from January to December 2021. Data on risk factors and persistent symptoms were collected from medical records and interviews. Results: The prevalence of Post-COVID-19 Syndrome was 31% (>4 weeks), 18.24% (>8 weeks), and 10.64% (>12 weeks). Significant predictors included frailty (OR 2.814), immobility during hospitalization (OR up to 4.767), higher number of initial symptoms (OR 2.043), constipation, instability, and sensory impairment during follow-up. Conclusions: Frailty, symptom burden, and geriatric syndromes, particularly immobility are strongly associated with Post-COVID-19 Syndrome in older adults. Clinical Implications: Early identification of frailty, geriatric syndromes (especially immobility), and high initial symptom burden is essential for risk stratification, targeted monitoring, and implementation of preventive and rehabilitative interventions to reduce long-term post-COVID-19 complications in older populations.

COVID doi: 10.3390/covid6060090

Authors: Nilihan E. M. Sanal-Hayes Kate Slade Marie Mclaughlin Ethan Berry Emma Swift Gabrielle Humphreys Nabil Hasshim William S. Royle Lawrence D. Hayes

Background: Globally, around 400 million people are estimated to be affected by long COVID, yet treatment options remain scarce. A systematic review published in 2025 indicated that non-invasive brain stimulation may help reduce some long COVID symptoms. If repetitive transcranial magnetic stimulation (rTMS) has therapeutic potential for these patients, then a clear synthesis of the evidence is necessary to determine efficacy and potential for implementation. Methodology: This systematic review and narrative synthesis was conducted in accordance with PRISMA guidelines. The search, completed on the 4th of December 2025, covered four databases and grey literature. Studies were included if they examined long COVID and rTMS. Findings: A meta-analysis was not possible due to insufficient reported data across studies. Instead, a structured narrative synthesis was conducted on four included studies. The structured narrative synthesis of four studies indicates that rTMS is feasible and is associated with reported improvements in fatigue, mood, and cognitive symptoms in individuals with long COVID. However, all included evidence is based on uncontrolled case series and retrospective analyses, meaning no causal conclusions can be drawn and findings should be interpreted as exploratory. Conclusions: Taken together, the evidence remains preliminary and highlights the need for well-designed randomised controlled trials to assess efficacy.

COVID doi: 10.3390/covid6050089

Authors: Handan Ciftci Ramazan Sabirli Aylin Koseler Omer Canacik Emre Karsli Dogan Ercin Emin Ediz Tutuncu Ozgur Kurt

This study investigated the association between serum hypoxia-inducible factor 1-alpha (HIF-1α) levels and clinical severity in patients with coronavirus disease 2019 (COVID-19). This prospective case–control study included 91 patients with confirmed COVID-19, of whom 51 had severe-critical disease with pneumonia and 40 had mild disease without pneumonia, as well as 39 healthy controls. Vital signs, including body temperature, pulse rate, respiratory rate, oxygen saturation, and blood pressure, were recorded. Biochemical parameters such as complete blood count, D-dimer, ferritin, creatinine, urea, and high-sensitivity cardiac troponin T were analyzed. Serum HIF-1α levels were measured using ELISA. Median HIF-1α levels were 132.9 pg/mL (IQR: 131.7–138.0) in the severe-critical disease group, 137.35 pg/mL (IQR: 131.65–152.75) in the mild disease group, and 136.6 pg/mL (IQR: 132.2–162.2) in controls. Significant differences were observed between groups (p = 0.012). ROC analysis showed a discriminatory performance for HIF-1α, with a sensitivity of 89.01% and specificity of 35.90% at a cut-off value of ≤154 pg/mL for distinguishing mild disease from controls, and a sensitivity of 86.3% and specificity of 42.5% at a cut-off value of ≤141.1 pg/mL for distinguishing severe-critical disease from mild disease. HIF-1α levels decreased with increasing disease severity. HIF-1α levels were found to be associated with disease severity; however, the low AUC values indicate that this parameter has limited discriminative ability for clinical use when used alone.

COVID doi: 10.3390/covid6050088

Authors: Lam Thi Le Johnston H. C. Wong Yen Thi Truong Bich-Hanh Thi Nguyen Nguyet Thi Trinh

Background: The COVID-19 pandemic has generated widespread concerns regarding its long-term effects on children’s mental health. While numerous studies documented increased psychological distress among children during the pandemic, less is known about how children’s emotional and behavioral functioning have evolved in the post-pandemic period. Objective: This study examines patterns of children’s mental health using survey data collected in 2023 and 2025. Guided by the dual-factor model of mental health, the analysis considers both psychological difficulties and positive social functioning in order to provide a multidimensional understanding of children’s well-being. Method: Data were collected using the Strengths and Difficulties Questionnaire (SDQ-25), a widely used behavioral screening instrument assessing emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. These domains were analyzed across two time points to explore patterns of change in internalizing difficulties, externalizing difficulties, and social strengths among school-age children in the post-pandemic context (N = 1262 students in 2023 and N = 575 students in 2025). Results: The findings suggest that children’s mental health after the pandemic reflects both persistent vulnerability and adaptive capacity. Emotional symptoms and behavioral challenges remain present among a proportion of children, indicating that the psychological effects of pandemic-related disruptions may extend beyond the immediate crisis period. At the same time, many children demonstrate relatively stable levels of prosocial behavior, highlighting the continued importance of positive social functioning as a protective factor for psychological adjustment. Contributions: These results underscore the importance of adopting a comprehensive perspective on children’s mental health that recognizes both difficulties and strengths. The study highlights the role of schools and families in supporting children’s post-pandemic recovery through early mental health screening, social–emotional learning initiatives, and programs that promote empathy and peer support. Such approaches may contribute to strengthening children’s resilience and long-term well-being in the aftermath of large-scale social disruptions.

COVID doi: 10.3390/covid6050087

Authors: Gulomjon Kholov Nilufar Akhmedova Ulugbek Ochilov Sukhrob Nurulloyev Sitora Mukhammadiyeva Nozima Djuraeva Otabek Fayzulloyev Abdugappor Insopov Sanobar Rakhmonova Mehriniso Ochilova Rajab Bobokalonov Akmal Djumaev Zulfiya Abulova Dildora Otajonova Mokhibegim Nematova Nigina Shukurova Navbakhor Nazarova Dildora Komilova Mehinbonu Nurmukhammedova Dilfuza Rakhmonova

Background: Hypertension is one of the most prevalent comorbidities in patients with COVID-19 and a major contributor to chronic kidney disease (CKD). Traditional kidney injury markers, including creatinine, estimated glomerular filtration rate (eGFR) and microalbuminuria, reflect renal injury only after substantial nephron loss has already occurred. Urinary podocyte proteins, such as nephrin (nephrinuria), have been suggested as early markers of glomerular barrier dysfunction; however, their clinical behavior and diagnostic value in hypertensive patients with previous SARS-CoV-2 infection are unknown. Aim: To assess urinary nephrinuria, microalbuminuria, transforming growth factor β1 (TGF-β1), aldosterone, vascular endothelial growth factor A (VEGF-A) and renal hemodynamics across different stages of hypertension in patients with and without a history of COVID-19 and to assess the response to conventional antihypertensive and nephroprotective treatment. Methods: In a prospective comparative cohort study, 120 patients (aged 30–60 years) with stage I–III essential hypertension were stratified by COVID-19 history into a post-COVID-19 group (n = 60) and a non-COVID-19 group (n = 60); within each group, 20 patients were assigned to each hypertension stage. Comparisons were performed between the post-COVID-19 and non-COVID-19 subgroups at the same hypertension stage. Serum creatinine, cystatin-C, aldosterone, TGF-β1 and VEGF-A, urinary microalbumin and nephrin and intrarenal Doppler hemodynamics were measured at baseline and after six months of guideline-based treatment. Results: Nephrinuria was markedly increased in post-COVID-19 patients in all stages of hypertension, including stage I, where serum creatinine, cystatin-C and eGFR were within the normal range (126.5 ± 9.1 vs. 91.9 ± 8.3 pg/mL, p < 0.01). Nephrinuria was strongly correlated with renal functional reserve (r = −0.824, p < 0.001), eGFR (r = −0.797, p < 0.001), microalbuminuria (r = 0.758, p < 0.001), aldosterone (r = 0.613, p < 0.001) and VEGF-A (r = 0.589, p < 0.001). Antihypertensive and nephroprotective treatment for six months decreased nephrinuria, blood pressure and TGF-β1, with more limited effects in stage III disease. Conclusions: Nephrinuria was found to be an early marker of renal involvement in COVID-19, occurring before microalbuminuria and conventional functional markers and with a greater relative difference than these markers in stage I disease, suggesting podocyte injury as an early and potentially reversible mechanism of post-COVID renal involvement in hypertensive patients. Nephrinuria seems to be a potential biomarker for early renal surveillance in this population and its prognostic role for incident CKD needs to be validated in longitudinal outcome studies.

COVID doi: 10.3390/covid6050086

Authors: Maria Mardalena Martini Kaisar Tria Asri Widowati Helen Kristin Sheila Jonnatan Sem Samuel Surja Enty Tjoa Venna Jullyanny Waty Wijaya Anita Devi Krishnan Thantry Ivonne Martin Soegianto Ali

Understanding COVID-19 transitions towards endemicity is vital by examining center-specific data within provincial and national contexts. This retrospective study aimed to enhance public health management and understanding of COVID-19 dynamics using data from Atma Jaya Catholic University of Indonesia (AJCUI) and open-source databases from Jakarta and Indonesia’s official websites from July 2020 to December 2022. Trends across data sources were compared, and correlations between positivity rates at AJCUI and Jakarta/Indonesia were assessed using linear regression. A total of 8,354,809 positive samples were analyzed nationally, showing similar trends and peaks of positivity rates across databases, with positive correlations between AJCUI–Jakarta (β = 1.154; p < 0.001; 95% CI = 0.86–1.45) alongside AJCUI–Indonesia (β = 1.262; p < 0.001; 95% CI = 0.74–1.79). Mobility restriction policies substantially reduced the positivity rate within the study period. Further analysis of AJCUI showed that higher proportions of low Ct value (≤30) were associated with increased contemporaneous positivity at AJCUI (β = 0.442; p < 0.001) and Jakarta (β = 0.319; p < 0.001), although inadequately reflected in Indonesia (β = 0.039; p = 0.589). This study highlights the potential of incorporating Ct value distributions as epidemiological indicators within surveillance systems. These findings support the importance of comprehensive laboratory data recording to better characterize COVID-19 transmission patterns across different surveillance levels, alerting policymakers to establish efficient policies.

COVID doi: 10.3390/covid6050085

Authors: Rodrigo Portes Ureshino Larissa Augusta de Sousa Rafaela Brito Oliveira Giulia Alves Saullo Pedro Henrique Zonaro Louise Newson Carla Máximo Prado Roberta Sessa Stilhano

Excitotoxicity is one of the factors that participates in neurodegeneration, impairing neuronal and glial cells’ function, and leading to the development of chronic neurodegenerative diseases. The main mechanism of action lies in the overstimulation of excitatory receptors, especially the NMDA (N-methyl-D-aspartic acid) receptor, by glutamate, which promotes a massive influx of Ca2+ that is not sufficiently buffered by the intracellular machinery, or not released by mechanisms such as Ca2+ ATPase and plasma membrane Ca2+/Na+ exchanger promoting, among other toxic effects, mitochondrial damage and an increase in reactive oxygen species (ROS). Notably, many cases reported of long COVID-19 describe significant brain alterations and neuropsychiatric disorders, including delirium, depression, etc., and patients required increased use of antidepressant or anxiolytic drugs, for example. In addition, emerging evidence links neurodegeneration as a potential long-term sequelae associated with an increased number of patients with cognitive disorders. This review analyzes data from the literature regarding brain alterations associated with post-COVID-19 syndrome and explores a potential link to the excitotoxicity pathways, due to its participation in neurodegeneration by homeostatic failure, and it is clearly present in various brain conditions, such as Alzheimer’s and Parkinson’s diseases.

COVID doi: 10.3390/covid6050084

Authors: Julian Brauchle Valentin Unger Fabian Grünig Laura Schmidberger Jan Hochweber

COVID-19-related school closures substantially disrupted students’ daily lives. While prior research has predominantly relied on externally assessed achievement data and proxy indicators of well-being, less is known about students’ own perceptions of their experiences during distance learning. This study addresses this gap, using a qualitatively informed quantitative analysis. First, open-ended responses from N = 698 students from German and Swiss schools were analyzed to identify perceived positive and negative aspects of distance learning, thereby providing experience-based indicators of how the pandemic affected students’ well-being. Quantitative content analysis revealed that students most frequently mentioned advantages such as being at home and experiencing greater independence, while common disadvantages included a lack of social contact and insufficient learning support. Second, random forest models were applied to identify individual, contextual, and background-related predictors of these perceptions. Students with stronger self-regulation skills, lower levels of procrastination, and better-equipped home learning environments were more likely to emphasize positive experiences. Conversely, younger students and those with weaker self-regulation and fewer home learning resources more frequently reported negative experiences. The findings reveal substantial variability in students’ perceptions of distance learning, shaped by learner-related, contextual, and broader background factors. They underscore the importance of fostering self-regulation and ensuring equitable access to learning resources to better prepare schools for future crises.

COVID doi: 10.3390/covid6050083

Authors: Daniela A. Marques Cristiana P. Von Rekowski Cecília R. C. Calado Luís Bento Iola Pinto

Traditional and COVID-19-specific severity scores are applied in intensive care units (ICUs) to guide decision-making and predict mortality. Since traditional severity scores (APACHE II, SAPS II, SAPS 3, and SOFA) were not originally designed for SARS-CoV-2, this study compared their performance with COVID-19–specific models (Shang-COVID and SEIMC), including a novel distinction between early (≤7 days) and late (>7 days) ICU mortality. Adult ICU COVID-19 patients from the first two pandemic waves in Portugal were included (n = 286). Six scores were calculated, and four outcomes assessed: hospital, ICU, early ICU, and late ICU mortality. Discrimination was assessed using ROC curves with AUCs, 95% CIs, and p-values. AUCs were compared using the Delong test (early vs. late ICU mortality and across scores within each wave) and the Hanley & McNeil test (between waves for each score). Traditional scores demonstrated robust mortality prediction. SEIMC performed well for hospital (AUCwave1 = 0.808; AUCwave2 = 0.724) and ICU mortality (AUCwave1 = 0.805; AUCwave2 = 0.706). SEIMC (AUCwave1 = 0.786; AUCwave2 = 0.800) and Shang-COVID (AUCwave1 = 0.617; AUCwave2 = 0.736) showed potential for early mortality prediction but require further validation and recalibration. Overall performance was superior during the first wave, likely reflecting differences in patient characteristics, viral variants, and health measures. Traditional severity scores demonstrated stable robust prediction of ICU and hospital mortality in COVID-19 cases. Disease-specific scores did not significantly outperform established models, though also showed good predictive ability in some contexts, particularly early ICU mortality. These findings highlight the need for continuous validation and recalibration of predictive tools as clinical contexts evolve.

COVID doi: 10.3390/covid6050082

Authors: Adriano Luis Fonseca Miriã Cândida Oliveira Daniela Rosana Pedro Fonseca João Pedro R. Afonso Heren Nepomuceno Costa Paixão Jairo Belém Soares Ribeiro Júnior Larissa Rodrigues Alves Tiago Vieira Fernandes Daniel Grossi Marconi Rodrigo A. C. Andraus Carlos Hassel Mendes Silva Iransé Oliveira-Silva Orlando Aguirre Guedes Claudia S. Oliveira Natasha Yumi Matsunaga Spicacci Maria Clara Real Pedro Fonseca Wilson Rodrigues Freitas Júnior Paolo Capodaglio Luis Vicente F. Oliveira

Introduction: Coronavirus disease 2019 (COVID-19) can cause persistent cardiovascular alterations, including autonomic dysfunction. Heart rate (HR) recovery (HRR) after exercise is a simple marker of autonomic modulation associated with functional capacity and clinical prognosis. Evaluating HRR during the six-minute walk test (6MWT) may help identify residual functional limitations in diverse patients. Objective: To compare pulmonary function, maximal inspiratory pressure (MIP), functional capacity, dyspnea, fatigue, and functional status in post-COVID-19 patients. Methods: This cross-sectional study included 75 adults (mean age: 47.6 ± 13.1 years; 54.7% male) who recovered from COVID-19 divided into 2 groups based on HRR 1 min after the 6MWT: delayed (≤12 beats/min); and non-delayed (>12 beats/min). Pulmonary function, MIP, exercise capacity (via 6MWT), dyspnea, muscle fatigue, and functional status were assessed. Results: Based on HRR 1 min after 6MWT, 27 (36%) participants were classified with abnormal HRR and 48 (64%) with normal HRR. There were statistical differences between the groups regarding demographic or clinical characteristics, pulmonary function, MIP, muscle fatigue, or functional status (p > 0.05). The delayed HRR group exhibited a smaller reduction in HR in first minute of recovery (ΔHR = 6 vs. 23 beats/min), higher baseline HR (p = 0.010), and greater dyspnea (p = 0.020). Furthermore, this group exhibited worse functional performance in the 6MWT, with shorter distance walked (437.33 vs. 494.27 m; p = 0.019) and a lower percentage of predicted distance (74.66 ± 12.98% vs. 82.94 ± 15.71%; p = 0.023) compared with the non-delayed HRR group. Conclusion: Delayed HRR post-COVID-19 was associated with poorer functional performance and greater dyspnea, regardless of pulmonary function. The blunted reduction in HRR after exertion suggests impaired cardiovascular autonomic modulation, possibly related to attenuated vagal reactivation, which may contribute to exercise intolerance observed in this population.

COVID doi: 10.3390/covid6050081

Authors: Cindy M. M. de Jong Bas F. M. van Raaij Louisa (M. L.) Antoni Sesmu (M. S.) Arbous Miranda (J. J. M.) Geelhoed Michiel A. de Graaf Geert H. Groeneveld Chris (S. C. H.) Hinnen Veronica R. Janssen Moniek M. ter Kuile Anna H. E. Roukens Lauran (J. L.) Stöger Maarten S. Werkman Frederikus A. Klok Bob Siegerink on behalf of the COVID-19 LUMC Group on behalf of the COVID-19 LUMC Group

Since the introduction of the Post-COVID-19 Functional Status (PCFS) scale early in the COVID-19 pandemic, the scale has been incorporated in research and clinical guidelines to assess and monitor functional status. In this explorative study, we aimed to evaluate characteristics of the PCFS scale based on its use during a 12-month follow-up of COVID-19 survivors to increase understanding of the scale over a longer period of time. Adult COVID-19 patients who were evaluated by multidisciplinary measures at 6 weeks and 12 months post-discharge at the Leiden University Medical Center (The Netherlands) were included. The distribution of PCFS scale grades, as well as descriptive patterns between PCFS grades and patient-reported outcome measures (PROMs), pulmonary function and physical function were evaluated with descriptive analyses; no statistical tests were performed due to data availability. Of the 79 included patients, 62% had a change in PCFS grade between the 6-week and 12-month follow-ups, of whom 63% improved over time. At 12 months, abnormal PROMs regarding psychological symptoms (according to clinical cut-offs), relatively lower quality of life (EQ VAS) scores, and MRC dyspnea grades ≥ 2 were observed in patients scoring PCFS grade ≥ 2. With increasing PCFS grade, a decrease in pulmonary function and physical function outcomes was observed. Higher PCFS grades (worse functional status) seemed related to worse outcomes at 12-month follow-up. Future studies are needed to investigate whether changes in PCFS grade reflect clinically relevant changes in patients’ self-perceived functioning.

COVID doi: 10.3390/covid6050080

Authors: Maya Asami Takagi Hevatib Mehmood Asef Raiyan Hoque Neli Ragina

American Indian and Alaska Native (AI/AN) communities experienced disproportionate COVID-19 morbidity and mortality, particularly in rural areas with limited public health infrastructure. This study examined primary COVID-19 information sources among AI/AN adults in rural Michigan and evaluated how trust in these sources relates to health knowledge, attitudes, and vaccination behaviors. We conducted a prospective, randomized pre-post interventional study among 273 adults at a tribal health clinic in rural Isabella County, Michigan (2022–2024). Participants were assigned to receive a culturally tailored educational video or infographic, and surveys assessed COVID-19 knowledge, vaccine attitudes, information sources, and perceived reliability. Social media was the most frequently used information source but was rated as less reliable, whereas healthcare workers (HCWs) were considered the most trusted. Reliance on HCWs and personal relationships was associated with higher baseline vaccine knowledge and greater uptake of influenza vaccination. Both educational formats resulted in modest improvements in COVID-19 knowledge and vaccine attitudes. While no consistent differences were observed between formats overall, infographic-based education was associated with greater gains in select vaccine knowledge domains among participants who relied on trusted interpersonal or clinical information sources. These findings highlight a “usage-trust gap” in rural AI/AN health communication, where frequently used information channels are not necessarily the most trusted. Culturally tailored messaging delivered through trusted clinical and interpersonal networks may enhance the effectiveness of public health communication and support vaccine uptake in underserved communities.

COVID doi: 10.3390/covid6050079

Authors: Elisa Bósquez Diana C. Oviedo-Céspedes Gabrielle B. Britton Adam E. Tratner Sofía Rodríguez-Araña Ramón Mon

Many people experienced difficulties grieving the death of a loved one during the COVID-19 pandemic. The main objective of this research was to examine the psychological manifestations of grief for people who experienced the death of a loved one between March 2020 and March 2022 in Panama. A sample of 110 participants completed an online survey including sociodemographic questions and psychological questionnaires. A subsample of twenty-six participants was interviewed about their experience of loss leading up to death, at the time of death, and after death. Results indicated that 43.6% of participants suffered from complicated grief (CG). Participants who experienced CG had more post-traumatic stress symptoms, somatic symptomatology, anxiety/insomnia, social dysfunction, severe depression, use of avoidant coping mechanisms, and more anxiety about the pandemic than participants who did not experience CG. A logistic regression analysis indicated that anxiety/insomnia symptoms, denial as a coping mechanism, and post-traumatic stress symptoms increased the likelihood of CG. For qualitative analyses, the most relevant themes that emerged were distress associated with contagion and illness, hospitalization and access to healthcare services, communication with medical staff, the impact of the news of death, inability to view the body, emotions following the loss, farewell rituals, and coping mechanisms.

COVID doi: 10.3390/covid6050078

Authors: Vidya Keshav Lesley Scott Lucia Hans Wendy Stevens

Rapid antigen tests targeting SARS-CoV-2 nucleocapsid protein were essential for decentralised testing during the COVID-19 pandemic. Independent performance evaluations are essential to support regulatory approval and inform clinical implementation, particularly in resource-limited settings. This study presents a retrospective analytical and operational evaluation of two instrument-based fluorescent immunoassays (FIAs): the PCL COVID-19 Ag Rapid FIA and LumiraDx SARS-CoV-2 Ag Test. Analytical sensitivity was determined using recombinant nucleocapsid protein and viral cultures. Clinical performance was assessed using residual clinical specimens (n = 110) with RT-PCR as a reference, stratified by cycle threshold (Ct). Operational characteristics were assessed using a structured Likert framework. Overall sensitivity was 63% (51–73) for PCL and 95% (88–99) for LumiraDx. For Ct ≤ 25, sensitivity increased to 93% and 100%. Specificity was ≥97% for both. LumiraDx maintained sensitivity (83–94%) at Ct 25–30, whereas PCL did not detect any positives in this range. The limit of detection was 39 pM (PCL) and 0.6 pM (LumiraDx). Operational usability was high for both (90% PCL, 87% LumiraDx). LumiraDx showed higher analytical sensitivity across a broader viral load range, supporting primary diagnostic use, whereas PCL was limited to high viral loads. This evaluation provides a reproducible framework for rapid diagnostic assessment during emerging outbreaks.

COVID doi: 10.3390/covid6050077

Authors: Marina Kloni Alexandros Heraclides Theognosia Panteli Alexios Klonis Panagiotis Rentzias Christos Karagiannis

Background: Post-COVID-19 syndrome (PCS) is associated with impairments in mobility, balance, and physical function, which may reduce quality of life. The 30 s Sit-to-Stand (30STS) and Timed Up and Go (TUG) tests are widely used clinical measures; however, their intra-rater reliability in older adults with PCS has not been established. Reliable outcome measures are essential for clinical assessment and rehabilitation planning. Methods: In this single-center pilot study, nineteen older adults with PCS were recruited as a convenience sample. Participants completed three trials of the 30STS and TUG tests on day one, with the protocol repeated after three days. The 30STS evaluates lower-limb strength and functional performance, while the TUG assesses balance, gait, and fall risk. Intra-class correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC) were calculated. Results: The TUG showed an ICC of 0.995 (95% CI: 0.991–0.998), SEM of 0.48 s, and MDC of 1.33 s. The 30STS showed an ICC of 0.986 (95% CI: 0.973–0.994), SEM of 0.26 repetitions, and MDC of 0.72 repetitions. Conclusions: The TUG and 30STS demonstrate excellent intra-rater reliability and appear to be feasible clinical tools for assessing functional performance in older adults with PCS. However, findings should be interpreted cautiously due to the small, single-center pilot design and single evaluator. Further research is needed to confirm generalizability across broader PCS populations and clinical settings.

COVID doi: 10.3390/covid6050076

Authors: Domna Tichala Dimitrios Papagiannis Ourania Kotsiou

Background: Understanding how demographic and clinical factors influence SARS-CoV-2 infection patterns, vaccination uptake and disease outcomes in community settings is essential for effective primary care-based public health planning. Objectives: This study aimed to investigate the distribution of SARS-CoV-2 infections among adults attending Primary Healthcare (PHC) facilities in Giannitsa, Greece, from 2020 to 2024, and to examine associations between demographic and clinical characteristics, vaccination category and disease outcomes. Methods: A retrospective analysis was conducted using data from the National Registry of Patients with COVID-19. The study included 1144 adults diagnosed with SARS-CoV-2 at PHC facilities from 19 November 2020 to 3 October 2024; all cases included in the present analysis had been confirmed by rapid antigen testing. Variables included age, gender, residence, registry-recorded underlying medical conditions, vaccination category, seasonality and clinical outcome. Results: Significant shifts in case distribution were observed across time, with younger adults predominating in 2020–2022 and older adults (61–90 years) in 2023–2024 (p < 0.001). Winter months showed higher case incidence overall (p < 0.001). Vaccination coverage increased annually, reaching 84.8% in 2024 (p < 0.001). Hospitalization/death occurred in 1.7% of patients and was strongly associated with age ≥61 years (6.0% vs. 0.3%), the presence of at least one registry-recorded underlying medical condition (9.2% vs. 0.9%) and vaccination category; specifically, hospitalization/death occurred in 10.4% of individuals diagnosed during the pre-vaccine period, 2.3% of unvaccinated individuals during the vaccination era and 0.9% of vaccinated individuals (all p < 0.001). Conclusions: Older age, underlying medical conditions and a lack of vaccination were key predictors of worse outcomes. The findings underscore the importance of strengthening vaccination outreach and targeted PHC interventions, particularly for high-risk and rural populations.

COVID doi: 10.3390/covid6050075

Authors: George Cătălin Alexandru Doina Chioran Mircea Riviș Cristina Modiga Loredana-Neli Gligor Marius Octavian Pricop Ștefania Dinu Ciprian I. Roi Cristina Dumitrescu Andreea Mihaela Kiș Tudor Rareş Olariu

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors.

COVID doi: 10.3390/covid6050073

Authors: Amanda Caroline Silva Rívolli Isabela Antunes de Souza Lima Camila Candida Compagnoni dos Reis Íngrid Ribeiro Antonio Márcia Marcondes Altimari Samed

Background/Objectives: The COVID-19 pandemic imposed logistical challenges on health systems, particularly for mass vaccination campaigns under emergency conditions. In decentralized health systems, the absence of a structured preparedness phase may compromise coordination, allocation, and operational performance. This study analyzes the vaccination campaign in a municipality in southern Brazil, examining how the overlap of the preparedness and response phases affected outcomes and how alternative logistical scenarios could have altered campaign performance. Methods: An empirical analysis was conducted using scenario-based simulation with stock and flow structures. The model represents vaccine procurement, distribution across national, state, regional, and municipal levels, and municipal vaccination capacity. Real data from the 2021 vaccination campaign in the municipality were used to build a Business-as-Usual scenario, compared with alternative scenarios involving changes in procurement predictability, allocation rules, and operational capacity. Results: Vaccination outcomes were strongly conditioned by upstream allocation decisions, particularly at the national state level. Isolated adjustments at intermediate supply chain levels produced limited improvements when upstream constraints persisted. Scenarios combining improved alignment between forecasted and acquired doses with operational capacity showed higher vaccination potential, revealing a gap between observed performance and system capacity. Conclusions: The findings reinforce that preparedness is a critical determinant of vaccination performance and must precede response in emergency contexts. Supply predictability alone is insufficient without coordinated allocation mechanisms and operational readiness across governance levels. This study provides empirical evidence on how preparation-related decisions shape vaccination outcomes in decentralized health systems and inform logistical coordination in future emergencies.

COVID doi: 10.3390/covid6050074

Authors: Maya Asami Takagi Asef Raiyan Hoque Neli Ragina

The COVID-19 pandemic highlighted substantial variability in public health information environments, yet the relationship between information source, perceived credibility, and behavioral response remains incompletely understood. This study evaluated how information sources influence COVID-19-related knowledge and behaviors and whether targeted educational interventions modify these relationships. We conducted a prospective survey-based study (July–December 2021) among adults recruited from outpatient clinics in Michigan (N = 209). Participants completed pre- and post-intervention surveys assessing information sources, perceived reliability, knowledge, and behaviors, and were randomized to receive either a video or infographic. Social media was the most frequently reported source (n = 95) but had lower perceived reliability (mean 2.97/5), whereas healthcare workers (HCWs) were rated most reliable (mean 4.26/5) despite lower utilization (n = 60). Use of HCWs, print media, and websites was associated with higher baseline knowledge, while television and radio were associated with lower knowledge of vaccine side effects (p = 0.011 and p = 0.003). Educational interventions improved knowledge and attitudes, with differential effects across source groups, while infographic-based interventions were more effective among social media users (p = 0.034). Information sources and perceived credibility significantly shape health knowledge and behavior, highlighting the need for communication strategies that integrate trusted messengers, high-reach platforms, and health literacy to improve public health outcomes.

COVID doi: 10.3390/covid6050072

Authors: Pantea Kiani Dana M. Dijkgraaf Sophie I. Groenewoud Anje A. te Velde Edith J. M. Feskens Aletta D. Kraneveld Johan Garssen Berber J. Vlieg-Boerstra Joris C. Verster

Post-acute sequelae of SARS-CoV-2 infection (PASC), also referred to as Long COVID, affects millions worldwide and is characterized by persistent fatigue, reduced immune fitness, and mood disturbances. The aim of the current study was to identify if immune fitness, mood, fatigue, and quality of life prior to SARS-CoV-2 infection could predict PASC fatigue severity. A retrospective cross-sectional survey was conducted among 299 Dutch PASC patients. Participants completed validated measures of immune fitness, fatigue (assessed with both the Fatigue Severity Scale and a single-item scale), mood (including stress, anxiety, depression, hostility, loneliness, and happiness) and quality of life for the three months prior to SARS-CoV-2 infection. The same assessments were made for the month before survey completion (i.e., during PASC). Correlational and regression analyses were conducted to identify possible predictors of PASC fatigue severity. Participants were predominantly female (90%): mean age 44.1 (SD 11.2) years. Both assessments of PASC fatigue did not correlate significantly with the prior SARS-CoV-2 assessments of immune fitness, fatigue, mood, and quality of life. The regression analyses revealed no significant predictors for PASC fatigue severity. In conclusion, immune fitness, fatigue, mood and quality of life prior to SARS-CoV-2 infection were not identified as independent predictors of PASC fatigue severity.

COVID doi: 10.3390/covid6040071

Authors: Stefan Kurbatfinski Deborah Dewey Nicole Letourneau

Background: The COVID-19 pandemic increased stress experienced by children through individual-, family-, and community-level factors, with potential sex-specific impacts on behavioural outcomes. Children’s resilience may buffer these effects. This exploratory study investigated associations between COVID-19 stress and children’s internalising, externalising, and overall behavioural symptoms, and whether child resilience and sex assigned at birth moderated these associations. Methods: Data (N = 68) came from the longitudinal COVID-19 Impact Study of the Canadian APrON pregnancy cohort of mothers and their children followed for more than 9 years. COVID-19 stress, combining individual-, family-, and community-level stressors, was reported by mothers (mean age = 42.37, SD = 3.72) and their children (53% female; mean age = 10.21 years, SD = 0.43) across three timepoints (October–December 2020; February–May 2021; June–August 2021). Children’s behavioural problems and self-reported resilience were assessed between April and September 2022. Results: COVID-19 stress was not significantly associated with children’s behavioural problems. Moderated-moderation suggested that the association between COVID-19 stress and children’s internalising (T-score estimate = −2.38, 95% CI [−4.08, −0.68]), externalising (T-score estimate = −3.21, 95% CI [−5.09, −1.33]), and overall (T-score estimate = −2.79, 95% CI [−4.45, −1.12]) symptoms may vary by child resilience and child sex assigned at birth. Among females, COVID-19 stress appeared to be associated with more behavioural problems at lower levels of resilience and fewer problems at higher levels of resilience. Significance: The association between COVID-19 stress and children’s behavioural symptoms across children’s resilience levels may vary based on sex assigned at birth, with effects suggested among females. Null findings may reflect the modest sample size and limited statistical power.

COVID doi: 10.3390/covid6040070

Authors: Olga Valderrama-Rios Rosario Miraval-Contreras Noemí Zuta-Arriola Mercedes Ferrer-Mejía Vanessa Mancha-Alvares César Paredes-Román Haydee Paredes-Román María Porras-Roque Lourdes Luque-Ramos Edgar Zárate-Sarapura Evelyn Sánchez-Lévano

This study evaluates the performance of a semi-dynamic negative binomial model with cubic spline smoothing to characterize the spatiotemporal dynamics of COVID-19 mortality in Peru, a setting marked by significant data inconsistency and reporting delays. Using nationwide weekly mortality data, we compared a Poisson regression against a semi-dynamic NB model with a population offset and cubic splines (df = 6). The models were evaluated using Akaike Information Criterion and log-likelihood to handle overdispersion and temporal non-stationarity. The NB model demonstrated a superior fit, reducing the AIC from 136,596.4 to 75,668.25 and improving log-likelihood by over 30,000 points. Demographic analysis revealed an 81.6% higher risk of death in males (IRR = 1.816; 95% CI: 1.753–1.881) and an exponential gradient with age, peaking at an IRR of 4.717 (95% CI: 4.499–4.945) for individuals ≥80 years. Departmental fixed effects identified significant spatial heterogeneity, with higher diffusion in coastal regions. The semi-dynamic NB model with splines provides a robust, parsimonious, and scalable framework for epidemiological surveillance in resource-limited settings. By effectively correcting for overdispersion and stabilizing weekly reporting fluctuations, this approach offers a reliable tool for public health decision making in environments with fragmented data quality.

COVID doi: 10.3390/covid6040069

Authors: Claudine J. Egol Katherine M. Piderman Harold G. Koenig Victor N. Nettey Matthew J. Van Ligten Mohamed Aly Shirshendu Sinha Terry D. Schneekloth Osama A. Abulseoud

Background: Religious affiliation has traditionally served as a coping strategy during stressful events such as the COVID-19 pandemic. Pregnant women faced heightened stress during the pandemic due to concerns about their health as well as that of their fetus. This study examined the prevalence of self-reported religious affiliation among SARS-CoV-2-positive pregnant women and investigated differences in psychiatric diagnoses and pregnancy outcomes based on religious affiliation. Methods: The study included all asymptomatic or mildly symptomatic SARS-CoV-2-positive pregnant women who received care at the Mayo Health System from March 2020 through October 2021 and completed the routine religious affiliation questionnaire. Those selecting “none” were categorized as having no religious affiliation (RA−), whereas those selecting a specific religion were categorized as religiously affiliated (RA+). Results: Among 609 women, 49.6% were RA+ and 50.4% were RA−. RA+ women were more likely to be white, married, college-educated, and have fewer prior abortions. There were no significant differences in rates of depression, anxiety, psychotropic medication use, substance use, or pregnancy and labor complications between RA+ and RA− groups. Conclusions: Half of the women in this cohort reported no religious affiliation. Previously reported protective associations between religiosity and mental health were not observed when religious affiliation alone was examined.

COVID doi: 10.3390/covid6040068

Authors: Salvador Domènech-Montoliu Óscar Pérez-Olaso Diego Sala-Trull Paloma Satorres-Martinez Laura López-Diago Isabel Aleixandre-Gorriz Maria Rosario Pac-Sa Manual Sánchez-Urbano Cristina Notari-Rodriguez Juan Casanova-Suárez Raquel Ruiz-Puig Gema Badenes-Marques Laura Aparisi-Esteve Carmen Domènech-León Maria Angeles Romeu-Garcia Alberto Arnedo-Pena

Background and Objective: After SARS-CoV-2 infection, Long COVID (LC) syndrome has occurred in a high proportion of patients, affecting their health. The aim of this study was to estimate the incidence of LC, as well as its risk and protective factors. Materials and Methods: We conducted a prospective population-based cohort study of the Borriana COVID-19 cohort (Castellon Province, Valencia Community, Spain) from May 2020 to August 2023, with a follow-up of 40 months, using the LC definition given by the World Health Organization. Inverse probability-weighted regression adjustment was applied in the statistical analysis. Results: With a participation rate of 63.8% and a total of 722 participants, the mean age was 37.7 ± 17.4 years, and 460 (62.3%) were female. Among them, 644 had experienced a SARS-CoV-2 infection, and 184 developed LC, corresponding to a cumulative incidence of 28.6%. At the time of follow-up, 135 patients remained affected by LC, and one LC-related death was recorded. Significant risk factors for LC included older age, female sex, being part of a small family, having a chronic disease, SARS-CoV-2 exposure, and disease severity. Asymptomatic COVID-19 infection and SARS-CoV-2 vaccination were significantly protective factors. Conclusions: A substantial incidence of LC was observed, along with a low recovery rate. Several risk and protective factors were identified. Continued follow-up of this cohort, improved medical care for patients with non-recovered LC, ongoing surveillance of SARS-CoV-2 infections, and vaccination of the at-risk populations against SARS-CoV-2 are recommended.

COVID doi: 10.3390/covid6040067

Authors: Boban Stolić Nataša Katanić Bojan Joksimović Jelena Filimonović Ksenija Bojović Aleksandar Pavlović Jasmina Poluga Nikolina Elez-Burnjaković Biljana Mijović Nenad Lalović Milena Anđelković Milica Milentijević Siniša Ristić Miloš Vasiljević Alma Prtina Miljan Adamović Marija Milić

Background: The clinical course of COVID-19 is highly variable, ranging from asymptomatic infection to critical illness with hyperinflammation and multiorgan failure. Oxidative stress plays a central role in COVID-19 pathogenesis, and genetic polymorphisms in glutathione S-transferase (GST) enzymes, particularly GSTM1 and GSTT1 null genotypes, may impair antioxidant defense and exacerbate inflammatory responses. This study aimed to investigate the association of GSTM1 and GSTT1 null genotypes with both disease severity and serum cytokine levels in hospitalized COVID-19 patients. Methods: This cross-sectional study enrolled 137 COVID-19 patients hospitalized during the second pandemic wave (July–September 2020). Patients were stratified into mild (n = 67) and severe (n = 70) groups based on clinical criteria. GSTM1 and GSTT1 polymorphisms were determined by multiplex polymerase chain reaction. Serum levels of 13 cytokines were measured using flow cytometry. Logistic regression analyzed genotype associations with disease severity, and multivariate linear regression assessed relationships between null genotypes and pro-inflammatory cytokine levels (IL-6, TNF-α, IL-17A, IFN-γ), adjusted for age, sex, hypertension, and diabetes. Results: The GSTT1 null genotype was significantly associated with severe COVID-19 (adjusted OR = 2.56, 95% CI: 1.08–6.07, p = 0.032). Severe patients exhibited significantly elevated levels of IL-6 (75.6% increase, p = 0.008), TNF-α (69.4% increase, p = 0.005), IL-17A (54.4% increase, p = 0.016), and IFN-γ (10.1% increase, p = 0.021). Both GSTM1 and GSTT1 null genotypes were associated with higher levels of these cytokines, with stronger effects observed for GSTT1 null. In multivariate analysis, GSTT1 null independently predicted elevated IL-6 (β = 52.6, p = 0.003), TNF-α (β = 13.8, p = 0.002), IL-17A (β = 2.4, p = 0.001), and IFN-γ (β = 56.4, p = 0.012). The combined both null genotype showed the strongest associations but was limited by small sample size (n = 10) and should be interpreted with caution. Conclusions: The GSTT1 null genotype is associated with severe COVID-19 and appears to be associated with heightened pro-inflammatory cytokine responses, particularly IL-6, TNF-α, IL-17A, and IFN-γ. These findings suggest a potential role for genetic impairment of antioxidant defense may contribute to hyperinflammation in COVID-19 hyperinflammation, although validation in larger cohorts is needed.

COVID doi: 10.3390/covid6040066

Authors: Raya Kh. Yashooa Dara K. Mohammad Shawnim M. Maaruf Treska S. Hassan Azhin D. Aziz Wissam Albeer Nooh Ghoorbat A. Mustafa Sevan O. Majed Gaylany H. Abdullah Galawezh O. Othman Suhad A. Mustafa

Coronavirus disease-2019 COVID-19 exhibits marked inter-individual variability in susceptibility and clinical outcomes, suggesting a role for host genetic factors. Vitamin D exerts immunomodulatory effects through the vitamin D receptor (VDR), and genetic variation in the VDR gene may influence host responses to SARS-CoV-2 infection. This study aimed to investigate the association between VDR-gene polymorphisms—FokI (rs2228570), TaqI (rs731236), ApaI (rs7975232), and BsmI (rs1544410)—and COVID-19 susceptibility in the Kurdish population. The FokI polymorphism was significantly associated with COVID-19 susceptibility. Interestingly, the GG-genotype was more frequent among Patients than controls and was associated with increased odds of infection (OR = 9.00; 95% CI: 3.22–25.15; p < 0.0001), whereas the AG-genotype was associated with reduced susceptibility (OR = 0.33; 95% CI: 0.14–0.76; p = 0.001). Additionally, the G-allele was also more prevalent in Patients than controls (OR = 1.87; 95% CI: 1.21–2.89; p = 0.004). Similarly, the TaqI TT-genotype was more frequent among Patients and was associated with increased susceptibility (OR = 36.0; 95% CI: 11.2–115.8; p < 0.0001). In contrast, the ApaI AA-genotype was less frequent among Patients and was associated with reduced odds of COVID-19 susceptibility under a recessive model (OR = 0.15; 95% CI: 0.03–0.68; p = 0.003). Moreover, the BsmI polymorphism was monomorphic in both groups and therefore not informative. Genetic variation in the VDR gene, particularly at the FokI, TaqI, and ApaI loci, was associated with COVID-19 susceptibility in the case–control study, while BsmI showed no variations. These findings suggest that genetic variation in the VDR gene may contribute to inter-individual differences in susceptibility to SARS-CoV-2 infection in the Kurdish population. Larger studies incorporating functional validation and detailed clinical data are required to confirm these associations.

COVID doi: 10.3390/covid6040065

Authors: Miryam Lora-Loza Jean Hernández Angulo José Elías Cabrejo Paredes Maribel Díaz Espinoza Jean Carlos Zapata Rojas

Health crises hinder the provision of intensive care for critical obstetric conditions such as preeclampsia and eclampsia, where timely decision making and system capacity directly impact maternal and fetal outcomes. This study compared the clinical and epidemiological profile and care processes in the ICU for cases of preeclampsia and eclampsia before and during the COVID-19 health crisis in Alto Amazonas, Loreto (Peru), using a comparative mixed-method approach. Quantitative data were obtained from ICU medical records for two periods (2015–2019 and 2020–2022). Categorical variables were compared using exact methods (Fisher’s exact test for 2 × 2 tables and exact procedures for scatter tables with multiple categories), and continuous variables were compared using nonparametric tests where appropriate. The most notable change was an increase in the frequency of cesarean sections during the health crisis, which should be interpreted with caution given the small sample size and potential changes in admission criteria and system limitations. Other clinical indicators and discharge status showed no clear evidence of substantial differences between the periods. Qualitative findings highlighted systemic limitations affecting continuity of care, particularly those related to timely access to safe blood products and referral pathways. These results align with SDG 3 (Good Health and Well-being) and support strengthening preparedness, referral coordination, and the availability of essential resources to protect maternal health during large-scale emergencies.

COVID doi: 10.3390/covid6040064

Authors: Ko Miyazawa Takuya Sakamoto Daisuke Sakamoto Tsugiyasu Kanda Tamaki Takano

The concurrent occurrence of COVID-19 and the 2024 Noto Peninsula earthquake resulted in a “compound disaster” in Japan. This retrospective study, spanning 11 years (2015–2025), examines the impact of these crises on trends in cardiovascular surgery, focusing on infective endocarditis (IE). A total of 2444 surgical cases were analyzed across three distinct periods: pre-pandemic (2015–2019), pandemic (2020–2023), and compound disasters (2024). While overall surgical volumes exhibited fluctuations, there was a notable increase in the number of interventions for IE and renal failure in 2024. Additionally, the 2024 IE cohort revealed a significant epidemiological shift, characterized by a younger median age (56 years compared to 70 years pre-pandemic), absence of pre-existing valvular disease, and a marked rise in blood culture-negative endocarditis (BCNE), which accounted for 83.3% of IE cases. In 2025, the number of surgical IE cases decreased to zero, highlighting the acute nature of the peak in 2024. These findings illustrate that compound disasters can disrupt cardiovascular surgical trends and underscore the susceptibility of IE to compromised healthcare access and environmental stress. The development of resilient diagnostic pathways is essential for managing complex public health emergencies.

COVID doi: 10.3390/covid6040062

Authors: Robert R. Wright Macey Bunnell Given Chatelain Eve McCulloch Alexis L. Soelberg Devon Marrott

For vaccine-preventable diseases, vaccination uptake is among the best public health behaviors to prevent infection, disease and death. However, public confidence in this behavior has waned in recent years alongside the twin respiratory threats of influenza and COVID-19. Moreover, certain populations, such as emerging adults, may be amenable to vaccination attitude and behavior change as they navigate their path between adolescence and adulthood. The current investigation presents two studies that address influenza and COVID-19 vaccination uptake among emerging adults. First, among more than 2000 emerging adults during the years of 2022–2024, we examined rates of vaccination uptake and attitudes, as well as relationships of vaccine rates with other concomitant health behaviors. Second, we explored the efficacy of a classroom-based vaccination promotion experience in altering both attitudes and behaviors regarding vaccination uptake among 275 emerging adults at college. Results highlighted some health behaviors that are related to influenza uptake but not COVID-19 uptake. Moreover, results from Study 2 demonstrated that attitudes, but not behavior, seem to be most amenable to the classroom-based approach to encourage health behavior change, as a significant increase in positive attitudes toward both influenza and COVID-19 vaccines was observed. These findings are discussed further, considering theoretical and practical applications.

COVID doi: 10.3390/covid6040063

Authors: Dartagnan Pinto Guedes Sandro Lucas Sofiati Alessandro Bressan Godoy

Previous studies have suggested that the COVID-19 pandemic exposed children to an increased risk of greater body weight accumulation; however, the evidence found is limited to examining relatively short periods in children from Asian, European, and North American countries and, in most cases, using cross-sectional designs, while studies with longitudinal designs are scarce. To our knowledge, to date, no study involving Brazilian children has examined temporal trends in body weight during the pandemic period using a longitudinal approach. Objective: To report the weight status of children aged 6 to 11 years pre-, during, and post-school closures in response to restrictions imposed by the COVID-19 pandemic, using a six-year school-based longitudinal cohort design (2020–2025). Method: Weight status was analyzed using the body mass index and diagnostic criteria proposed by IOFT. Initial data collection took place in 2020 (baseline—pre-school closures), in 2021 and 2022 (pandemic period—school closures), and in 2023, 2024, and 2025 (post-pandemic period—after the reopening of schools). Results: The data collected confirmed that restrictions imposed to mitigate the adverse impact of the COVID-19 pandemic, including the full or partial closure of schools, substantially increased children’s weight above what would be expected for their gender and age. After two years of the pandemic period, 23% of children identified in the baseline pre-school closures with normal body weight migrated to overweight, while 34% of overweight children became obese. Data equivalent to the post-pandemic period showed signs of a reduction in the excess body weight accumulated during the pandemic; however, the prevalence rates of overweight and obesity remained significantly higher than pre-school closures. Conclusions: The findings suggest that the harmful effects contributing to the greater accumulation of body weight during the COVID-19 pandemic tended not to reverse spontaneously, even five years after its onset. Therefore, specific actions to prevent, combat, and control overweight and obesity are essential to avoid present and future adverse consequences for children’s health.

COVID doi: 10.3390/covid6040061

Authors: Celalettin Topbaş Ayfer Atav Muhsin Ergen

Objective: Dental professionals are routinely exposed to infectious agents through contact with blood, saliva, and aerosols. This cross-sectional survey aimed to evaluate and compare knowledge, attitudes, and self-reported practices related to infectious diseases among dental students and practicing dentists in the post-COVID era. Methods: This web-based cross-sectional survey was conducted between January and March 2024 at a single dental faculty. Fourth- and fifth-year dental students and practicing dentists were invited to participate. A 30-item questionnaire assessed knowledge of infectious disease transmission and immunological markers (Questions Q1–Q19), as well as attitudes and self-reported practices toward patients with infectious diseases (Q20–Q30). Descriptive statistics were calculated, and comparisons between groups were performed using Pearson’s chi-square or Fisher’s exact tests (α = 0.05). Internal consistency of the questionnaire was acceptable (Cronbach’s alpha: 0.81 for knowledge items and 0.88 for attitude/practice items). Results: A total of 221 dental students and 33 dentists were included in the final analysis. Both groups demonstrated high awareness of respiratory transmission routes for COVID-19 and influenza. In contrast, recognition of bloodborne transmission pathways was limited, with approximately half of participants identifying blood contact and blood-contaminated instruments as potential sources of infection. Significant differences were observed between students and dentists in the interpretation of SARS-CoV-2 IgG antibodies, with dentists more frequently associating IgG positivity with prior infection (p = 0.009) and immunity (p < 0.001). Cautious behavior toward treating patients with infectious diseases was common in both groups, whereas reluctance to provide treatment and lower self-perceived knowledge were more frequently reported among students. Conclusions: Despite adequate awareness of respiratory infection transmission, important deficiencies persist in bloodborne pathogen knowledge, serological interpretation, and confidence in managing infected patients, particularly among dental students. These findings underscore the need for targeted, practice-oriented infection control education that integrates immunological principles and hands-on training to enhance clinical preparedness in the post-COVID era.

COVID doi: 10.3390/covid6040060

Authors: Tania Llana Sara Garces-Arilla Marta Mendez

COVID-19 is increasingly recognized as a multisystemic disease with significant neurocognitive consequences. However, its specific impact on spatial memory, a cognitive domain essential for daily navigation and functional independence, remains insufficiently explored. This narrative review provides a critical synthesis of current evidence regarding spatial and visuospatial memory alterations across acute and post-acute phases, and post COVID-19 condition (PCC). Clinical findings, conventional and emerging assessment tools ranging from static tasks to immersive virtual reality environments, as well as potential neurobiological mechanisms, were considered. Results suggested that spatial memory is frequently compromised after COVID-19 disease, with deficits being most pronounced at longer retention intervals and within navigational contexts. Neuroimaging and biomarker data further reveal selective vulnerability in the medial temporal lobe, characterized by hippocampal atrophy, hypoperfusion, and disrupted functional connectivity. Importantly, traditional neuropsychological tools may underestimate these impairments due to limited ecological validity. Therefore, implementing multimodal assessment frameworks that integrate navigational paradigms is essential to enhance diagnostic sensitivity and facilitate the development of targeted rehabilitation strategies for PCC patients.

COVID doi: 10.3390/covid6040059

Authors: Elvira Hasanović Nataša Trifunović Hasiba Erkočević Irma Džambo Zaim Jatić

Background: The COVID-19 pandemic has been associated with increased psychological distress globally. However, the independent psychological impact of prior COVID-19 infection remains heterogeneous, particularly in primary healthcare populations. This study aimed to examine differences in anxiety and depressive symptoms between individuals with and without a history of COVID-19 infection in a primary healthcare setting. Methods: A cross-sectional study was conducted in April 2022 in five family medicine practices in the primary health care facility of Sarajevo Canton. A total of 279 participants without previously diagnosed mental disorders completed an online questionnaire. Anxiety and depressive symptoms were assessed using the GAD-7 and PHQ-9 scales. Multivariable regression models were performed, and propensity score matching (1:1 nearest-neighbor matching, caliper = 0.2) was conducted to address baseline imbalance. Results: No statistically significant independent association was detected between prior COVID-19 infection and anxiety or depressive symptoms in multivariable models. Propensity score matching yielded 84 well-balanced pairs. In the matched sample, no significant differences were observed in GAD-7 (p = 0.229) or PHQ-9 scores (p = 0.139), nor in clinically relevant cut-offs. Female sex and chronic disease were independently associated with higher anxiety levels. Conclusions: In this primary healthcare population, we did not observe an independent association between prior COVID-19 infection and anxiety or depressive symptoms after covariate adjustment and propensity score matching. These findings should be interpreted cautiously given the cross-sectional design, possible exposure misclassification, and residual confounding.

COVID doi: 10.3390/covid6040057

Authors: Stanisław Słyk Jan Kochanowski Michał Białobrzewski Katarzyna Stopińska Viktor Lipko Patryk Sochań Joanna Cegielska Izabela Domitrz

The neuroinvasive and neurotropic character of coronaviruses is a likely reason for neurological complications which may occur during acute COVID illness and sometimes persist or newly emerge in the post-acute phase. Terminology and temporal classification remain heterogeneous. A retrospective case series was conducted in a single center (Department of Neurology, Bielański Hospital, Warsaw, Poland). Medical records from March 2020 to December 2023 were screened. Inclusion criteria: (1) confirmed SARS-CoV-2 infection (polymerase chain reaction or antigen test and radiological findings), (2) new neurological syndrome within acute, post-acute, or post-COVID interval, and (3) diagnostic documentation. Exclusion criteria: alternative established etiology fully explaining the neurological condition. Six cases were selected for detailed analysis due to diagnostic completeness as well as etiological and temporal diversity. Cases included: (1) persistent neurocognitive and sensory symptoms (post-COVID), (2) acute ischemic stroke with internal carotid artery dissection during severe COVID-19, (3) cytotoxic lesion of the corpus callosum (CLOCC) during acute COVID-19, (4) Guillain–Barré syndrome (post-acute), (5) longitudinally extensive transverse myelitis (post-acute), and (6) delayed autoimmune cerebral vasculitis (post-COVID). Neurological presentations ranged from mild persistent symptoms to fatal outcome. Neurological complications span inflammatory, vascular, and autoimmune mechanisms across distinct temporal phases of SARS-CoV-2 infection. Precise temporal classification and systematic diagnostic protocols are essential. Prospective longitudinal studies integrating biomarkers and standardized neuroimaging are required.

COVID doi: 10.3390/covid6040058

Authors: Alice Yip Zoe Tsui Jeff Yip Ka Man Rachel Yip Chun Kit Jacky Chan

The COVID-19 pandemic transformed healthcare education, increasing the shift to digital tools and establishing a hybrid curriculum blending online learning with traditional clinical practice. This study aims to understand how this shift impacts the educational growth and skill building of nursing students. A qualitative approach was conducted to understand the experience of Hong Kong nursing students adapting to online learning during the pandemic and beyond. Fifty nursing students were interviewed, and Colaizzi’s phenomenological method revealed key themes in their learning narratives. The analysis revealed four distinct themes characterizing the students’ experiences: (i) Learning on their terms: the mandated shift in healthcare reflecting a lack of agency during the educational transition; (ii) Knowledge without touch: the perceived incompetence of the COVID-19 nursing cohort, highlighting anxieties regarding a lack of hands-on clinical proficiency; (iii) Words left unsaid: The weight of insecurity, indicating a decline in interpersonal skills due to isolation; and (iv) Beyond the perfect algorithm: the unrehearsed art of care, describing the difficulty in translating digital simulations to complex, human-centric patient care. Findings show that while digital progress ensured continuity in education, it also contributed to reduced clinical confidence, weaker communication skills, and shifts in how nursing students approached their learning. Consequently, the post-COVID environment demands that training programs evolve to address these specific deficits. Advancing the existing pandemic-era nursing literature, this study emphasizes the need for diverse, targeted teaching methods to mitigate these gaps. By intentionally bridging theoretical knowledge with hands-on clinical practice, educators can better support student wellbeing and help restore the confidence and competence required of future graduates.

COVID doi: 10.3390/covid6040056

Authors: Murat Razi Manuel Graña

Objectives: While the previous literature has established that meteorological conditions are associated with COVID-19 mortality fluctuations, the relative effect of each of these highly correlated factors remains unclear. This study aims to conduct a comparative analysis to determine which of three main meteorological variables—Ambient Temperature, Ultraviolet (UV) Index, and Sunlight Duration—have the strongest negative association with COVID-19 mortality. The objective is to quantify and rank their impact over a 7-to-21-day biological exposure window. Methods: We conducted retrospective spatiotemporal analyses in the form of panel Poisson Distributed Lag Models (PDLMs) regression using daily data from 21 January 2020 to 10 January 2023, spanning 129 distinct geographical regions worldwide. To ensure a direct and fair comparison of effect sizes, all meteorological and environmental variables were Z-score standardized. We estimated three independent PDLMs—each focusing separately on UV Index, Ambient Temperature, and Sunlight Duration—with lags ranging from 7 to 21 days. These models controlled for overarching time trends and utilized a categorical variable to account for Region Fixed Effects modeling time-invariant regional health and socioeconomic determinants (e.g., obesity, age demographics, healthcare capacity). Furthermore, distributed lags of daily PM2.5 (air pollution) and relative humidity were explicitly included in each model as dynamic confounders. Results: The comparison of PDLM results reveals that the UV Index has the strongest negative association with COVID-19 mortality. A one standard deviation increase in the UV Index corresponds to a massive, highly significant cumulative reduction in deaths observed 1 to 3 weeks later (p < 0.001). Sunlight Duration is the second-strongest protective meteorological factor, whereas Ambient Temperature has the weakest effect. The distributed lags of particulate matter (PM2.5) and relative humidity were found to be statistically insignificant when modeled alongside the meteorological variables. Conclusions: After standardizing variables and controlling for dynamic environmental confounders like air pollution and humidity, the study findings provide robust empirical evidence that meteorological conditions have a strong significant association with COVID-19 mortality fluctuation with a temporal delay, overcoming the confounding effects of merely dry or clear-air conditions.

COVID doi: 10.3390/covid6030055

Authors: Andrada Todor Raluca Lupusoru Tudor Moga Paul Tirla Anca Voron Camelia Nica Teofana Bizerea-Moga Mickael Naassila Melena Dreinaza Roxana Sirli Alina Popescu

Background: The COVID-19 pandemic significantly altered the daily routines of young adults. This study investigated alcohol consumption patterns and associated factors among young adults in Romania during this period. Method: A cross-sectional study was conducted using an online survey. Participants were asked to retrospectively report their alcohol consumption patterns before and during the COVID-19 pandemic, including the period of university campus closures. A cohort of 249 young adults (68.6% female) participated in an online survey focused on their alcohol consumption patterns, utilizing the standardized AUDIT-C questionnaire and some modified questions to better establish the habit of drinking. Results: In total, 41.7% of the included subjects were in medical school, 10% in IT, and 44% in various areas of work. Most respondents were female, between 20 and 25 years old (65%) and living in urban areas, with wine being the most favorable drink. Regarding AUDIT scores, approximately 90% fall into low-risk drinking or even abstinence, 10% belong to the high-risk group of alcohol consumption, and 3 people have a high score, which suggests drinking abuse and the likelihood of developing alcohol dependence. A comparison of pre- to post-closure drinking among medical students showed statistically significant changes in the typical number of drinks per week (from 11.5 to 9.9) and maximum drinks per day (from 4.9 to 3.3) and a slight increase in typical drinking days per week (from 3 to 3.2), p < 0.05, outlining a decrease in alcohol consumption. Conclusions: The study highlights specific drinking patterns during the pandemic. While some individuals decreased consumption, a significant portion remained at risk for alcohol-related complications, emphasizing the need for targeted screening and prevention programs.

COVID doi: 10.3390/covid6030054

Authors: Hae-Jin Park Jung Min Cho Eun-Mi Ahn Jaehoon Bae

The COVID-19 pandemic has led to an unprecedented global health crisis, with millions recovering from acute infection but experiencing lingering symptoms, collectively referred to as post-acute sequelae of COVID-19 (PASC), or “long COVID.” While the precise mechanisms underlying long COVID remain elusive, one hypothesis gaining traction is the persistence of viral reservoirs in various tissues. Despite evidence of viral RNA and proteins detected in post-acute patients, the concept of viral reservoirs in the context of long COVID remains a subject of debate. This review explores the current scientific evidence for the existence of persistent SARS-CoV-2 in human tissues beyond the acute infection phase, focusing on the molecular mechanisms by which the virus may evade immune surveillance. We examine the role of immune dysregulation, chronic inflammation, and viral persistence in tissues such as the lungs, heart, brain, and gut. Additionally, we explore how these persistent viral elements may be associated with ongoing symptoms in long COVID and discuss the biological plausibility of these links. Finally, we discuss the clinical implications of viral persistence in post-COVID care, potential therapeutic strategies, and the need for further research to resolve the open questions surrounding this phenomenon.

COVID doi: 10.3390/covid6030053

Authors: Elisa Perego

Long COVID is the disease entity triggered and potentially driven by SARS-CoV-2 infection. It is an heterogeneous condition characterized by dozens of different symptoms, signs and sequelae, which can affect all organs and body systems and evolve over the disease course. Clinical manifestations of Long COVID can vary from individual to individual and across the broader patient population. Pathology can range from asymptomatic and subclinical manifestations to fatal outcomes. Over 400 million people worldwide are estimated to suffer, or have suffered, from Long COVID, making the sequelae of SARS-CoV-2 infection one of the greatest public health challenges of the 21st century. This article provides an updated overview of epidemiology, definitions, main concepts and terminology for Long COVID. It also summarizes key evidence of pathology and disease mechanisms in major organs and body systems, such as the immune system, cardiovascular system, endothelium, heart, lungs, central nervous system, peripheral nervous system, gastrointestinal system, hapatobiliary system, pancreas and kidney. Heterogeneity in manifestations, potential risk of death and the degree of disability in several disease subsets call for timely diagnosis of each Long COVID types and a fuller understanding of their pathophysiological underpinnings. Further research is recommended to better understand pathobiology, develop effective clinical trials, and identify treatments and scalable biomarkers.

COVID doi: 10.3390/covid6030052

Authors: Eili Y. Klein Alexander Tulchinsky Fardad Haghpanah Gary Lin Wilbur H. Chen Jacky M. Jennings

In the early stages of the COVID-19 pandemic, uncertainty around the extent of SARS-CoV-2 spread hampered policymakers’ understanding of the epidemic’s extent. Mathematical models, which proved vital for aiding decision-making, relied primarily on reported cases that were unreliable due to significant underdetection and underreporting. While serological data was used to improve understanding of the epidemiology, it can be costly and difficult to implement without bias. To counter these issues, we integrated serological data from 7229 remnant serum samples collected in 15 Maryland emergency departments (EDs) in Maryland between August and December 2020 into a Bayesian modeling approach to derive an estimate of the incidence of infection and the case fatality rate during the pandemic’s initial wave. We estimated that 5.2% (95% CI, 3.7–7.2%) of the population of Maryland had been infected by late fall 2020. The inferred reporting rate that was estimated started low (<10% in March 2020) and increased to 32% (95% HDI = 26–41%) by the fall, while the estimated infection fatality rate was likely initially higher but fell to 0.51% (95% HDI = 0.43–0.68%) after 1 September 2020. These results demonstrate how existing ED infrastructure can be leveraged to generate less biased, more accurate estimates of the true prevalence of a disease, improving the ability to make decisions and allocate resources under uncertainty.

COVID doi: 10.3390/covid6030051

Authors: Rebeccah M. Ayako Kirtika Patel Isaac Ndede Simeon K. Mining Jonas Klingström Johan Nordgren Marie Larsson

The clinical severity of COVID-19 is influenced by cellular and humoral immune responses, as well as the dynamics of viral replication. In line with this, the current study examined systemic and mucosal immunity responses alongside viral load in unvaccinated SARS-CoV-2-infected individuals during the period of Omicron predominance. Between 2022 and 2023, when Omicron prevalence was at its peak, 48 SARS-CoV-2-positive cases with varied severity were recruited using positive PCR testing, and 48 negative controls were recruited using negative PCR testing at Moi Teaching and Referral Hospital, Kenya. Severe patients showed higher viral loads and systemic anti-spike IgG levels compared to moderate and asymptomatic individuals. Asymptomatic individuals had higher mucosal anti-spike IgG and receptor-binding domain (RBD) levels compared to severe patients. Systemic IFN-α mRNA transcripts were higher in asymptomatic individuals compared to patients with severe COVID-19 and healthy individuals. Severe patients had significantly lower expression of IFN-γ mRNA transcript levels in both blood and mucosa, as well as significantly lower systemic IFI-16 mRNA transcript levels. These findings reflect associations observed in a cross-sectional design and should not be interpreted as causal mechanisms. Suppressed interferon responses, both mucosal and systemic, were associated with severe disease. In conclusion, high systemic IgG and viral loads and low interferon responses were closely linked to severe COVID-19 outcomes.

COVID doi: 10.3390/covid6030050

Authors: Maha Ouarab Zineb Rhazzar Nadia Touil Elmostafa El Fahime

Vaccines worldwide reduce severe coronavirus disease 2019 (COVID-19) consequences; however, viral evolution escapes immunity, raising global concerns about vaccine protection and requiring monitoring. Bioinformatics is crucial for studying vaccine escape, speeding up variant detection, mapping antibody evasion epitopes and ensuring updated vaccines and public health responses. This study combines bibliometric analysis of the Scopus literature (n = 416) on SARS-CoV-2 immune evasion using bioinformatics tools with descriptive analysis of the top ten most highly cited original articles. Our results showed the United States (USA) as the dominant contributor, leading in publication output, citation impact and collaboration networks. The key themes identified were immune evasion, spike protein mutations, and viral evolution, highlighting the structural, functional and immune evasion mechanisms of spike mutations. Leading authors and journals reveal a globally connected research community that is making advances in our understanding of SARS-CoV-2 vaccine evasion, and supporting the development of future treatments and vaccines. The top ten articles showed molecular docking, dynamics simulations, and protein modeling as crucial to studying vaccine escape. In conclusion, global research led mainly by the USA and supported by active contributions has used bioinformatics to elucidate SARS-CoV-2 immune evasion, guiding variant future vaccine and treatment development, variant monitoring, and preparedness for emerging variants.

COVID doi: 10.3390/covid6030049

Authors: Pattharawin Pattharanitima Suthiya Anumas Manoch Rattanasompattikul Sukit Raksasuk Suchai Sritippayawan Thatsaphan Srithongkul

Background: During the COVID-19 pandemic, Thailand prioritized hemodialysis patients for vaccination. Due to limited supply, heterologous regimens were used. This study evaluates the mortality rate and risk factors in hemodialysis patients who received heterologous versus homologous vaccine regimens. Methods: We retrospectively reviewed data of hemodialysis patients in Thailand from January 2021 to December 2022, using data from the Department of Medical Sciences, Ministry of Public Health, and Thailand Renal Replacement Therapy Registry. Mortality was defined as death within 30 days of a positive RT-PCR or rapid antigen test for SARS-CoV-2. Multivariate logistic regression was used to identify mortality risk factors. Results: The associated risks of mortality in hemodialysis patients with COVID-19 were female sex, age ≥ 50 years, diabetes, and BMI ≥ 25.0 kg/m2. Regarding vaccination regimens, the inactivated–Viral vector–mRNA regimen was associated with lower mortality compared with the mRNA–mRNA regimen (OR 0.29, 95% CI 0.08–0.99). In contrast, no vaccination (OR 16.95, 95% CI 7.86–36.54) and single-dose vaccination with inactivated vaccine (OR 17.54, 95% CI 7.01–43.88) or Viral vector vaccine (OR 20.74, 95% CI 9.38–45.86) were associated with markedly higher mortality risk. Conclusion: The inactivated–Viral vector–mRNA vaccine regimen was associated with a decreased mortality risk among this population.

COVID doi: 10.3390/covid6030048

Authors: Padmakumar Krishnankutty Nair Russell F. Dsouza Ivone Duarte Rui Nunes

Introduction: Healthcare institutions and care providers, including medical professionals, were at the forefront of the rapid response to the challenges of the pandemic. As medical professionals across the country actively fought the COVID-19 pandemic, many ethical, social, and legal challenges arose that had not been previously encountered. This study was conducted to determine the ethical challenges and dilemmas faced by medical professionals during the COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional questionnaire-based survey was conducted among the registered medical practitioners in the year 2022. The study setting included health care institutions in India where COVID patients were treated. Results: 558 participants took part in this study. The availability of personal protective equipment was sufficient in 519 (93%) of cases, while 39 (7%) of respondents reported insufficient quantities of personal protective equipment. Overall, 318 (56.99%) respondents were comfortable with their duty patterns, and 435 (77.96%) medical professionals received clear-cut and updated guidelines for practicing safely; 534 (95.70%) completed both doses of vaccines available at that time in India. Conclusions: Indian medical professionals experienced substantial ethical, occupational, and psychological challenges during the COVID-19 pandemic, despite the high availability of protective equipment and vaccination coverage. Resource allocation dilemmas, demanding duty patterns, and psychological distress during quarantine underscore the need for stronger institutional support, clear guidelines, and mental health interventions during future public health crises.

COVID doi: 10.3390/covid6030047

Authors: Malvina Todorova Victoria Tsvetkova Milena Atanasova Adelaida Ruseva Katya Todorova

Coronavirus disease 2019 (COVID-19) is associated with systemic inflammation and immune dysregulation, potentially affecting hypothalamic–pituitary–adrenal (HPA) axis function and glucocorticoid signaling. However, the dynamics and clinical relevance of these alterations across different disease phases remain insufficiently defined. In this cross-sectional observational study, 101 participants were divided into three groups: patients with active COVID-19 (n = 33), individuals ≥ 6 months post-COVID-19 (n = 35), and a reference group of healthy individuals (n = 33). Serum cortisol, circulating glucocorticoid receptor alpha (GRα), and selected cytokines were measured. Statistical analysis included parametric and non-parametric tests, multivariable generalized linear models adjusted for age and sex, correlation analysis, and receiver operating characteristic (ROC) analysis. Lower serum cortisol levels were observed in approximately two-thirds of patients during the acute phase. Circulating GRα concentrations demonstrated a significant gradient across groups, with the lowest levels in active infection and partial restoration post-COVID. Active COVID-19 status remained independently associated with reduced GRα levels after adjustment for age and sex. The cytokine profile, including interleukin-17A (IL-17A), tumor necrosis factor-alpha (TNF-α), and interleukin-10 (IL-10), provided a mechanistic context for inflammation-associated modulation of glucocorticoid signaling, most evident during acute infection. Significant correlations between cortisol, GRα, and inflammatory mediators were observed only in this phase. ROC analysis demonstrated a high degree of statistical separation between active COVID-19 and healthy individuals (AUC 0.942; 95% CI: 0.878–1.000). Given the predefined group structure and modest sample size, these findings should be considered exploratory. Overall, the results support the presence of dynamic and potentially reversible immune–endocrine dysregulation during and after SARS-CoV-2 infection. Further validation in larger prospective cohorts is required.

COVID doi: 10.3390/covid6030046

Authors: Roberto Surek Gonçalves da Silva Nathalia Marçallo Peixoto Souza Christiane Mayrhofer Grocoske de Lima Paula Rothbarth Silva Ademir Luiz do Prado Meri Bordignon Nogueira Indianara Rotta Gislaine Custódio Marcel Henrique Marcondes Sari Geraldo Picheth Fabiane Gomes de Moraes Rego

Infection with SARS-CoV-2, the virus responsible for COVID-19, is associated with cytokine storm, an excessive immune response. Interleukin-6, a multifunctional cytokine, is involved in the COVID-19 immune response. Functional polymorphisms in the interleukin-6 gene promoter, namely rs1800796, rs1800797, and rs2069845, may contribute to individual susceptibility to or severity of COVID-19. In this study, 106 healthy SARS-CoV-2-negative individuals (controls) and 106 patients with severe COVID-19 (COVID-19 group), confirmed by qPCR or rapid antigen tests, were genotyped using fluorescent probes for polymorphisms. All participants were from southern Brazil. Groups were matched for sex and body mass index, with a median age of 56–57 years. The COVID-19 group exhibited blood biomarker concentrations consistent with severe disease. No significant differences were detected in genotypic or allelic frequencies between groups, and all polymorphisms conformed to the Hardy–Weinberg equilibrium. The control group minor allelic frequencies for rs1800796 (allele C, 11.3%; 95% CI, 7–16), rs1800797 (allele A, 28.3%; 95% CI, 22–34), and rs2069845 (allele G, 36.8%; 95% CI, 30–50) were similar to those of African, American, and European populations. The polymorphisms investigated were not associated with severe COVID-19 in this cohort.

COVID doi: 10.3390/covid6030045

Authors: Vaidyanathan Gowri Marwa Al-Riyami Deepthy Geetha Shadia Al-Sinawi Khalfan Al Jabri Younis Al-Mufargi Nadia Al-Abri Adham Al-Rahbi Srinivasa Rao Sirasanagandla

Background: Autophagy is a conserved intracellular degradation pathway essential for maintaining cellular homeostasis by recycling damaged organelles and proteins. Dysregulation of autophagy has been implicated in pregnancy-related complications such as preeclampsia and fetal growth restriction, underscoring its importance in maternal and fetal health. However, the autophagy status in the placental tissue of COVID-19-infected pregnant women remains unknown. Objective: To investigate autophagy activity in term placentas from pregnant women infected with COVID-19 compared to those from uninfected control pregnant women. Methods: In this prospective cross-sectional single-center study, 15 COVID-19-positive and 15 COVID-19-negative term pregnant women who delivered at Sultan Qaboos University Hospital between January 2020 and December 2022 were included. Immediately after delivery, the placental tissue samples were collected and assessed for autophagy activity using immunohistochemistry for LC3B and p62 markers, histopathological examination, and transmission electron microscopy. The proportion and intensity of LC3B and p62 staining were quantified. Statistical analysis was performed using the Mann–Whitney U test. Results: There was a significant reduction in p62 and LC3B expression in both the proportion and intensity in COVID-19 placentas compared to the control group. The proportion of p62 (p = 0.001) and LC3B (U = 46.000, p = 0.003) was significantly reduced in infected placentas. Similarly, intensity levels of both markers showed significant differences (p < 0.05), supporting the evidence of reduced LC3B/p62, suggesting autophagy modulation in COVID-19 patients’ placentas. Additionally, abnormal ultrastructural changes were observed in COVID-19–positive placentas, including mitochondrial injury, endoplasmic reticulum stress, microvillus loss, and basement membrane thickening. Conclusion: The study results from a limited sample size demonstrate a significantly altered autophagy flux in the placental tissues of term pregnant women with COVID-19 infection. These findings highlight the potential impact of COVID-19 infection on placental function and fetal development and underscore the need for further investigation into autophagy-modulating strategies to improve maternal–fetal health.

COVID doi: 10.3390/covid6030044

Authors: Paulina Bartoszek Emilie Ates Pauline Sambon Lucie Pothen Alexandra Kozyreff

An 87-year-old woman was referred to our ophthalmology ward due to decreased visual acuity and intense right orbital pain, which had been present for four weeks. The anamnesis was not contributory, except that she had been vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) four weeks prior to symptom onset. Her best-corrected visual acuity was hand movements in the right eye and 20/20 in the left eye. Intra-ocular pressure was 34 mmHg and 16 mmHg, respectively. Right eye slit lamp examination revealed palpebral oedema, chemosis, and temporal scleral thickening with conjunctival injection. The cornea was edematous with endothelial precipitates. The anterior chamber was shallow with a closed angle, associated with grade 1+ cells and 1+ flare, according to the SUN grading system. Mild vitreous inflammation was present (grade 0.5+ vitreous cells), and a total choroidal detachment was visible. In the absence of any other plausible cause, unilateral choroidal effusion with secondary angle-closure due to severe panuveitis was considered a possible adverse event following vaccination against SARS-CoV2.

COVID doi: 10.3390/covid6030043

Authors: Subhasree Basu Roy

This paper studies the mental health impacts of the COVID-19 pandemic on older adults with a particular focus on the role of technology use. We use nationally representative individual-level survey data from a random sample of 3257 community-dwelling older Americans (65+) from the National Health and Aging Trends Study (NHATS) COVID-19 supplement (2020). We empirically estimate the impact of COVID-19 (under three alternative specifications) on the five mental health outcomes while controlling other confounding factors. The mental health indicators include feelings of loneliness, anxiety, feeling sad or depressed, poor sleep quality, and not feeling hopeful about the future. The confounding control factors in our empirical model are age, gender, race, financial difficulty, physical health, area of residence, and living arrangement. We further examine whether the mental health effects differ between the technology users and the non-users of technology. Our findings indicate a lower likelihood of adverse health outcomes among technology users (compared to the non-users of technology) during the pandemic. These results validate the potential use of technology for healthcare delivery, mental health therapy, and other lifestyle interventions to improve the quality of life in the older population.

COVID doi: 10.3390/covid6030042

Authors: Rami Bzeih MacKenzie Mayo Twylla Tassava Abdulhameed Aziz

Background: Patients diagnosed with Acute Respiratory Distress Syndrome (ARDS) who require Intensive Care Unit (ICU) admission often require invasive vascular access including central venous catheters and arterial lines. Early reports of excessive thrombosis combined with the severity of illness in COVID-19 could lead to more line-related thrombosis and infections, requiring more line replacements. This retrospective cohort study explores differences in vascular access usage and line-related complications between patients with COVID-19 ARDS and non-COVID-19 ARDS. Methods: A cohort of patients with COVID-19 ARDS (n = 81) was compared to a cohort of patients with non-COVID-19 ARDS (n = 46). We compared baseline characteristics, total number and placement rate of lines (arterial lines, central venous catheters, and dialysis catheters), and incidence of line-related complications (bleeding, thrombosis, or infection). Statistical analysis was performed utilizing Excel software, with associations assessed using Chi-squared, Fisher’s exact, and t-tests. A p-value < 0.05 was considered statistically significant. Results: The COVID-19 cohort had significantly greater total number of lines per patient (4.00 vs. 2.76, p < 0.001). This was due to more arterial (2.17 vs. 1.41, p = 0.003) and dialysis lines (0.43 vs. 0.13, p = 0.002) per patient. There was no significant difference in the number of central venous catheters. When adjusted for length of stay in the ICU, the rate of line placement was not significantly different between groups. The COVID-19 cohort had a significantly greater number of line-related complications defined as thrombosis, bleeding, and infections (18 vs. 2, p = 0.008). Conclusions: The significantly greater total number of lines in the COVID-19 group was likely attributable to COVID-19 patients’ longer lengths of stay in the ICU. Patients with COVID-19 appear to have significantly more line-related complications, which may be due to the greater total number of lines, the longer lengths of stay, and inherent demographic and comorbid differences. Future studies are needed to assess methods for prevention of line-related complications in patients with COVID-19 ARDS.

COVID doi: 10.3390/covid6030041

Authors: Assel Izekenova Dinara Sukenova Ardak Nurbakyt Maimakova Akmaral Aigulsum Izekenova Filip Milanovic Irena Lazic Dejan Nikolic

The aim of this study was to examine the factors associated with COVID-19-related fear in older adults from Kazakhstan, and to explore its associations with sociodemographic characteristics, health status and multiple domains of quality of life in a regional context. A total of 445 individuals aged 60 and above from both urban and rural locations in Kazakhstan participated in this cross-sectional study. To assess the quality of life among older people we used the OPQoL (Older People’s Quality of Life) Scale. Further variables were evaluated: sociodemographic (age, gender, education level, marital status, and place of residence); health-related (self-reported overall health, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, and chronic obstructive pulmonary disease (COPD); and COVID-19-related fear variable. Female gender (OR = 2.344; p = 0.001), present hypertension (OR = 2.106; p = 0.008), the specialized secondary educational level (OR = 2.321; p = 0.012) and at the border of significance university educational level (OR = 1.832; p = 0.051) were variables significantly associated with the COVID-19-related fear in older adults. For individuals with reported COVID-19-related fear, advanced age was significantly negatively associated with leisure and activities domain (B = −0.747; p = 0.020) of OPQoL; better self-reported overall health was significantly positively associated with life overall domain (B = 0.691; p < 0.001), health domain (B = 1.320; p < 0.001), psychological and emotional well-being domain (B = 0.395; p = 0.001), home and neighborhood domain (B = 0.249; p = 0.036), independence, control over life and freedom domain (B = 1.082; p < 0.001), financial circumstances domain (B = 1.132; p < 0.001), and leisure and activities domain (B = 0.556; p = 0.026) of OPQoL; present hypertension was significantly negatively associated with health domain (B = −0.888; p = 0.004) of OPQoL; present cardiovascular disease was significantly negatively associated with life overall domain (B = −0.588; p = 0.027), health domain (B = −0.967; p = 0.009), and independence, control over life and freedom domain (B = −0.542; p = 0.039) of OPQoL; being single was significantly negatively associated with life overall domain (B = −0.481; p = 0.033), social relations domain (B = −0.671; p = 0.014) and financial circumstances domain (B = −0.694; p = 0.036) of OPQoL; and urban place of residency was significantly positively associated with health domain (B = 0.735; p = 0.011) and psychological and emotional well-being domain (B = 0.483; p = 0.010) of OPQoL. Our findings pointed that numerous variables were associated with the COVID-19-related fear and quality of life domains regarding COVID-19-related fear in older adults from Kazakhstan during pandemics.

COVID doi: 10.3390/covid6030040

Authors: Joseph Musonda Chalwe Retsilisitsoe Raymond Moholisa Ndimo Rahab Modipane Saidon Herbert Mbambara Relebohile Matobole Boitumelo Moetlhoa Mike Machaba Sathekge Mankgopo Kgatle

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19), exploits angiotensin-converting enzyme 2 (ACE2) for cell entry, implicating the renin–angiotensin system (RAS) in disease pathogenesis. Hypertension (HT), a major comorbidity, is strongly influenced by genetic factors within RAS, including angiotensin ii receptor type 1 (AGTR1) and ACE2) polymorphisms. However, data on these variants in African populations remain scarce. This study investigated associations between AGTR1 and ACE2 single-nucleotide polymorphisms (SNPs), HT, and COVID-19 severity in patients at a Tshwane Academic Hospital. Methods: We genotyped AGTR1 and ACE2 SNPs in 94 PCR-confirmed COVID-19 patients using Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight (MALDI-TOF) mass spectrometry. Clinical data were extracted from hospital records. Ordinal logistic regression models assessed relationships between SNPs, HT, and COVID-19 severity. Results: The cohort (mean age: 53.9 years; HT prevalence: 54.9%) exhibited mild (54.9%), moderate (18.6%), and severe (26.5%) COVID-19. Although the rs2106809 A genotype appeared to be associated with lower odds of severe disease (OR = 0.39, 95% CI: 0.14–1.08, p = 0.04), this observation should be interpreted with caution given the limited sample size of this study. Other SNPs and clinical variables showed no significant associations. Conclusions: This exploratory study represents the first description of AGTR1 and ACE2 SNP patterns in COVID-19 patients from Tshwane. While the rs2106809 variant may indicate a possible protective trend, the evidence remains preliminary. Age correlated with severity. Larger, multi-ethnic studies are needed to confirm these findings.

COVID doi: 10.3390/covid6030039

Authors: Matheus Torres Giulia Davanço Isabela de Paula Destro Neif Murad Glaucia Luciano da Veiga Pedro Henrique Alves Reis Renata de Lion Botero Martins Beatriz da Costa Aguiar Alves Rodrigo Daminello Raimundo Juliana Zangirolami-Raimundo Fernando Luiz Affonso Fonseca

Long COVID is a complex condition characterized by persistent symptoms following SARS-CoV-2 infection. Understanding its biochemical mechanisms is essential for effective management and treatment strategies. Objective: This study investigated biochemical alterations associated with long COVID in unvaccinated individuals presenting symptoms persisting for more than six months, highlighting the prolonged nature of the condition and its systemic and neurological manifestations. A cross-sectional study was conducted with 60 unvaccinated patients at least six months post-COVID-19 infection. Serum biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), N-terminal pro-brain natriuretic peptide (NT-proBNP), and irisin, were analyzed. Correlations between these biomarkers and persistent symptoms were assessed using statistical regression models. Elevated CRP levels were significantly associated with persistent respiratory and musculoskeletal symptoms, suggesting ongoing inflammation. Increased IL-6 levels correlated with fatigue and musculoskeletal complaints. NT-proBNP elevations were linked to cardiovascular manifestations, including dyspnea and chest pain. A positive correlation between irisin and persistent sensory impairments, such as anosmia and dysgeusia, indicates potential neuroinflammatory mechanisms. This study highlights that persistent inflammation plays a critical role in long-term (>6 months) post-COVID manifestations. Monitoring biomarkers such as CRP, IL-6, NT-proBNP, and irisin may enhance understanding and management of prolonged post-COVID conditions.