COVID, Volume 4, Issue 7 (July 2024) – 19 articles

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in more than 692 million cases worldwide and nearly 7 million deaths (August 2023). Severe COVID-19 is characterised in part by vascular thrombosis and a cytokine storm due to increased plasma concentrations of pro-thrombotic proteins such as von Willebrand factor and cytokines secreted from endothelial and T-cells. EFCAB4B is a gene that encodes for two proteins (CRACR2A and Rab46) that play important roles in endothelial and T-cell secretion. In this study, using patient data recorded in the UK Biobank, we demonstrate the importance of variants in the EFCAB4B genetic sequence with COVID-19 fatality. Using logistic regression analysis, we determined that three single-nucleotide polymorphisms (SNPs) in the gene cause missense variations in CRACR2A and Rab46, which are associated with COVID-19 fatality (rs9788233: p = 0.004, odds ratio = 1.511; rs17836273: p = 0.012, odds ratio = 1.433; rs36030417: p = 0.013, odds ratio = 1.393). All three SNPs cause changes in amino acid residues that are highly conserved across species, indicating their importance in protein structure and function. Two SNPs, rs17836273 (A98T) and rs36030417 (H212Q), cause amino acid substitutions in important functional domains: the EF-hand and coiled-coil domain, respectively. Molecular modelling shows minimal impact by the substitution of threonine at position 98 on the structure of the EF-hand. Since Rab46 is a GTPase that regulates both endothelial cell secretion and T-cell signalling, these missense variants may play a role in the molecular mechanisms underlying the thrombotic and inflammatory characteristics observed in patients with severe COVID-19 outcomes. Full article

We assessed depression, anxiety, and stress in healthcare workers (HCWs) in 2023 and the evolution of depression in 2023 compared with 2022. In September–November 2023, 181 HCWs from the Infectious Diseases Hospital, Cluj-Napoca, Romania, completed the Depression, Anxiety, and Stress 21 Scale (DASS-21 R), the Patient Health Questionnaire 9 (PHQ-9), and the Hamilton Anxiety Rating Scale (HAM-A). The prevalence of moderate-to-severe levels was 13.8% for DASS-Depression, 18.8% for DASS-Anxiety, 16.1% for DASS-Stress, 19.9% for PHQ-9, and 18.2% for HAM-A. Moderate-to-severe PHQ-9 depression was significantly lower in the 2023 study group (19.9%, N = 181) compared with 2022 (30.6%, N = 114) (p = 0.04), also within the 2022–2023 follow-up participants (N = 88) (p = 0.03). We did not find significant statistical differences between those infected vs. non-infected, vaccinated vs. non-vaccinated, or working with vs. not working with SARS-CoV-2 infected patients. Males were significantly more stressed (p = 0.02) and anxious (p = 0.03), and physicians in training had the highest prevalence of moderate-to-severe depression (31.6%), followed by physicians (25.6%). In 2023, depression, anxiety, and stress symptoms decreased but remained within a concerning range. By addressing these psychological issues, we may reduce the possibility of medical errors and prevent professional crises in the healthcare system. Full article

The unprecedented introduction and spread of SARS-CoV-2, responsible for the COVID-19 epidemic, had many varied and unanticipated consequences for the United States and other countries. In addition to the direct effects of human infection, multiple industries, commodities, and jobs were impacted. This review describes the impact on an academic institution, with a chronological account of events related to constantly changing perceptions and understanding of the pandemic. Although a personal account, the objective is to document how leadership was able to adjust to circumstances in order to support research activities, student education, and the academic goals of our land grant university. It is hoped that these examples will inspire and better prepare us for a subsequent event and avoid what for the COVID-19 situation might be summarized as a progression from procrastination-pandemic-panic-pandemonium-endemic Full article

This study investigated the prevalence, severity, and implications of depressive and anxiety behaviors among individuals aged 30–75+ who have recovered from COVID-19. The COVID-19 pandemic has exacerbated mental health challenges, prompting a critical examination of its psychological aftermath. Employing a quantitative research design, the study utilized a cross-sectional approach to gather data from 422 participants recruited through convenience sampling from healthcare facilities, community organizations, and online platforms. Participants, who had tested positive for COVID-19 and recovered, completed standardized assessments including the Patient Health Questionnaire (PHQ-9) for depressive symptoms and the Generalized Anxiety Disorder seven-item scale (GAD-7) for anxiety symptoms. Demographic variables were also collected to explore the correlations and potential risk factors using SPSS software. Key findings highlight significant levels of depressive and anxiety-related symptoms among the study population, emphasizing the necessity for tailored interventions and support services. The study’s limitations include the inability to establish causal relationships due to its cross-sectional nature and potential biases associated with convenience sampling. Nevertheless, the research underscores the urgent need for healthcare and mental health professionals to prioritize the psychological well-being of COVID-19 survivors through targeted strategies and resource allocation. By addressing these challenges, policymakers and practitioners can enhance the resilience and recovery of individuals affected by the pandemic’s psychological toll. Full article

Skepticism of COVID-19 has consequences for public health. We examined several variables that we reasoned were related to skepticism, including demographic factors, people’s perceptions and experiences related to COVID-19, and social media usage. The sample consisted of 294 participants recruited in April of 2020. Participants filled out a survey that included questions related to demographics, social media use, COVID-19 anxiety, COVID-19 interference, and COVID-19 skepticism. In the main, biological sex, ethnicity, and social media use were not significantly associated with skepticism regarding COVID-19. Alternatively, older participants and those who experienced greater anxiety related to the pandemic were less skeptical of COVID-19. Interestingly, people who experienced more interference in their lives because of COVID-19 were more skeptical of the pandemic. Finally, social media use moderated the influence of anxiety and interference on skepticism. The negative effect of anxiety on skepticism became weaker as people’s use of social media increased. The positive effect of interference related to COVID-19 on skepticism became stronger as people used more social media. Our findings underscore the importance of personal beliefs, attitudes, and experiences when explaining skepticism of the pandemic. Full article

Vaccines decrease morbidity and mortality. Nevertheless, their benefits depend on public response. During COVID-19, vaccine hesitancy and refusal were rampant, threatening public health. A thorough understanding of opponents’ arguments is required to address the diffusion of unreliable information on social media and prevent vaccine hesitancy from developing into vaccine refusal. The focus on the opponents’ viewpoints and their justifications makes the study unique. Accordingly, textual content analysis of reader comments on three health-related Israeli Facebook pages was conducted. Data collection encompassed the Israeli COVID-19 vaccination period from October 2020 to May 2022. The comments were analyzed according to the health beliefs model (HBM). We found that vaccine opponents were characterized by low perceptions of the severity of the disease combined with high perceptions of the damages of the vaccine; low perceived benefits of vaccine compliance; vaccine hesitancy and fear along with public distrust as barriers to change; and call for action to resist the vaccine and spread related anti-establishment views on the web. Hesitancy was found to develop into public distrust in the state systems and escalate into conspiracy beliefs and anti-vaccination activism. These results are important and instructive that early detection is necessary to prevent future vaccine resistance. Full article

Objective: The COVID-19 pandemic has raised significant concerns about public health, particularly in terms of mental well-being due to heightened fear and uncertainty. The findings of this study are based on a survey conducted to evaluate the mental health status of the general population in Croatia during the COVID-19 pandemic. Methods: A survey conducted randomly and cross-sectionally included 588 respondents from all 21 counties in Croatia. The survey gathered demographic data and assessed various factors related to pandemic response measures and mental health using the Mental Health Continuum—Short Form (MHC-SF) scale. Results: Despite feeling adequately informed about COVID-19 (76.0%), most respondents (60.8%) expressed concerns about their loved ones during the pandemic. There were significant numbers who felt there was no risk of infection (50.9%) or believed they would not get infected (40.2%), while 72.4% were content with government measures. A statistical analysis indicated that mental health was not significantly different between genders, but age-related differences were evident, with those under 21 experiencing the most distress. The lowest level of psychological and social well-being was observed in respondents who were unemployed. Conclusions: The study identifies vulnerable groups in the Croatian population during the pandemic, including younger individuals, those on parental leave, students, and the unemployed, who exhibited worse mental health. The importance of implementing targeted mental health interventions to support these vulnerable groups is highlighted by these findings. Full article

This study aims to explore the experiences of frontline hospital nurses over 18 months of struggle with the COVID-19 pandemic. The qualitative thematic analysis method was applied. Twenty-three nurses from nine tertiary hospitals in Israel were interviewed using semi-structured interviews via the ZOOM platform between August and September 2021. Interviews were video recorded and transcribed verbatim. Trustworthiness was assured by using qualitative criteria and the COREQ checklist. Results: Both negative and positive experiences were reported: threat and uncertainty along with awareness of their important mission; anxiety and helplessness alongside courage and heroism. Personal management strategies emerged: regulating overwhelming emotions and managing work–life balance. Team support emerged as the most meaningful source of nurses’ struggle with the pandemic. A sense of intimacy and solidarity enabled the processing of the shared traumatic experiences. Conclusions: A deeper understanding of nurses’ experiences through the pandemic was gained. Informal peer support has proven effective in struggling with the events. Formal interventions, such as affective–cognitive processing of traumatic events, need to be integrated into practice. Healthcare policymakers should promote better support for caregivers, which will contribute to their well-being and impact the quality of care they provide. Full article

Objectives: We aimed to assess the prevalence of long COVID-19 and estimate the average time to its diagnosis and meta-regression for covariates. Methods: We conducted a systematic review, meta-analysis, and meta-regression from 43 studies (367,236 patients) (June 2020–August 2022). With the random-effects model, the pooled prevalence of long COVID-19 was measured. Publication bias was ascertained, and meta-regression analysis was performed on predetermined covariates. The trial was registered with PROSPERO (CRD42022328509). Results: The pooled prevalence of long COVID-19 was 42.5% (95% CI 36% to 49.3%), with 25% and 66% at four and two months, respectively. Mostly, long COVID-19 signs and symptoms occurred at three (54.3%) to six (57%) months (p < 0.0001), further increasing at 12 months (57.9%, p = 0.0148). Hypertension was significantly associated with long COVID-19 at 32% (0.322 (95% CI 0.166, 0.532) (p < 0.001) and hospital re-admission contributed to 17% (Q = 8.70, df = 1, p = 0.0032) (R² = 0.17). All the covariates explained at least some of the variance in effect size on long COVID-19 at 53% (Q = 38.81, df = 19, p = 0.0047) (R² analog = 0.53). Conclusion: The prevalence of long COVID-19 was 42.5% when linked with a cardiovascular disorder. Hospital re-admission majorly predicted the incidence of long COVID-19. Clinical and methodological characteristics in a specific study contributed to over 50% of long COVID-19 events, with most signs and symptoms occurring between 3 and 6 months and increasing at 12 months. Full article

Apart from reverse-transcription polymerase chain reaction (RT-PCR) testing, chest radiographs (CXR) and computed tomography (CT) scans were employed as crucial diagnostic methods for detecting the 2019 new coronavirus disease (COVID-19). Our objective is to examine three notable COVID-19 instances from patients across the globe, along with their CXR and CT data. The evaluation of the imaging characteristics of the reported instances was the primary objective of a methodical examination of the literature. We located more than several articles that had been published between 2020 and 2023. After the papers were examined, three major cases were chosen, including a COVID-19 assessment of imaging features (chest X-ray and CT scan). Corona viral diseases (COVID-19) pose a significant risk to healthcare facilities, especially when the patient has additional medical issues. It is challenging to understand the various chest radiography results because of the use of specialized and ambiguous terminology such as “airspace disease”, “pneumonia”, “infiltrates”, “patchy opacities”, and “hazy opacities”. The current investigation considered peer-reviewed case reports with Images features. Study designs, including reporting cases, were considered for imaging feature analysis. Full article

The reproduction number, $R_0$, is an important parameter in epidemic models. It is interpreted as the average number of new cases resulted from each infected individual during the course of infection. In this paper, the $R_0$ estimates since the outbreak of COVID-19 till 10 August 2020 for eight countries were computed using the package R{eSIR}. The computed values were examined and compared with the daily $R_0$ estimates obtained by a static SIR model by aligning the days of infection, assuming a fixed number of days for the infected person to become confirmed/recover/die. The results showed that running R{eSIR} to obtain $R_0$ estimates provided an easy mean of exploring epidemic data. Care must be taken in the interpretation of $R_0$ as a measure of severity of the spread of an epidemic. Other factors, such as imported cases, need to be considered. Full article

Background: Over the past 100 years, the discovery of antibiotics is regarded as one of the most significant advances in medical research and has saved millions of lives. However, the emergence of antimicrobial-resistant bacteria has significantly reduced the efficacy of antibiotics against infectious disorders. Antimicrobial resistance is mostly caused by antibiotic misuse for conditions that may be treated with self-care. During the COVID-19 pandemic, antibiotic use has been out of control among the general population. Aim: The objective of this study is to investigate the prevalence of antibiotic misuse during the COVID-19 pandemic in Lebanon. Methods: In January 2024, a descriptive cross-sectional study was conducted amongst students registered at the Islamic University of Lebanon. Individuals who have been infected with COVID-19 at least once were eligible for the study and were selected by a non-random snowball sampling technique. Descriptive and quantitative analyses were performed using SPSS 21. Results: Out of the 478 participants who completed the questionnaire, 40.2% (n = 192) received antibiotics during the COVID-19 infection. A physician’s prescription is mentioned by some participants (51%, n = 98), followed by a pharmacist’s (23.4%, n = 45), self-taken (14.5%, n = 28), and others as family or friends (10.9%, n = 21). Moreover, 59.3% (n = 114) of the respondents respected the antibiotic therapy’s rules, and 40.6% (n = 78) discontinued taking the antibiotic when they felt better. Conclusion: Our results showed that participants were likely to show unsatisfactory compliance and to use non-prescribed antibiotics. Campaigns are urgently needed to promote appropriate antibiotic use. Full article

NSAIDs and paracetamol are commonly used as antipyretic treatments, which may impair renal and hepatic function, respectively. Both organ systems are also negatively affected by COVID-19. In two retrospective case–control studies, we investigated whether COVID-19 is a risk factor for the development of renal or hepatic function impairment after NSAID and paracetamol use, respectively. In the NSAID study, we defined cases as patients with a decrease of ≥15% in the estimated glomerular filtration rate (eGFR). We matched them using a 1:2 ratio with controls who did not show a decrease in the eGFR. For the paracetamol study, we matched patients with ALT or ALP ≥ 3x, the upper limits of normal, using a 1:3 ratio with controls whose liver enzymes did not increase. In both studies, we selected demographic data, comorbidities, drug doses, and laboratory values as predictors in addition to SARS-CoV-2 test status. We applied different machine learning models to predict renal and hepatic function impairment. From the cohort of 12,263 unique adult inpatients, we found 288 cases of renal function impairment, which were matched with 576 controls, and 213 cases of liver function impairment, which were matched with 639 controls. In both case–control studies, testing positive for SARS-CoV-2 was not an independent risk factor for the studied adverse drug effects. Full article

The emergence of the coronavirus COVID-19 in December 2019 in Wuhan, China, affected all facets of people’s lives worldwide. As a result of the severity of the pandemic, governments worldwide adopted several policies and containment measures, such as social isolation, especially for vulnerable populations, including older adults. This study aimed to explore these older adults’ experiences of social isolation during COVID-19. A systematic review method based on the PRISMA protocol was used, and five databases (EMBASE, PsycINFO, PsycEXTRA, CINAHL, and Medline) were comprehensively searched. Studies were limited to those published between 2020 and 2023. Thirteen qualitative studies met the inclusion criteria and were analysed thematically. A thematic analysis identified the following five major themes: intense feeling of loneliness due to social isolation; use of social media as a coping mechanism during social isolation; anxiety during social isolation; fear during social isolation; and financial security during social isolation. This review provides useful information on how to mitigate the effects of social isolation on the elderly population during future public health crises. Full article

Coronavirus disease 2019 (COVID-19) is associated with increased risk of microvascular complications; however, reports of ophthalmic manifestations associated with retinal vascular occlusion associated with COVID-19 are limited. In this report, we describe two middle-aged female patients who were admitted for acute hypoxic respiratory failure secondary to COVID-19-induced pneumonia. Following prolonged intensive care unit admission requiring mechanical ventilation and critical care interventions, both patients reported substantially reduced vision upon regaining consciousness. Dilated funduscopic exam showed multiple blot hemorrhages in all quadrants of the posterior pole, bilateral retinal hemorrhage, macular edema, and retinal vascular tortuosity. Both patients were diagnosed with retinal ischemic events owing to bilateral ophthalmic artery occlusion in the first patient, and bilateral central retinal vein occlusion (CRVO) in the second individual. While uncommon, retinal microvascular complications associated with COVID-19 leading to vision loss require prompt evaluation and referral given their potential long-term impact following acute illness. Full article

Under the aegis of the National Infectious Diseases Act, the virus transitioned from a category 2 menace to category 5, analogous to seasonal influenza. For this classification to be appropriate, a comprehensive assessment of the immune status of the Japanese population must be conducted to ensure adequacy. The current study has investigated the protracted immune responses of healthcare workers (HCWs) to SARS-CoV-2 in Japan. One year subsequent to the systematically implemented SARS-CoV-2 vaccination campaign among HCWs, humoral and cellular immune responses were sustained at levels as high as or higher than those immediately following the third booster vaccination. Persisting immunity has highlighted the resilience and lasting memory exhibited in HCW defense against the virus, suggesting that the classification of SARS-CoV-2 infection as a category 5 in Japan has appeared judicious. Full article

As a result of the COVID-19 pandemic, media consumption has begun playing a more significant role in shaping public perceptions and well-being. The current study examines the effects of risk perception, economic situation, and negative emotions during the COVID-19 pandemic on preventive behaviors, while focusing on the mediating role of media exposure levels. An online survey was conducted during the 2020 outbreak of COVID-19 in Israel. SEM analysis results show that during the pandemic, media exposure increased with negative emotions levels, increased with higher exposure to the pandemic and increased as the economic impact of the pandemic increased. In addition, preventive behavior increased with media exposure. Moreover, the media exposure variable was found to mediate the effect of negative emotions and of the perceived risk of being infected with coronavirus on preventive behavior. Implications for government policy are discussed. Full article

(1) Background: To mitigate COVID-19 transmission, global public health interventions were swiftly implemented. However, a comprehensive understanding of individual variations in adhering to these recommendations remains elusive. Addressing this gap is crucial for effectively managing future epidemic and pandemic scenarios. This study aims to explore individual differences in attachment, emotion regulation, and risk for COVID-19 infection using virtual reality (VR). (2) Methods: The sample included 73 (88%) university students and 10 (12%) university staff. Participants completed questionnaires on sociodemographic information, the Difficulties in Emotion Regulation Scale, the Experiences in Close Relationships—Relationship Structures Questionnaire, and the fear of COVID-19 Scale. Additionally, each participant engaged in five daily situations using a VR simulator to assess the risk of COVID-19 infection. (3) Results: Our study revealed that high levels of attachment anxiety, difficulties controlling impulsive behaviors, and limited access to emotion regulation strategies were strong predictors of elevated risk of COVID-19 infection. Conversely, high levels of fear of COVID-19 and attachment avoidance were associated with lower risk of COVID-19 infection. (4) Conclusions: We discuss the importance of policymakers and health professionals being aware of some psychological characteristics that make it difficult for some individuals to adhere to public health measures involving social distancing. Full article

Background and Objectives: SARS-CoV-2 is the pathogen that causes COVID-19 disease. Although the rate of COVID-19 reinfection is significant, the possible factors associated with this condition remain to be fully elucidated. The aim of the study was to identify clinical and serological factors associated with SARS-CoV-2 reinfection. Materials and Methods: We followed up on 120 patients with mild COVID-19 for one year. Various clinical data were collected, and serum levels of IgG anti-SARS-CoV-2 Spike antibodies were tested on days 21, 60, 90, and 180. The diagnosis of COVID-19 was based on symptomatology and the detection of viral RNA in nasal swabs using real-time PCR. Results: We observed eleven episodes of reinfection. Although no clinical or demographic characteristics were associated with reinfection, significantly higher levels of anti-Spike antibodies and a seropositive status at day 90 were significantly associated with the absence of reinfection. Moreover, the symptoms during the COVID-19 episode associated with seropositivity at day 90 were mainly headache, sneezing, anosmia, and runny nose. Conclusions: SARS-CoV-2 reinfection is not associated with the clinical or demographic characteristics of COVID-19 patients. Furthermore, our findings suggest that the presence and levels of IgG anti-Spike antibodies at day 90 of infection play a protective role against reinfection. Serological immunity at day 90 influences the response to vaccination. Full article