COVID

South Africa’s health system was affected by the various mitigation measures implemented to control the rapid spread of the COVID-19 pandemic. However, innovative interventions were introduced to ensure service continuity. This study sought to explore the perspectives of stakeholders regarding the pre-exposure prophylaxis (PrEP) innovative interventions implemented during the COVID-19 lockdown period among adolescent girls and young women (AGYW), as well as their successes and improvements. We selected and interviewed 12 PrEP stakeholders, including professional nurses, case managers, peer educators, and counselors from the TB HIV Care programme in the Dr. Kenneth Kaunda District, in the North-West Province. The qualitative questions explored (1) how PrEP services were disrupted during the lockdown period, (2) how the disruptions were managed, and (3) the challenges and successes of the innovative interventions implemented. The interviews were audio-taped, transcribed, and thematically analyzed through Tesch’s eight steps of analysis. The stakeholders confirmed that COVID-19 disruptions affected the provision of PrEP services in terms of recruitment, counseling, HIV testing, and adherence support offered in different community hotspots. Responding to these difficulties, alternative avenues such as social media platforms were implemented and used for service continuity. The themes that emerged were organized into the following two categories: PrEP services provided during and after the COVID-19 lockdown period, as well as the successes and challenges. The current study provides further insight into COVID-19, aiming to inform preparations for future pandemics. Innovative PrEP interventions alleviated COVID-19 disruptions in some settings and improved HIV services, but this was not the case in the selected study area. Full article

Patients with COVID-19-associated pulmonary embolism have been reported to require higher doses of unfractionated heparin (UFH) to achieve therapeutic activated partial thromboplastin time (APTT) levels. This study aimed to compare the UFH dose in ICU patients with COVID-19 and control ICU patients, exploring possible explanatory factors. In this retrospective cohort study at Leiden University Medical Center, 162 COVID-19 ICU patients (admitted between 15 March 2020 and 1 January 2022) and 1006 control patients (admitted from 1 January 2014 to 1 January 2020) were included. All patients had an indication for therapeutic UFH. The primary endpoint was the UFH dose. A mixed linear model was used to assess the relationship between UFH dose, APTT, antithrombin (AT), c-reactive protein (CRP), and BMI. COVID-19 patients received a median UFH dose of 383 IU/kg/day compared to 308 IU/kg/day in controls (p < 0.001). Median APTT was lower in COVID-19 patients (63 vs. 66 s, p < 0.001). Median CRP was lower and median AT higher in COVID-19 patients. In the mixed linear model, only UFH dose showed a significant relationship with APTT (p = 0.0316). COVID-19 patients received higher UFH doses but had lower APTT values compared to controls. These differences could not be explained by BMI, CRP, or AT levels, suggesting other patient-related factors may influence heparin dosing, for example, factor VIII and fibrinogen. Full article

Objective: To measure the quality of the transition of care for COVID-19 patients after discharge from hospital to home. Method: A cross-sectional, prospective study carried out in a hospital in Santa Catarina, with 201 patients hospitalized for COVID-19. An instrument was used to characterize the patients and the Brazilian version of the Care Transitions Measure. The data were analyzed using descriptive statistics, represented by absolute and relative frequency, and Cronbach’s alpha and parametric tests were used, including the t-test, considering statistical significance at p < 0.05. Results: There was a predominance of male patients (55.2%), with a mean age of 22.2 years (SD = 9.9), 79.6% white, and 60.2% married or in a stable union. The overall mean of the CTM-15 was 52.97, with the highest mean observed in the preparation for self-management factor (58.31) and the lowest in the care plan factor (34.00). Conclusion: The quality of the transition of care for patients hospitalized due to COVID-19 was unsatisfactory. Full article

Cardiovascular diseases (CVD) are among the leading causes of morbidity and mortality worldwide. This descriptive-correlational cross-sectional study analyzed the relationship between lifestyle factors and cardiovascular parameters in 206 university students from the University of Los Lagos in the post-COVID-19 context, with a focus on gender differences. Indicators such as body mass index, waist circumference, blood pressure, blood glucose, sedentary behavior, tobacco and alcohol consumption, sleep quality, and self-reported stress were assessed. The results showed a higher prevalence of abdominal obesity and sedentary behavior in women, whereas men presented higher rates of hypertension and elevated blood glucose. While tobacco and alcohol consumption did not differ significantly between genders, both remain relevant risk factors in the university population. Sleep quality and stress were significantly correlated with various cardiovascular risk factors in both genders. These findings highlight the need for gender-specific interventions to address cardiovascular risk factors in university populations, emphasizing the promotion of physical activity among women and dietary strategies targeting sodium reduction among men. Future longitudinal research should assess whether these trends persist over time and explore effective intervention strategies. Full article

The COVID-19 pandemic has led to persistent complications beyond the respiratory system, with emerging evidence highlighting the role of gut dysbiosis in long COVID. Given the established gut–skin axis, alterations in gut microbiota post-COVID-19 may contribute to persistent dermatologic conditions such as eczema, acne, and rosacea. This review explores the mechanisms by which SARS-CoV-2 disrupts the gut microbiome, leading to systemic inflammation and skin disease. Furthermore, it examines potential interventions, including probiotics, prebiotics, and dietary modifications, as microbiome-targeted therapeutic strategies for post-COVID dermatologic recovery. Understanding this link may open new avenues for treating chronic inflammatory skin conditions in long COVID patients. Full article

During the COVID-19 pandemic, vaccination hesitancy (VH) posed an equally unexpected and significant obstacle to the effectiveness of public health interventions. VH has not only the potential to stir up public unrest, but it may also impede the success of entire immunization programs and thus prevent the attainment of herd immunity. This cross-sectional, quantitative, and descriptive study examined VH and vaccination behavior (VB) among 3486 university students in Ghana, using a standardized self-administered questionnaire based on the 5Cs model among other relevant variables. The findings confirm a significant VH and a VB influenced by both sociodemographic factors, such as gender (OR: 1.45; [CI: 1.26–1.67]), study program (OR: 0.55; [CI: 0.47–0.64]), and ethnicity (OR: 1.31; [CI: 1.12–1.52]) and also four of the 5Cs, i.e., Confidence (OR:1.56; [CI: 1.45–1.68]), Constraints (OR: 0.83; [CI: 0.78–0.87]), Calculation (OR:0.85; [CI: 0.78–0.92]), and Collective Responsibility (OR:1.27; [CI: 1.16–1.38]), yet not Complacency, nor religion. Notably, VH was further shaped by previous vaccine experience, information sources, vaccine attributes, stance on vaccine passport, and conspiracy beliefs, with misinformation from unofficial sources playing a key role. The multiple regression models explained 11% to 34% of the variance in the 5Cs, indicating varying degrees of explanatory power for each factor influencing VB and eventually also VH. This study highlights the urgent need for targeted public health interventions, such as integrating vaccine education into university orientation programs, streamlining vaccination processes, and leveraging influencers for trust-building campaigns. Full article

Long COVID is characterized by persistent symptoms following the resolution of an acute COVID-19 infection. Long COVID may affect cognition due to possible ischemia, neuro-inflammation, and hypoxia related to COVID-19. The purpose of this study was to analyze the association of long COVID with severe cognitive limitations. Utilizing data from the 20 September–2 October 2023 Census Household Pulse Survey among adults, COVID status was categorized as: (1) long COVID, (2) COVID-19, or (3) no COVID. The cognitive limitations were abstracted from the Washington Group Short Set on Functioning, as follows: No difficulty; Some difficulty; A lot of difficulty; and Cannot do at all; we combined “a lot of difficulty” or “unable to do” under the category “severe cognitive limitation”. Rao–Scott Chi-square tests and multivariable multinomial logistic regressions that accounted for replicate weights were used to analyze the adjusted association of long COVID with cognitive limitations. Overall, 15.1% had long COVID. A higher percentage of adults with long COVID (13.1% vs. 4.1%) reported severe cognitive limitations compared to no COVID (p < 0.001). In a fully adjusted logistic regression model, adults with long COVID were more likely to report at least a lot of difficulty in cognition (aOR = 1.64 95% CI = 1.38, 1.96) compared to no COVID. Full article

Background: Compared to other groups of Canadians, Black people have been significantly more affected by COVID-19 and appear to be more hesitant to receive the COVID-19 vaccine. This article identifies approaches or strategies to increase vaccine confidence and uptake among Black people in Canada. Methods: Thirty-six Black people of diverse ethnicities, aged 18 years and above, living in six provinces across Canada were interviewed. An inductive thematic approach was employed to analyze the interview data. Results: Building trust was at the center of the strategies identified and spoke to the meaningful and practical ways the sociocultural realities of Black people living in Canada can be used to inform and implement the most effective health interventions. Identified strategies include public education, building trust through Black-led community engagement, and addressing barriers to vaccine convenience focusing on health literacy and communication. Together, these strategies consider the nuance of the message, diversity of messenger(s), and communication channels and call for a move away from generic health promotion messages to tailored communications grounded in community expertise and the experiences of Black people across all levels of healthcare service provision. Conclusions: Health promotion and public health messages must acknowledge difference, tailor approaches to target audiences, and foster lasting collaborations informed by members of the Black community. Government agencies and healthcare service providers should foster the relationships established during the pandemic, document lessons learned, remove systemic barriers to healthcare, and create an emergency preparedness guide for community engagement and health promotion for Black people living in Canada. Full article

The emergence of COVID-19 necessitated the rapid development of vaccines. While highly effective at reducing severe disease and death, breakthrough infections remain a problem as the virus continues to mutate. To help address this issue, we show the utility of a multiplex immunoassay in measuring multiple aspects of the antibody response generated by SARS-CoV-2 vaccines. We use a multiplex immunoassay platform to measure spike-specific IgG concentration, avidity, and receptor-binding inhibition. In addition, we correlate results from an ACE-2 receptor-binding inhibition assay with corresponding data from a SARS-CoV-2 microneutralization assay to establish this inhibitory assay as a potential predictor of virus neutralization. We studied these antibody responses in SARS-CoV-2-naïve and -convalescent vaccinees. Our results showed increased IgG concentrations, avidity, and inhibition following vaccination in both groups. We were also able to differentiate the immune response between the two groups using the multiplex immunoassay platform to look at antibody diversity. The receptor-binding inhibition assay has strong correlations with a cell-based pseudovirus neutralization assay as well as with WT SARS-CoV-2 Washington and Delta variant PRNT₅₀ assays. This suggests that the inhibition assay may be able to simultaneously predict virus neutralization of different SARS-CoV-2 variants. Overall, we show that the developed custom multiplex immunoassay with several experimental variations is a powerful tool in assessing multiple aspects of the SARS-CoV-2 antibody response in vaccinated individuals. Full article

This analysis was conducted in the context of the crisis caused by the COVID-19 pandemic, when the uncertainty and demand for food modified consumption patterns. Therefore, this study aimed to analyze variations in the expenditures allocated to pasteurized and powdered milk during and after the pandemic, considering the socioeconomic and demographic factors influencing these choices. A cross-sectional ordinary least squares (OLS) regression model was implemented using data from the National Household Income and Expenditure Survey for 2018, 2020, and 2022. The model evaluated variables such as income, household size, educational level, and gender of the household head, as well as the presence of minors and older adults at the regional level. The findings demonstrated that, in 2020, expenditure on pasteurized milk exhibited an elasticity of 0.888, suggesting heightened sensitivity to income during the pandemic period. In contrast, the elasticity of powdered milk was lower, with a value of 0.013 between 2018 and 2020, and negative values by 2022. Additionally, households headed by women, households with a higher level of education, and households with children spent more on pasteurized milk. These findings confirm the importance of milk as an essential commodity and highlight the substitute role of powdered milk in low-income households. Full article

Highly Urbanized Cities (HUCs) in the Philippines were at the forefront of public health surveillance and response during the COVID-19 pandemic. With the rapid spread of COVID-19 to Philippine cities, local government units continuously assessed, adapted, and implemented public health interventions (PHIs) and depended on available open-source government data (OSGD). This study consolidated PHIs in selected HUCs in the Philippines using high-quality OSGD to create a timeline of interventions and document good practices in local COVID-19 control. OSGD resources were collected from February 2020 to January 2023, and the data quality of OSGD was evaluated using the Journal of the American Medical Association (JAMA) benchmarks. A total of 180 metadata sources that met at least two core standards (Authorship and Currency) were included in the analysis. COVID-19 control strategies were analyzed vis-à-vis the rise of COVID-19 cases and types of PHIs, including the control of imported cases, case management, contact management, behavioral modification, and pharmaceutical intervention. Travel bans and hard lockdowns in Luzon early in the pandemic delayed the introduction of COVID-19 to other parts of the country. Good practices of LGUs for local COVID-19 control, such as quarantine passes, curfews and liquor bans, using QR-based contact tracing, massive community testing in high-risk communities, and free public swabbing centers, were implemented to slow down the local spread of COVID-19. With the evolving scenarios in city-level COVID-19 epidemics, local risk assessments based on available OSGD drove the adoption of relevant and innovative control strategies in HUCs in the Philippines. Lessons learned must be integrated into epidemic preparedness and response programs against future emerging or re-emerging infectious diseases. Full article

On 11 March 2020, the World Health Organization (WHO) declared a pandemic caused by SARS-CoV-2, raising global health concerns. Reports of persistent and new symptoms following the acute phase of infection highlighted the complexities of recovery and prompted the investigation of what is now termed long COVID. Officially recognized by the WHO in October 2021, long COVID presents various health implications, though the terminology—such as post-COVID syndrome and post-acute sequelae of COVID-19 (PASC)—remains inconsistent, complicating diagnostic standardization. Long COVID affects an estimated 10% to 30% of SARS-CoV-2-infected individuals, with common symptoms including fatigue, dyspnea, cognitive dysfunction, and joint pain, all of which significantly impair quality of life. Public perception is influenced by factors like education and health history, while misinformation and stigma hinder accurate diagnosis and treatment. The absence of biomarkers and overlap with other post-viral syndromes further complicate clinical recognition. Experts emphasize the need for refined diagnostic criteria and integrated strategies combining biomedical research, public policy, and educational initiatives to improve clinical management, address healthcare inequalities, and mitigate the impacts of long COVID. This review unveils the state of the art and knowledge gaps to encourage discussion, with the aim of achieving better clinical decision-making and public awareness related to long COVID. Full article

Background: South Korea was one of the first countries to experience the Coronavirus disease (COVID-19) epidemic, and the regional-level trends and patterns in the incidence and case-fatality rates have been observed to evolve with time. This study established yearly spatiotemporal evolution patterns of COVID-19 by region and identified possible regional risk factors accounting for the observed spatial variations. Methods: COVID-19 data between 20 January 2020 and 31 August 2023 were collected from the Korean Centers for Disease Prevention and Control (KCDA). We generated epidemic curves and calculated the yearly incidence and case-fatality rates for each region. In addition, choropleth maps for the location quotient of cases and deaths to visualize yearly regional intensities were generated and the Moran’s I calculated. Associations between the incidence and case-fatality rates with regional risk factors were estimated using regression models. All analyses were performed in R version 4.4.2. Results: We noted a significant difference in the incidence rate by year, with 2022 recording the highest for all regions. A consistent and significant spatial autocorrelation for cases and deaths across all years was observed with Moran I values above 0.4 (p < 0.05). There was a positive association of COVID-19 incidence rates with the population density (RR = 0.02, CI: 0.01–0.04, p = 0.03), percentage aged 60 years and above (RR = 0.03, CI: 0.01–0.05, p = 0.01), smoking prevalence (women) (RR = 0.79, CI: 0.54–1.04, p = 0.01), and diabetes prevalence (women) (RR = 0.51, CI: 0.32–0.71, p = 0.04). Conclusions: The spatiotemporal evolution patterns of COVID-19 in Korea consisted of oscillating hot and cold spots across the pandemic period in each region. These findings provide a useful reference to the government as it continues with the routine surveillance of COVID-19 across the country. Full article

While COVID-19 imposed significant risks to the mental health of individuals of all ages, research suggests that university students were particularly vulnerable to such risks in this period. This study examined whether personality traits predicted the impact of COVID-19 on Chinese university students’ mental health during the COVID-19 pandemic; whether the coping strategies they used mediated such relationships; and whether the patterns of relationship differed across males and females. Participants (453 females, 374 males) completed online measures of personality, coping strategies, and of adverse shifts to mental health during the COVID-19 pandemic. Stepwise multiple regression analyses were conducted to assess the extent to which personality traits predicted mental health shifts, and path analyses were conducted to investigate whether these relationships were mediated by the coping strategies used. Neuroticism was found to be a significant predictor of more adverse mental health responses for both sexes during the pandemic, which was partially mediated by the coping strategies students used (in particular, avoidance coping strategies). Coping strategies played a weaker mediating role for females, suggesting that additional factors may influence their mental health responses. Tailored mental health support interventions should, therefore, consider both personality traits and the coping mechanisms used by individuals in response to stressful life events. Full article

This study examines the factors influencing the behavioral intention and compliance behavior of Transportation Network Vehicle Service (TNVS) drivers during the COVID-19 pandemic. Grounded in the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM), the study integrates psychological, environmental, and organizational factors to explain TNVS drivers’ adherence to safety protocols. Data were collected from 342 TNVS drivers in the National Capital Region (NCR) and CALABARZON through a structured survey. Structural Equation Modeling (SEM) was employed to analyze the relationships among variables and assess the determinants of compliance behavior. The results indicate that attitude toward compliance (β = 0.453, p < 0.001), risk perception (β = 0.289, p = 0.001), availability of personal protective equipment (PPE) (β = 0.341, p < 0.001), passenger compliance (β = 0.293, p = 0.002), company policies (β = 0.336, p = 0.001), and organizational support systems (β = 0.433, p < 0.001) significantly influence behavioral intention. In turn, behavioral intention strongly predicts compliance behavior (β = 0.643, p < 0.001), confirming its mediating role in linking influencing factors to actual adherence. However, stress and fatigue (β = 0.131, p = 0.211), ride conditions (β = 0.198, p = 0.241), and communication and training (β = 0.211, p = 0.058) showed non-significant relationships, suggesting that their direct effects on behavioral intention are limited. The model explains 69.1% of the variance in compliance behavior, demonstrating its robustness. These findings highlight the importance of fostering positive attitudes, ensuring adequate resource availability, and reinforcing organizational support to improve TNVS drivers’ compliance with safety measures. Practical recommendations include implementing educational campaigns, ensuring PPE access, strengthening company policies, and promoting passenger adherence to safety protocols. The study contributes to the broader understanding of health behavior in the ride-hailing sector, offering actionable insights for policymakers, ride-hailing platforms, and public health authorities. Future research should explore additional contextual factors, gender-based differences, and regional variations, as well as assess long-term compliance behaviors beyond the pandemic context. Full article

Background: Discussing healthcare professional safety—not just patient safety—is crucial for delivering safe and high-quality healthcare, an essential component for achieving the third Sustainable Development Goal. The evaluation of the safety of healthcare professionals requires instruments that address multiple dimensions of their safety: organizational, emotional, professional and structural. The aim of this study was to validate the Questionnaire on Health Professional Safety in the COVID-19 Pandemic (QSP COVID-19). Methods: This is a methodological study to develop and validate the QSP COVID-19. Data were collected in a Brazilian municipality in 2022 and 2023. Exploratory factor analysis was carried out using the FACTOR software version 12.04.04. Results: A total of 259 professionals answered the QSP COVID-19. The factor analysis extracted four factors (organizational, emotional, professional and structural dimensions) which explained 55.4% of the total variance. The QSP COVID-19 has 30 items, all of which had factor loadings above 0.300. The latent and observed H-index of the four domains suggests that the factors may be replicable in future studies. Conclusions: the QSP COVID-19 has evidence of validity for assessing the safety of healthcare professionals in the context of COVID-19. Full article

Despite the end of the COVID-19 pandemic, there still remain risks of new aggressive strains of coronavirus. As the human population increases progressively, it is mandatory to ensure both preventive measures and an immediate response to emerging infectious threats. Another essential component for rapidly restraining a new possible pandemic is the development of new anticoronaviral therapeutics. In the present study, the anticoronaviral capabilities of Gc protein-derived macrophage-activating factor (GcMAF) are characterized. It is demonstrated that the administration of GcMAF to Syrian hamsters infected with SARS-CoV-2 within the first phase of infection (six days postinfection) is accompanied by (i) a statistically significant reduction in the viral load of the lung tissue and (ii) the switching of the inflammatory status of the lung tissue to a neutral one in terms of mRNA expression levels of the groups of pro/anti-inflammatory cytokines and chemokines. The potential mechanism for this antiviral action and the containment of the inflammatory response by the drug associated with the engagement of terminal N-acetylgalactosamine GcMAF and C-type lectin domain containing 10A expressed at the surface of lung-infiltrating macrophages and pneumocytes, which simultaneously express angiotensin-converting enzyme 2, is discussed. Full article

Given the critical role of media in times of crisis, particularly for relaying scientific knowledge and political decisions, we evaluated to what extent the first COVID-19 pandemic wave affected the treatment by traditional media of important societal topics. We searched a database of 650 French-speaking Swiss media outlets using specific keywords and reported the number of publications per month containing these items, associated or not with SARS-CoV-2. The number of publications related to viruses increased 12-fold during the first semester 2020, while the media coverage of topics about bacteria, parasites, and fungi remained stable. During the first pandemic wave, media generated a larger number of publications treating of political and medical subjects than before the pandemic, whereas the coverage of other topics was unchanged. All topics were viewed through the prism of the pandemic, up to 82% of the publications being associated with COVID-19. The media largely covered all medical aspects related to SARS-CoV-2 infection and offered scientists multiple opportunities to communicate with the public. However, their influence was strongly challenged by the capacity of social networks to disseminate rumors and misinformation. We also assessed the articles published in traditional media during the five subsequent epidemic waves, showing that the largest media peaks occurred during the first infection wave studied extensively in the present work, and during the huge fifth infection wave due to Omicron variant BA1. Undoubtedly, the COVID-19 pandemic highlighted how important it is for science communication to harness the tremendous power of social media. Full article

During the COVID-19 pandemic, concerns grew about excessive opioid dosing in Intensive Care Unit (ICU) patients. This study aimed to evaluate opioid dosing in the ICU by comparing objective (Nociception Level Monitor (NOL)) and subjective (Behavioral Pain Score (BPS)) pain measurement tools in COVID-19 and non-COVID-19 ICU patients. This observational study included 40 sedated, mechanically ventilated ICU patients, with half confirmed as COVID-19. Measurements included NOL, BPS, Richmond Agitation Sedation Scale (RASS), Bispectral Index (BIS) and nurse questionnaires. NOL was categorized as <10 (possible excessive analgesia), 10–25 (adequate analgesia), and >25 (possible need for more analgesia). The Time Weighted Average (TWA) assessed the duration of NOL >25 (TWA_NOL>25). Primary outcomes were NOL and BIS over time. COVID-19 patients received higher sufentanil (18 ± 9 µg/h versus 9 ± 6 µg/h) and propofol (307 ± 127 mg/h versus 277 ± 137 mg/h) doses (p < 0.001). No significant differences were found in TWA_NOL>25 (p = 0.78) or BPS (p = 0.1). NOL values were <10 for 63% and 57% of the time in COVID-19 and non-COVID-19 patients. BIS (p < 0.001) and RASS (p = 0.02) were lower in COVID-19 patients. While COVID-19 patients received higher opioid doses, low NOL and BPS were seen in all patients, suggesting high analgesia in all patients. Based on our data, we cannot determine whether higher opioid doses in COVID-19 were warranted. Full article