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Open AccessArticle

Wastewater-Based Epidemiology Monitoring for Endemics Like COVID-19 in India Through a Bi-Phase Detection Approach

by Aditi Nag, Sudipti Arora, Ekta Meena, Tamanna Pamnani, Komal Sharma, Aakanksha Kalra, Sandeep K. Shrivastava and Akhilendra B. Gupta

COVID 2025, 5(9), 147; https://doi.org/10.3390/covid5090147 - 4 Sep 2025

Abstract

Wastewater-based epidemiology (WBE) is increasingly recognized as a valuable tool for monitoring disease cycles, including pandemics like COVID-19. Unlike pandemics, epidemics exhibit distinct dynamics, spread patterns, multiple origin points, and varying levels of population immunity. This study evaluates the applicability of WBE for [...] Read more.

Wastewater-based epidemiology (WBE) is increasingly recognized as a valuable tool for monitoring disease cycles, including pandemics like COVID-19. Unlike pandemics, epidemics exhibit distinct dynamics, spread patterns, multiple origin points, and varying levels of population immunity. This study evaluates the applicability of WBE for epidemic monitoring and emergency preparedness by analyzing SARS-CoV-2 presence in Jaipur’s wastewater over one year post-second pandemic wave, covering a minor surge (third) and a mild resurgence (fourth) of COVID-19. A total of 1050 samples from different city localities were analyzed using a combination of two concentration methods (the direct method and the Polyethylene Glycol (PEG) method) and two detection kits (qualitative and quantitative). WBE effectively detected both minor and major epidemic outbreak cycles of SARS-CoV-2. A total of 62.91% samples out of all untreated samples tested, were found to be positive with viral genome; however, the positivity rate of any particular day did not exceed 25% even during the peaks. Notably, short-distance transportation under ambient conditions had no significant impact (p > 0.05) on detection, and the combination of the direct method with quantitative kits provided the highest sensitivity. Based on these findings, a cost-effective bi-phase surveillance model is proposed for year-round epidemic monitoring. This model suggests routine use of the faster, cheaper direct method, switching to the PEG concentration method during rising viral loads for enhanced resolution. Such an approach ensures sustainable, resource-efficient surveillance, particularly benefiting low- and middle-income countries facing financial constraints. Full article

(This article belongs to the Special Issue COVID and Public Health)

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13 pages, 344 KB

Open AccessArticle

A Cross-Sectional and Longitudinal Analysis of Cognitive Function and Well-Being of Older Adults in Panama During the COVID-19 Pandemic

by Stephanie Lammie, Sofía Rodríguez-Araña, Camilo Posada Rodríguez, Julio Flores-Cuadra, Ambar Pérez-Lao, Gabrielle B. Britton, Diana C. Oviedo and Adam E. Tratner

COVID 2025, 5(8), 128; https://doi.org/10.3390/covid5080128 - 7 Aug 2025

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Abstract

The COVID-19 pandemic exacerbated mental illness, accelerated cognitive decline, and deepened social inequalities. In low and middle-income countries (LMIC) such as Panama, it is unclear as to whether, and to what extent, the pandemic lockdowns affected cognitive, mental, and physical health of older [...] Read more.

The COVID-19 pandemic exacerbated mental illness, accelerated cognitive decline, and deepened social inequalities. In low and middle-income countries (LMIC) such as Panama, it is unclear as to whether, and to what extent, the pandemic lockdowns affected cognitive, mental, and physical health of older adults. This study investigated changes in cognitive function, mental health, and physical health in a sample of Panamanian older adults assessed before and during the pandemic, and examined whether sociodemographic variables were associated with cognition and mental health. Participants completed in-person interviews between 2018 and early 2020 and a follow-up telephone interview between February and May 2021. Repeated measures analyses showed no significant changes in cognitive function or depression; however, participants reported fewer chronic illnesses. Linear regression analysis indicated that higher cognitive function during the pandemic was associated with younger age, higher education, and having sufficient income. An attrition analysis compared participants who completed both interviews to those who were lost to follow-up, revealing that participants who dropped out of the study had lower socioeconomic status and greater impairment at baseline. These findings highlight the need for targeted support for vulnerable older adults during public health crises. Full article

(This article belongs to the Special Issue COVID and Public Health)

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10 pages, 751 KB

Open AccessArticle

SARS-CoV-2 Infection Epidemiology Changes During Three Years of Pandemic in a Region in Central India

by Pravin Deshmukh, Swati Bhise, Sandeep Kokate, Priyanka Mategadikar, Hina Rahangdale, Vaishali Rahangdale, Sunanda Shrikhande, Sana Pathan, Anuradha Damodare, Sachin Baghele, Juili Gajbhiye and Preeti Shahu

COVID 2025, 5(8), 125; https://doi.org/10.3390/covid5080125 - 4 Aug 2025

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Abstract

Background: The surge in COVID-19 cases during the pandemic created a disease burden. An epidemiological study on COVID-19 is required as not much is known about the impact of containment and mitigation on health. We aimed to compare the epidemiological features during the [...] Read more.

Background: The surge in COVID-19 cases during the pandemic created a disease burden. An epidemiological study on COVID-19 is required as not much is known about the impact of containment and mitigation on health. We aimed to compare the epidemiological features during the years of the COVID-19 pandemic in the Vidarbha region in Maharashtra, India, to understand the epidemiology changes throughout the pandemic’s progression. Method: All of the cases reported at our testing centers in Nagpur and its periphery during the three years of the pandemic (i.e., from February 2020 to December 2022) were included. Descriptive analyses of variables of interest and statistical measures were compared. Results: There were 537,320 tests recorded during the study period. Of these, 13,035 (13.29%), 42,909 (13.70%), and 19,936 (15.91%) tested positive in 2020, 2021, and 2022, respectively. Hospitalization decreased from 2020 to 2022. An age group shift from 45 to 16–30 years over the pandemic was noticed. Seasonally, positivity peaked in September (27.04%) in 2020, in April (43.4%) in 2021, and in January in 2022 (35.30%). The estimated case fatality ratio was highest in 2021 (36.68%) over the three years in the hospital setting. Conclusion: Understanding the changing epidemiology of SARS-CoV-2 strengthens our perceptive of this disease, which will aid in improving the healthcare system in terms of both controlling and preventing the spread of COVID-19. Full article

(This article belongs to the Special Issue COVID and Public Health)

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15 pages, 1293 KB

Open AccessArticle

Hesitant Minds in Vulnerable Times: COVID-19 Vaccine Hesitancy Among University Students in Ukraine

by Prince Yeboah, Afraa Razouk, Philip Skotzke, Werner Pitsch, Olena Chubuchna, Victoria Serhiyenko, Nataliia Slyvka, Serhii Holota, Muhammad Jawad Nasim, Ahmad Yaman Abdin and Claus Jacob

COVID 2025, 5(8), 122; https://doi.org/10.3390/covid5080122 - 31 Jul 2025

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Abstract

COVID-19 vaccine hesitancy (VH), like attitudes towards other vaccines, is a critical global public health concern. Despite numerous studies covering psychological, sociodemographic, and other determinants of vaccine acceptance, resistance, and hesitance, few studies have reported these factors among students, particularly in politically unstable [...] Read more.

COVID-19 vaccine hesitancy (VH), like attitudes towards other vaccines, is a critical global public health concern. Despite numerous studies covering psychological, sociodemographic, and other determinants of vaccine acceptance, resistance, and hesitance, few studies have reported these factors among students, particularly in politically unstable settings like Ukraine. This cross-sectional, descriptive, and quantitative study assesses hesitancy towards COVID-19 vaccines, utilizing the 5Cs Model. Among 936 respondents surveyed in 2023, 64% received at least one shot of the COVID-19 vaccine (acceptant), 11% were still considering getting vaccinated (hesitant), and 25% refused vaccination (resistant). Vaccination behavior is significantly associated with the 5Cs. Higher collective responsibility significantly increased acceptance and reduced resistance, while higher constraints lowered the chances of being either acceptant or resistant. Confidence protected against resistance. Complacency, counterintuitively, reduced odds of resistance, pointing to differences between passive hesitancy and active refusal. Male gender and sources of information and misinformation influenced confidence. Collective responsibility was positively associated with official sources and negatively with conspiracy beliefs. Complacency increased with official sources, while constraints and calculation were least explained by predictors. Practical barriers should be tackled through improved accessibility and fostering collective responsibility via targeted communication strategies. These findings provide actionable insights for policymakers, healthcare providers, and academic institutions to enhance vaccine uptake among university students, particularly in crisis settings. Full article

(This article belongs to the Special Issue COVID and Public Health)

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9 pages, 207 KB

Open AccessArticle

Vitamin D Status and SARS-CoV-2 Positivity in Lebanon Among Adults: A Cross-Sectional Study in South Lebanon

by Ahmed A. Madar, Firass Al Lababidi, Filali Samia and Haakon E. Meyer

COVID 2025, 5(7), 97; https://doi.org/10.3390/covid5070097 - 27 Jun 2025

Viewed by 417

Abstract

Background: The COVID-19 pandemic has affected countries globally, causing significant respiratory tract symptoms, including shortness of breath, coughing, chest tightness, and wheezing. Vitamin D has been proposed to play a key role, especially in upper respiratory tract infections. Recently, numerous studies and reports [...] Read more.

Background: The COVID-19 pandemic has affected countries globally, causing significant respiratory tract symptoms, including shortness of breath, coughing, chest tightness, and wheezing. Vitamin D has been proposed to play a key role, especially in upper respiratory tract infections. Recently, numerous studies and reports associating low serum 25-hydroxyvitamin D levels (s-25-(OH)D) and adverse outcomes in COVID-19 have emerged. We aimed to assess the association between vitamin D status and SARS-CoV-2 positivity among adults in Lebanon. Method: A cross-sectional study was conducted, recruiting 384 participants aged 18–75 years from a university hospital in South Lebanon. Background variables were collected through structured questionnaires. Serum 25(OH)D levels were measured using electrochemiluminescence immunoassay, and SARS-CoV-2 positivity was assessed through PCR testing. Results: The mean s-25(OH)D level was 46.8 nmol/L (SD 28.1), and 30% of the participants had vitamin D deficiency (s-25-(OH)D level <30 nmol/L). SARS-CoV-2 positivity was reported in 28% of participants. However, no significant association was found between s-25(OH)D levels and SARS-CoV-2 positivity. This study had several limitations, including potential selection bias due to recruiting participants from a hospital for PCR testing, the collection of data across different seasons, and the refusal of several eligible individuals to participate. Additionally, the lack of data on participants’ immunization status and assay variability may impact the generalizability and interpretation of the findings. Conclusion: There was a high prevalence of vitamin D insufficiency among adults participating in COVID-19 tests in Lebanon, but it was not associated with SARS-CoV-2 positivity. Full article

(This article belongs to the Special Issue COVID and Public Health)

16 pages, 413 KB

Open AccessArticle

Frequent Menstrual Disturbance Post-COVID-19 Vaccination in Saudi Arabia

by Khalid F. Alshammari, Kamaleldin B. Said, Ahmed Aljadani, Arwa A. Alotaibi, Fahad M. Alshammary, Ruba M. Elsaid Ahmed, Abdulrahman T. Alshammari, Turki A. Al-shammari, Hend Alkwai, Mona M. Shahin, Gamal Eldin M. O. Elhussein, Somaia Ibrahim, Fayez R. Alfouzan, Tarig Mahmoud, Rania A. H. Abdalla, Abdelrahim A. A. Mohamed, Zaid A. Albayih and Abuzar A. A. Osman

COVID 2025, 5(7), 95; https://doi.org/10.3390/covid5070095 - 20 Jun 2025

Viewed by 594

Abstract

The increased menstrual disturbances post-vaccination remain unclear. We examined factors, types, frequencies, and emotional challenges. We used a self-administered online questionnaire with the IBM-based SPSSv-24-Windows software for analysis. Of 1372 females, 61.1% (n = 838) were aged 19–29 years, 94.2% (n [...] Read more.

The increased menstrual disturbances post-vaccination remain unclear. We examined factors, types, frequencies, and emotional challenges. We used a self-administered online questionnaire with the IBM-based SPSSv-24-Windows software for analysis. Of 1372 females, 61.1% (n = 838) were aged 19–29 years, 94.2% (n = 1292) were Saudis, 66.4% (n = 911) were graduates, 70% (n = 965) were single, and 15% (n = 205) had chronic diseases. Moreover, 96.5% (n = 1285/1332) had two vaccine doses, mostly Pfizer’s first- and second doses (82% and 78, respectively), while 3.5% (n = 47) only had one. Vaccine groups significantly differed (Pfizer, Moderna, Oxford, and do not know) after the first (0.047) and second (0.049) doses, while Pfizer vaccines were predictive [OR = 2.09 (0.96–4.10), p = 0.029] at two-doses [OR = 3.21 (1.23–5.21), p = 0.030]. No acute COVID appeared. The majority (77%; n = 1057) had no issues, except, in a subgroup of 23% (n = 315) of participants, 43% (n = 135) experienced worsening issues. However, 47.2% (n = 629) complained only post vaccination. Most issues were (75%; n = 471) cycle-timing disruptions; the rest were minor (decreased blood or bleeding, missed-periods, or pain). Other potential reasons were fear, stress, and mental health problems, which occurred in 51% (n = 674) of the group, while 53% (n = 701) were worried. Intriguingly, the menstrual issues in the remaining 47% (n=631) who were not worried could be due to a direct molecular vaccine interaction, irrespective of any mental issue ([OR = 1.78 (0.76–3.21), p = 0.033]. Age proportionalities were significant (p = 0.05) in the 30–39 year-old group (51%). Postgraduate education [OR = 2.11 (0.98–4.72), p = 0.015) and employment [OR = 2.18 (0.95–4.86), p = 0.049] were also predictors. These findings have significant implications in women’s health and vaccine improvement. Future studies on diverse factors are warranted. Full article

(This article belongs to the Special Issue COVID and Public Health)

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15 pages, 605 KB

Open AccessArticle

Self-Reported Body Weight Change and Weight Loss Practices During the COVID-19 Pandemic: A Mixed-Methods Study from Türkiye

by Nagihan Kircali-Haznedar, Mehmet Haydaroğlu and Pelin Bilgiç

COVID 2025, 5(6), 94; https://doi.org/10.3390/covid5060094 - 19 Jun 2025

Viewed by 567

Abstract

The COVID-19 pandemic significantly impacted daily life, disrupting routines and altering lifestyle behaviors. This study aimed to investigate changes in body weight, nutritional status, and weight loss practices among adults in Türkiye during the first year of the pandemic. A cross-sectional online survey [...] Read more.

The COVID-19 pandemic significantly impacted daily life, disrupting routines and altering lifestyle behaviors. This study aimed to investigate changes in body weight, nutritional status, and weight loss practices among adults in Türkiye during the first year of the pandemic. A cross-sectional online survey was conducted between March and April 2021, including 806 participants. Height and weight were self-reported, and weight loss practices, along with their details, were evaluated. A qualitative component explored participants’ perceptions of weight change, with 274 valid responses. The mean weight gain during the pandemic was 0.88 kg (p < 0.001). Among participants, 44.9% reported weight gain, 22.6% reported weight loss, and 14.1% experienced weight fluctuation. Among those who experienced weight fluctuations, 47.4% resulted in weight loss, 14.9% showed no change, and 37.7% experienced weight gain. The prevalence of overweight increased from 19.2% to 22.8%, and obesity rose from 8.7% to 9.4% (p = 0.005). Regarding weight loss practices, 30.1% of participants engaged in physical exercise, while 25.7% reported following weight loss diets. Qualitative analysis revealed that changes in physical activity, eating habits, and psychological factors were key determinants of weight change. These findings emphasize the diverse effects of the pandemic on weight status and management. Full article

(This article belongs to the Special Issue COVID and Public Health)

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14 pages, 516 KB

Open AccessArticle

Rethinking the Impact of Social Media Exposure and Source Credibility on the Social Amplification of Risk and Public Engagement During the COVID-19 Pandemic

by Longfei Li and Ran Feng

COVID 2025, 5(6), 84; https://doi.org/10.3390/covid5060084 - 30 May 2025

Viewed by 999

Abstract

Promoting public engagement through social media has always been a core issue in risk communication studies. Based on the Social Amplification of Risk Framework (SARF), this study conducts an online survey in China (N = 908) and constructs a moderated mediation model. Using [...] Read more.

Promoting public engagement through social media has always been a core issue in risk communication studies. Based on the Social Amplification of Risk Framework (SARF), this study conducts an online survey in China (N = 908) and constructs a moderated mediation model. Using bootstrapped moderated mediation analysis, this study examines the relationships among social media exposure to pandemic information, risk perception, source credibility, and public engagement on social media at the early stages of the pandemic. The results demonstrate a positive relationship between social media exposure and public engagement, which can be mediated by risk perception. The relationship between social media exposure and public engagement via risk perception is moderated by source credibility. The higher perceived credibility of official and interpersonal sources undermines risk perception, but also hinders public engagement in the crisis. The moderating effect of professional source credibility is not significant. This study has expanded the SARF and has contributed to promoting risk communication strategies from the perspective of risk information processing. Full article

(This article belongs to the Special Issue COVID and Public Health)

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17 pages, 1101 KB

Open AccessArticle

Delay in COVID-19 Vaccinations: The Role of Travel Time to Vaccine Sites

by Yuxia Huang and Jim Lee

COVID 2025, 5(5), 70; https://doi.org/10.3390/covid5050070 - 12 May 2025

Viewed by 517

Abstract

Introduction: A growing body of literature has identified a variety of factors affecting vaccine uptake, but the role of geographic accessibility remains unclear. This study fills this knowledge gap by empirically investigating the extent to which the time driving to vaccine sites as [...] Read more.

Introduction: A growing body of literature has identified a variety of factors affecting vaccine uptake, but the role of geographic accessibility remains unclear. This study fills this knowledge gap by empirically investigating the extent to which the time driving to vaccine sites as a measure of geographic friction affected COVID-19 vaccine uptake. Methods: A logistic model and a hazard-based duration model were applied to the official data of more than 142,000 adults who took at least one COVID-19 vaccine in Nueces County, Texas, between December 2020 and August 2022. Using the street network, travel time was calculated from individuals’ home addresses to the addresses of the sites where they received their vaccinations. Results: The logistic model indicated that individuals living farther from vaccine sites were less likely to receive full vaccination, controlling for their sociodemographic characteristics that affected vaccine hesitancy. The duration model further showed that fully vaccinated persons would delay a booster shot longer if they had to travel longer for a vaccine. Conclusions: To the extent that the health protection of a COVID-19 vaccine declines over time, the integration of spatial and temporal dimensions in the duration model allowed us to shed light on the relationship between travel time and delay in booster vaccination. A vaccination campaign should make vaccination services physically convenient for vaccine recipients from different communities. Full article

(This article belongs to the Special Issue COVID and Public Health)

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11 pages, 528 KB

Open AccessArticle

High- and Low-Cost Healthcare Utilization for Cancer and COVID-19 Patients

by Li Huang and Sue Min Lai

COVID 2025, 5(4), 56; https://doi.org/10.3390/covid5040056 - 16 Apr 2025

Viewed by 718

Abstract

Background: Healthcare total spending accelerated during the COVID-19 pandemic. Understanding broad high- and low-cost healthcare utilization while the healthcare system is under stress can help identify strategies and gaps to improve the future quality of care while reducing high-cost care and maximizing low-cost [...] Read more.

Background: Healthcare total spending accelerated during the COVID-19 pandemic. Understanding broad high- and low-cost healthcare utilization while the healthcare system is under stress can help identify strategies and gaps to improve the future quality of care while reducing high-cost care and maximizing low-cost care. Methods: This was a population-based cross-sectional study with 56,141 individuals in the U.S. using 2020–2021 Medical Expenditure Panel Survey (MEPS) data sources. We applied a Poisson regression approach to test differences among patients with/without cancer/COVID-19 in healthcare utilization outcomes, including emergency department (ED) visits, inpatient discharge, inpatient nights of stay, outpatient visits, and home provider days. Results: Outpatient visits were affected by both cancer and COVID-19 diagnoses (86% to 109% higher for individuals with cancer and/or COVID-19, p < 0.001). COVID-19 patients with/without cancer had statistically significant increases in high-cost care, including (1) ED visits (151% to 245% higher, p < 0.001), (2) number of inpatient visits (94% to 170%, p < 0.001, p < 0.001), and (3) inpatient nights of stay (259% to 268% higher, p < 0.001). There were no statistically significant differences in home-based utilization when compared to individuals without cancer and without COVID-19. Conclusions: Improving and adopting innovative low-cost home-based care utilization are critical to reduce future healthcare spending and strengthen pandemic preparedness. Full article

(This article belongs to the Special Issue COVID and Public Health)

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17 pages, 1415 KB

Open AccessArticle

COVID-19 Control in Highly Urbanized Philippine Cities: Leveraging Public Health Open-Source Government Data for Epidemic Preparedness and Response

by Maria Catherine B. Otero, Lorraine Joy L. Bernolo, Refeim M. Miguel, Zypher Jude G. Regencia, Lyre Anni E. Murao and Emmanuel S. Baja

COVID 2025, 5(3), 42; https://doi.org/10.3390/covid5030042 - 19 Mar 2025

Viewed by 2908

Abstract

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 [...] Read more.

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

(This article belongs to the Special Issue COVID and Public Health)

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21 pages, 290 KB

Open AccessArticle

Examining the Relationships Between Workplace Policies and Practices, PTSD, and Distress Among Working Parents During the COVID-19 Crisis

by Samantha A. Meeker, Alicia Modestino, Jamie Ladge, Beth E. Molnar and Alisa K. Lincoln

COVID 2025, 5(3), 28; https://doi.org/10.3390/covid5030028 - 22 Feb 2025

Viewed by 640

Abstract

While the COVID-19 pandemic’s impact on mortality and morbidity is becoming more understood, the severity of the long-term effects remains unknown: this includes medical sequelae of long COVID but also the impact of the social and economic upheaval on population health. Working parents [...] Read more.

While the COVID-19 pandemic’s impact on mortality and morbidity is becoming more understood, the severity of the long-term effects remains unknown: this includes medical sequelae of long COVID but also the impact of the social and economic upheaval on population health. Working parents faced many challenges during the pandemic, and the impact of these on the mental health and well-being of parents has been demonstrated. However, the extent of trauma-related symptoms among working parents who have faced unique challenges related to the virus itself and the social and structural consequences of containment efforts remains underexamined. Using data from a national panel survey of fworking parents (n = 1941), we explored the relationship between workplace policies and practices and COVID-19-related PTSD and psychological distress. Results demonstrate that nearly 50% of working parents experienced COVID-19-related PTSD as measured by the Impact of Events Scale-6, and over 60% had moderate to high levels of psychological distress. We examined mechanisms to understand the impact of job support on employees’ levels of PTSD and distress and found that both socio-demographic factors and workplace support related to levels of PTSD and distress among working parents. Our study highlights the distress and PTSD levels experienced by working parents in the early stages of the pandemic, underscoring the impact of workplace support on mental health outcomes. Full article

(This article belongs to the Special Issue COVID and Public Health)

14 pages, 832 KB

Open AccessArticle

Can Self-Reported Symptoms Be Relied on for COVID-19 Screening in Low-Resource Settings?

by Suraj Singh Senjam, Garima Goel, Neiwete Lomi, Yatan Pal Singh Balhara, Yashdeep Gupta and Animesh Ray

COVID 2025, 5(2), 15; https://doi.org/10.3390/covid5020015 - 27 Jan 2025

Viewed by 995

Abstract

Background: Understanding the extent of the disease penetration and assessing its impact is critical during a pandemic. However, laboratory-based COVID-19 estimation can be resource-intensive and may not be feasible during an emergency, particularly in low-resource settings. Aim: To investigate whether self-reported symptoms can [...] Read more.

Background: Understanding the extent of the disease penetration and assessing its impact is critical during a pandemic. However, laboratory-based COVID-19 estimation can be resource-intensive and may not be feasible during an emergency, particularly in low-resource settings. Aim: To investigate whether self-reported symptoms can be used for COVID-19 screening to estimate the burden among individuals aged 18 years and above in a rural setting. Methods: A community-based cross-section study was conducted in a rural district of Haryana, a state in north India, using a self-reported semi-structured questionnaire developed on a digital platform. Information on COVID-19 manifestations as essential and non-essential, confirmed laboratory tests, and disability data using Washington Groups of Short Set were obtained. The sensitivity of the COVID-19 symptoms was estimated against laboratory-confirmed true positives. A chi-square or Fisher exact test for association and a multivariable regression to determine the predictors of the prevalence was carried out. Results: In total, 2954 respondents (79.8%), out of 3700 enumerated, were interviewed. The mean age of respondents was 42 years (SD 17.2), with 54.8% female respondents. The prevalence of COVID-19 based on self-reported symptoms was 6.2% (95%CI: 5.3–7.1). The age-adjusted prevalence was 6.04% (95%CI: 5.9–6.1). Of the total COVID-19 cases, 170 (5.7%, 95%CI: 4.9–6.5) revealed a laboratory-confirmed test. Given three essential symptoms to declare provisionally COVID-19 cases, the sensitivity was 82.9% (141/170), but considering two or more essential symptoms along with two or more non-essential, the sensitivity reached up to 91.8% (156/170). The multivariable analysis showed that increased age, higher education attainment, students, entrepreneurs, persons working in private sectors, and participants with poor hygiene were predictors. Conclusions: A symptoms-based identification of COVID-19 cases can give a reliable estimate and valuable insight into the extent of the penetration, especially in low-middle-income countries, and can be a supplement, not a replacement, to a laboratory test. Full article

(This article belongs to the Special Issue COVID and Public Health)

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15 pages, 531 KB

Open AccessArticle

Coping with Stress During the COVID-19 Pandemic: Resilience and Mental Health Among Latino Day Laborers

by Sylvia A. Ayieko, John Atkinson, Anna Llamas and Maria E. Fernandez-Esquer

COVID 2025, 5(1), 1; https://doi.org/10.3390/covid5010001 - 24 Dec 2024

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Abstract

Resilience, the successful process of growth and adaptation in the face of adversity, stress, or trauma, is crucial for optimal well-being. During the COVID-19 pandemic, Latino day laborers (LDLs) faced multiple stressors, making them vulnerable to poor mental health outcomes. Using a cross-sectional [...] Read more.

Resilience, the successful process of growth and adaptation in the face of adversity, stress, or trauma, is crucial for optimal well-being. During the COVID-19 pandemic, Latino day laborers (LDLs) faced multiple stressors, making them vulnerable to poor mental health outcomes. Using a cross-sectional study design, we examine the association between situational stressors, mental health, and resilience among LDLs during the COVID-19 pandemic. Data included sociodemographic information and measures of situational stressors, mental health (depression, anxiety, and stress), and resilience. Positive and negative resilience subscales were analyzed separately due to a high correlation. A total of 300 male participants completed the surveys, with a mean age of 45.1 years. Almost half had never been married (48%) and had completed nearly eight years of school. The results indicated no significant associations between stressors, positive resilience, and mental health outcomes (B = 0.023, NS) but a significant association between negative resilience, mental health outcomes, and some stressors, such as lack of money (B = 0.103; p < 0.05). The implications of this study include the need to further investigate the use of negatively worded items and how resilience is demonstrated among other vulnerable populations or cultural groups. Full article

(This article belongs to the Special Issue COVID and Public Health)

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11 pages, 4219 KB

Open AccessArticle

COVID-19 Trends in a Northeastern Brazilian State from the Start of the Pandemic: Exploring an Alternative Time Series Method

by Matheus Paiva Emidio Cavalcanti, Jorge de Oliveira Echeimberg, Tassiane Cristina Morais, Blanca Elena Guerrero Daboin, Fernando Augusto Marinho dos Santos Figueira, Carlos Mendes Tavares and Luiz Carlos de Abreu

COVID 2024, 4(12), 1960-1970; https://doi.org/10.3390/covid4120138 - 11 Dec 2024

Cited by 1 | Viewed by 1525

Abstract

Pernambuco, a northeastern Brazilian state, suffered significantly during the COVID-19 pandemic. The incidence, mortality, and fatality rates were incredibly high; these outcomes were a direct failure of the public health system to manage the COVID-19 pandemic. We developed an efficient method to analyze [...] Read more.

Pernambuco, a northeastern Brazilian state, suffered significantly during the COVID-19 pandemic. The incidence, mortality, and fatality rates were incredibly high; these outcomes were a direct failure of the public health system to manage the COVID-19 pandemic. We developed an efficient method to analyze the trends in incidence, mortality, and lethality indicators of COVID-19 and the dynamics of their main determinants in the state of Pernambuco from March 2020 to March 2022. This was a time series ecological study. We calculated the lethality, mortality, and incidence rates with official and public data from the Health Department of this state. The effective reproduction number (Rt) was estimated, and then the periods were delimited, thus creating the efficiency model. Differences were considered significant when p < 0.05. We found 585,551 cases and 18,233 deaths from COVID-19. January 2022 was the month with the highest number of cases (6312) and, in May 2020, we recorded the highest number of deaths (149). Our method was efficient in analyzing periods of COVID-19, noting a contrast between the early and most recent periods, with the latter showing a stable number of new cases and patient deaths. Full article

(This article belongs to the Special Issue COVID and Public Health)

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11 pages, 247 KB

Open AccessArticle

The Impact of the COVID-19 Pandemic on the Oral Hygiene Status of Children with High Caries Risk and Their Parents

by Zeliha Hatipoğlu Palaz, Nagehan Aktaş and Didem Atabek

COVID 2024, 4(12), 1897-1907; https://doi.org/10.3390/covid4120133 - 28 Nov 2024

Cited by 1 | Viewed by 1440

Abstract

Background: People consumed more sugary foods and neglected oral hygiene during the lockdowns due to the coronavirus disease (COVID-19) pandemic. The study aimed to compare the oral hygiene status and dietary habits of children with high caries risk and their parents before and [...] Read more.

Background: People consumed more sugary foods and neglected oral hygiene during the lockdowns due to the coronavirus disease (COVID-19) pandemic. The study aimed to compare the oral hygiene status and dietary habits of children with high caries risk and their parents before and after COVID-19. Methods: The study was conducted with the parents of 155 children aged 3–5 years. A questionnaire including both the children’s and parents’ dietary and oral hygiene habits was completed by the parents. Decay, missing, filling teeth (dmft/DMFT) status of the children was recorded before and after COVID-19. Results: A significant decrease was observed in the parents’ tooth brushing frequency (p = 0.028), while no difference was observed in the children’s brushing frequency before and after COVID-19 (p = 0.216). Both children and parents ate significantly more frequently (p = 0.047, p = 0.043). dmft/DMFT values increased significantly after COVID-19 (p = 0.005). Conclusions: The study showed that the COVID-19 pandemic had a limited effect on tooth brushing habits in children with high caries risk. Additionally, it resulted in increased consumption of sugary foods among both children and parents, exacerbating caries in children aged 3–5 years. Healthcare professionals and parents can work together to mitigate the negative effects of the COVID-19 pandemic on oral health, especially for high-caries-risk children. Full article

(This article belongs to the Special Issue COVID and Public Health)

24 pages, 3042 KB

Open AccessArticle

Exploring the Role of News Outlets in the Rise of a Conspiracy Theory: Hydroxychloroquine in the Early Days of COVID-19

by Robert Dickinson, Dominique Makowski, Harm van Marwijk and Elizabeth Ford

COVID 2024, 4(12), 1873-1896; https://doi.org/10.3390/covid4120132 - 27 Nov 2024

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Abstract

Improper use of hydroxychloroquine to treat COVID-19 has been linked to 17,000 preventable deaths. This content analysis study investigates the emergence of this conspiracy theory, the role of the news media in perpetuating and disseminating it, and whether coverage differed by outlet political [...] Read more.

Improper use of hydroxychloroquine to treat COVID-19 has been linked to 17,000 preventable deaths. This content analysis study investigates the emergence of this conspiracy theory, the role of the news media in perpetuating and disseminating it, and whether coverage differed by outlet political alignment. We searched Nexis for relevant media from 17–31 March 2020. A total of 128 media pieces were coded qualitatively and thematically analysed. The news media amplified the voices of right-wing political elites and used a variety of manipulative tactics in reporting on hydroxychloroquine. Powerful ingroup/outgroup mechanisms polarised the American public and created a schism between Trump supporters and the public health apparatus that reflected the political asymmetry in reporting on hydroxychloroquine. The widespread use of optimistic framings and anecdotal evidence contributed to public misunderstandings of the evidence. Therefore, strategic and interventionist public health efforts are required to combat misinformation. This study informs discussions of how politicised media coverage catalyses conspiracism. Full article

(This article belongs to the Special Issue COVID and Public Health)

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8 pages, 395 KB

Open AccessBrief Report

Profiling COVID-19 Cases in Tlemcen, Algeria: PCR and CT Imaging Insights

by Ilyes Zatla, Lamia Boublenza, Wafaa Lemerini, Chahinez Triqui and Nabahate Selka

COVID 2025, 5(9), 149; https://doi.org/10.3390/covid5090149 (registering DOI) - 5 Sep 2025

Abstract

The COVID-19 pandemic caused by SARS-CoV-2 has significantly impacted public health worldwide. This study aimed to assess the clinical and diagnostic features of COVID-19 cases in the Tlemcen region, Algeria, and analyze epidemiological trends from January to December 2021. This retrospective study included [...] Read more.

The COVID-19 pandemic caused by SARS-CoV-2 has significantly impacted public health worldwide. This study aimed to assess the clinical and diagnostic features of COVID-19 cases in the Tlemcen region, Algeria, and analyze epidemiological trends from January to December 2021. This retrospective study included 68,745 confirmed snapshot active COVID-19 cases from the Public Local Health Care Establishment (EPSP)—University Hospital of Tlemcen. Patients underwent PCR testing and chest CT imaging for clinical evaluation. Data on symptoms, PCR cycle threshold (Ct) values, and CT imaging findings were collected, and statistical analysis was performed to examine the patient’s viral load and lung involvement data. Among 488 confirmed cases, common symptoms included fever, cough, and shortness of breath. PCR Ct values ranged from 15 to 35, and CT imaging revealed widespread lung involvement, with ground-glass opacities being the predominant feature. Epidemiological trends showed a consistent increase in cumulative cases, highlighting sustained transmission throughout the study period. Over the study period, epidemiological surveillance recorded a progressive rise in daily cases, peaking in July with 72 cases, followed by a gradual decline toward the end of the year. The findings underscore the utility of PCR Ct values and CT imaging in evaluating disease severity and monitoring regional case progression. The upward trend in cumulative cases emphasizes the need for ongoing public health measures and diagnostic strategies to manage future outbreaks effectively. Full article

(This article belongs to the Special Issue COVID and Public Health)

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9 pages, 396 KB

Open AccessBrief Report

Neutrophil-to-Lymphocyte Ratio Predicts COVID-19 Mortality in the Yucatecan Maya Population: A Retrospective Cohort Study

by Adriel Ismael Alonso Batun, Vania Janet Tello Romero, Onel Abraham Pacheco Polanco and Nina Mendez-Dominguez

COVID 2025, 5(7), 96; https://doi.org/10.3390/covid5070096 - 26 Jun 2025

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Abstract

Background: Severe and critical forms of COVID-19 have been associated with high mortality, particularly in vulnerable or underrepresented populations. The neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory biomarker that may aid in early risk stratification. Objective: To evaluate the prognostic value of the [...] Read more.

Background: Severe and critical forms of COVID-19 have been associated with high mortality, particularly in vulnerable or underrepresented populations. The neutrophil-to-lymphocyte ratio (NLR) is an emerging inflammatory biomarker that may aid in early risk stratification. Objective: To evaluate the prognostic value of the NLR in hospitalized patients with severe or critical COVID-19 and assess its association with in-hospital mortality in the Yucatecan Maya population of southeastern Mexico. Methods: This retrospective cohort study included 172 adult patients admitted with severe or critical COVID-19 to a tertiary care center in Yucatán, Mexico. Clinical, demographic, and laboratory variables were analyzed. Univariate and multivariate logistic regression were used to identify predictors of in-hospital mortality. ROC analysis determined the optimal NLR threshold. Results: Among the 172 patients, 79 (45.9%) died during hospitalization. Non-survivors exhibited significantly higher NLR values compared to survivors (median 18.4 vs. 6.3; p < 0.001). In multivariate analysis, the NLR remained an independent predictor of mortality (OR 1.66; 95% CI: 1.26–2.17; p < 0.001). The ROC curve showed an AUC of 0. 0.83 for Intensive Care Unit and 903 for in hospital death. Conclusions: In this regional cohort of the Yucatecan Maya population, the NLR was a strong independent predictor of mortality in patients with severe or critical COVID-19. The identified cutoff of the NLR ≥ 9.76 may serve as a valuable, low-cost tool for early risk assessment in similar settings with limited resources. Full article

(This article belongs to the Special Issue COVID and Public Health)

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7 pages, 206 KB

Open AccessBrief Report

Adherence to Pelvic Floor Physical Therapy During COVID-19: A Retrospective Study

by Nicole P. Jenkins, Gregory W. Vurture, Amber Wai-San Chan, Stephanie Sansone, Nina Jacobson and Scott W. Smilen

COVID 2025, 5(5), 64; https://doi.org/10.3390/covid5050064 - 27 Apr 2025

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Abstract

COVID-19 introduced widespread challenges in healthcare access and was demonstrated to be a significant stressor for patients with pelvic floor dysfunction (PFD). Pelvic Floor Physical Therapy (PFPT) is a first line behavioral modification to address PFD. The impact of COVID-19 on PFPT adherence [...] Read more.

COVID-19 introduced widespread challenges in healthcare access and was demonstrated to be a significant stressor for patients with pelvic floor dysfunction (PFD). Pelvic Floor Physical Therapy (PFPT) is a first line behavioral modification to address PFD. The impact of COVID-19 on PFPT adherence rates in a urogynecologic population is unknown; therefore, a retrospective chart review was conducted looking at “pre-pandemic” (referring to before 1 March 2020) and “pandemic” (referring to after 1 March 2020) cohorts. A total of 173 women met the inclusion criteria (93 pre-pandemic vs. 80 pandemic). The PFPT adherence rates were similar between the pre-pandemic and pandemic groups (20.0% vs. 18.8%, p = 0.85). Patient-reported barriers to initiation included insurance coverage, transportation, and time commitment. When looking for clinical correlates associated with non-adherence, patients who utilized an internal referral to a hospital-associated PFPT facility were 4.9-fold more likely to adhere to PFPT for PFD (95% confidence interval: 1.31–18.23, p = 0.018). While COVID-19 was not identified as a barrier to PFPT adherence, identifying barriers preventing patients from attending PFPT remains an area for improvement. Increasing the utilization of an internal referral system to a hospital-associated PFPT facility may be an effective solution for increasing patient adherence. Full article

(This article belongs to the Special Issue COVID and Public Health)

11 pages, 187 KB

Open AccessBrief Report

Multi-Stakeholder Perspectives on COVID-19 Vaccine Acceptance: A Qualitative Study from African, Caribbean, and Black Communities in Ottawa, Ontario, Canada

by Josephine Etowa, Ubabuko Unachukwu, Sylvia Sangwa, Egbe B. Etowa, Haoua Inoua, Ruby Edet, Emmanuella Okolie, Erica Kamikazi, Emana Ifeoma Emiko, Luc Malemo and Biswajit Ghose

COVID 2025, 5(5), 62; https://doi.org/10.3390/covid5050062 - 25 Apr 2025

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Abstract

Through engagement with multi-stakeholders—including African, Caribbean, and Black (ACB) community members and leaders, as well as service providers in Ottawa, Ontario, Canada—this study explores in-depth narratives and first-hand accounts of their lived experiences in the context of COVID-19 vaccine promotion. A thematic analysis [...] Read more.

Through engagement with multi-stakeholders—including African, Caribbean, and Black (ACB) community members and leaders, as well as service providers in Ottawa, Ontario, Canada—this study explores in-depth narratives and first-hand accounts of their lived experiences in the context of COVID-19 vaccine promotion. A thematic analysis of the focus group discussions, conducted in NVivo, revealed that vaccine acceptance among ACB communities is shaped by factors such as racial discrimination, COVID-19 knowledge, misconceptions, communication strategies and barriers, preference for alternative medicines, and community resilience. These findings highlight several implications for policymakers and provide directions for future research. Full article

(This article belongs to the Special Issue COVID and Public Health)

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