International Journal of Environmental Research and Public Health

Editorial

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3 pages, 249 KiB

Open AccessEditorial

COVID-19: Time for Post-Exposure Prophylaxis?

by Ivan Gentile, Alberto Enrico Maraolo, Prisco Piscitelli and Annamaria Colao

Int. J. Environ. Res. Public Health 2020, 17(11), 3997; https://doi.org/10.3390/ijerph17113997 - 4 Jun 2020

Cited by 8 | Viewed by 4504

Abstract

From a healthcare perspective, infection due to the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and the ensuing syndrome called COVID-19 (coronavirus disease 2019) represents the biggest challenge the world has faced in several decades. Particularly worrisome are the high contagiousness [...] Read more.

From a healthcare perspective, infection due to the novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and the ensuing syndrome called COVID-19 (coronavirus disease 2019) represents the biggest challenge the world has faced in several decades. Particularly worrisome are the high contagiousness of the virus and the saturation of hospitals’ capacity due to overwhelming caseloads. Non-pharmaceutical interventions such as quarantine and inter-personal distancing are crucial to limiting the spread of the virus in the general population, but more tailored interventions may be needed at an individual level on a case-by-case basis. In this perspective, the most insidious situation is when an individual has contact with a contagious subject without adequate protection. If rapidly recognized afterwards, this occurrence may be promptly addressed through a post-exposure chemoprophylaxis (PEP) with antiviral drugs. This strategy has been implemented for other respiratory viruses (influenza above all) and was successfully used in South Korea among healthcare workers against the Middle East respiratory syndrome (MERS) coronavirus, by providing people who were exposed to high-risk contacts with lopinavir-ritonavir plus ribavirin. Initial experiences with the use of hydroxychloroquine to prevent COVID-19 also seem promising. Post-exposure chemoprophylaxis might help mitigate the spread of SARS-CoV-2 in the current phase of the COVID-19 pandemic. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

Research

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22 pages, 6012 KiB

Open AccessArticle

Interaction of Pelargonium sidoides Compounds with Lactoferrin and SARS-CoV-2: Insights from Molecular Simulations

by Federico Iacovelli, Gaetana Costanza, Alice Romeo, Terenzio Cosio, Caterina Lanna, Antonino Bagnulo, Umberto Di Maio, Alice Sbardella, Roberta Gaziano, Sandro Grelli, Ettore Squillaci, Alessandro Miani, Prisco Piscitelli, Luca Bianchi, Mattia Falconi and Elena Campione

Int. J. Environ. Res. Public Health 2022, 19(9), 5254; https://doi.org/10.3390/ijerph19095254 - 26 Apr 2022

Cited by 6 | Viewed by 3703

Abstract

(1) Background: Pelargonium sidoides extracts and lactoferrin are two important natural, anti-inflammatory, and antiviral agents, which can interfere with the early stages of SARS-CoV-2 infection. Molecular docking and molecular dynamics simulation approaches have been applied to check for the occurrence of interactions of [...] Read more.

(1) Background: Pelargonium sidoides extracts and lactoferrin are two important natural, anti-inflammatory, and antiviral agents, which can interfere with the early stages of SARS-CoV-2 infection. Molecular docking and molecular dynamics simulation approaches have been applied to check for the occurrence of interactions of the Pelargonium sidoides compounds with lactoferrin and with SARS-CoV-2 components. (2) Methods: Computational methods have been applied to confirm the hypothesis of a direct interaction between PEL compounds and the lactoferrin protein and between Pelargonium sidoides compounds and SARS-CoV-2 Spike, 3CLPro, RdRp proteins, and membrane. Selected high-score complexes were structurally investigated through classical molecular dynamics simulation, while the interaction energies were evaluated using the molecular mechanics energies combined with generalized Born and surface area continuum solvation method. (3) Results: Computational analyses suggested that Pelargonium sidoides extracts can interact with lactoferrin without altering its structural and dynamical properties. Furthermore, Pelargonium sidoides compounds should have the ability to interfere with the Spike glycoprotein, the 3CLPro, and the lipid membrane, probably affecting the functional properties of the proteins inserted in the double layer. (4) Conclusion: Our findings suggest that Pelargonium sidoides may interfere with the mechanism of infection of SARS-CoV-2, especially in the early stages. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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12 pages, 1333 KiB

Open AccessArticle

Burnout Impact of COVID-19 Pandemic on Health-Care Professionals at Assiut University Hospitals, 2020

by Shimaa A. Elghazally, Atef F. Alkarn, Hussein Elkhayat, Ahmed K. Ibrahim and Mariam Roshdy Elkhayat

Int. J. Environ. Res. Public Health 2021, 18(10), 5368; https://doi.org/10.3390/ijerph18105368 - 18 May 2021

Cited by 44 | Viewed by 6302

Abstract

Background: burnout syndrome is a serious and growing problem among medical staff. Its adverse outcomes not only affect health-care providers’ health, but also extend to their patients, resulting in bad-quality care. The COVID-19 pandemic puts frontline health-care providers at greater risk of psychological [...] Read more.

Background: burnout syndrome is a serious and growing problem among medical staff. Its adverse outcomes not only affect health-care providers’ health, but also extend to their patients, resulting in bad-quality care. The COVID-19 pandemic puts frontline health-care providers at greater risk of psychological stress and burnout syndrome. Objectives: this study aimed to identify the levels of burnout among health-care professionals currently working at Assiut University hospitals during the COVID-19 pandemic. Methods: the current study adopted an online cross-sectional design using the SurveyMonkey^® website for data collection. A total of 201 physicians were included and the Maslach Burnout Inventory (MBI) scale was used to assess the three burnout syndrome dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. Results: about one-third, two-thirds, and one-quarter of the respondents had high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Younger, resident, and single physicians reported higher burnout scores. The personal accomplishment score was significantly higher among males. Those working more than eight hours/day and dealing with COVID-19 patients had significantly higher scores. Conclusion: during the COVID-19 pandemic, a high prevalence of burnout was recorded among physicians. Age, job title, working duration, and working hours/day were significant predictors for burnout syndrome subscale results. Preventive and interventive programs should be applied in health-care organizations during pandemics. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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11 pages, 2126 KiB

Open AccessArticle

Investigation of Nasal/Oropharyngeal Microbial Community of COVID-19 Patients by 16S rDNA Sequencing

by Martina Rueca, Andrea Fontana, Barbara Bartolini, Pierluca Piselli, Antonio Mazzarelli, Massimiliano Copetti, Elena Binda, Francesco Perri, Cesare Ernesto Maria Gruber, Emanuele Nicastri, Luisa Marchioni, Giuseppe Ippolito, Maria Rosaria Capobianchi, Antonino Di Caro and Valerio Pazienza

Int. J. Environ. Res. Public Health 2021, 18(4), 2174; https://doi.org/10.3390/ijerph18042174 - 23 Feb 2021

Cited by 57 | Viewed by 5065

Abstract

Since December 2019, SARS-CoV-2 infection has been still rapidly spreading, resulting in a pandemic, followed by an increasing number of cases in countries throughout the world. The severity of the disease depends on the patient’s overall medical condition but no appropriate markers are [...] Read more.

Since December 2019, SARS-CoV-2 infection has been still rapidly spreading, resulting in a pandemic, followed by an increasing number of cases in countries throughout the world. The severity of the disease depends on the patient’s overall medical condition but no appropriate markers are available to establish the prognosis of the patients. We performed a 16S rRNA gene sequencing, revealing an altered composition of the nasal/oropharyngeal (NOP) microbiota in 21 patients affected by COVID-19, paucisymptomatic or in an Intensive Care Unit (ICU), as compared to 10 controls negative for COVID-19 or eight affected by a different Human Coronavirus (HKU, NL63 and OC43). A significant decrease in Chao1 index was observed when patients affected by COVID-19 (in ICU) were compared to paucisymptomatic. Furthermore, patients who were in ICU, paucisymptomatic or affected by other Coronaviruses all displayed a decrease in the Chao1 index when compared to controls, while Shannon index significantly decreased only in patients under ICU as compared to controls and paucisymptomatic patients. At the phylum level, Deinococcus-Thermus was present only in controls as compared to SARS-CoV-2 patients admitted to ICU, paucisymptomatic or affected by other coronaviruses. Candidatus Saccharibacteria (formerly known as TM7) was strongly increased in negative controls and SARS-CoV-2 paucisymptomatic patients as compared to SARS-CoV-2 ICU patients. Other modifications were observed at a lower taxonomy level. Complete depletion of Bifidobacterium and Clostridium was exclusively observed in ICU SARS-CoV-2 patients, which was the only group characterized by the presence of Salmonella, Scardovia, Serratia and Pectobacteriaceae. In conclusion, our preliminary results showed that nasal/oropharyngeal microbiota profiles of patients affected with SARS-CoV-2 may provide valuable information in order to facilitate the stratification of patients and may open the way to new interventional strategies in order to ameliorate the outcome of the patients. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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10 pages, 596 KiB

Open AccessArticle

Serum KL-6 Could Represent a Reliable Indicator of Unfavourable Outcome in Patients with COVID-19 Pneumonia

by Riccardo Scotto, Biagio Pinchera, Francesco Perna, Lidia Atripaldi, Agnese Giaccone, Davide Sequino, Emanuela Zappulo, Alessia Sardanelli, Nicola Schiano Moriello, Anna Stanziola, Marialuisa Bocchino, Ivan Gentile and Alessandro Sanduzzi

Int. J. Environ. Res. Public Health 2021, 18(4), 2078; https://doi.org/10.3390/ijerph18042078 - 20 Feb 2021

Cited by 25 | Viewed by 3423

Abstract

KL-6 is a sialoglycoprotein antigen which proved elevated in the serum of patients with different interstitial lung diseases, especially in those with a poorer outcome. Given that interstitial pneumonia is the most common presentation of SARS-CoV2 infection, we evaluated the prognostic role of [...] Read more.

KL-6 is a sialoglycoprotein antigen which proved elevated in the serum of patients with different interstitial lung diseases, especially in those with a poorer outcome. Given that interstitial pneumonia is the most common presentation of SARS-CoV2 infection, we evaluated the prognostic role of KL-6 in patients with COVID-19 pneumonia. Patients with COVID-19 pneumonia were prospectively enrolled. Blood samples were collected at the time of enrolment (TOE) and on day 7 (T1). Serum KL-6 concentrations were measured by chemiluminescence enzyme immunoassay using a KL-6 antibody kit (LUMIPULSE G1200, Fujirebio) and the cut-off value was set at >1000 U/mL. Fifteen out of 34 enrolled patients (44.1%) died. Patients with unfavourable outcome showed significantly lower P/F ratio and higher IL-6 values and plasmatic concentrations of KL-6 at TOE compared with those who survived (median KL-6: 1188 U/mL vs. 260 U/mL, p < 0.001). KL-6 > 1000 U/mL resulted independently associated with death (aOR: 11.29, p < 0.05) with a positive predictive value of 83.3%. Our results suggest that KL-6 is a reliable indicator of pulmonary function and unfavourable outcome in patients with COVID-19 pneumonia. A KL-6 value > 1000 U/mL resulted independently associated with death and showed good accuracy in predicting a poorer outcome. KL-6 may thus represent a quick, inexpensive, and sensitive parameter to stratify the risk of severe respiratory failure and death. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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13 pages, 1027 KiB

Open AccessArticle

The Professional and Psycho-Emotional Impact of the COVID-19 Pandemic on Medical Care—A Romanian GPs’ Perspective

by Celina Silvia Stafie, Lenuta Profire, Maria Manuela Apostol and Irina Iuliana Costache

Int. J. Environ. Res. Public Health 2021, 18(4), 2031; https://doi.org/10.3390/ijerph18042031 - 19 Feb 2021

Cited by 5 | Viewed by 3646

Abstract

The aim of this study was to assess the psycho-emotional impact and the adjustment degree of Romanian general practitioners (GPs) in the coronavirus disease 2019 (COVID-19) pandemic context. With a cross-sectional design, the study included 677 GPs to whom a validated questionnaire based [...] Read more.

The aim of this study was to assess the psycho-emotional impact and the adjustment degree of Romanian general practitioners (GPs) in the coronavirus disease 2019 (COVID-19) pandemic context. With a cross-sectional design, the study included 677 GPs to whom a validated questionnaire based on different items targeting three factors was sent: burden of prevention, presence of stress symptoms, and adjustment to pandemic. The burden of prevention and the adjustment effort to the pandemic were felt significantly more by female doctors and by GPs working in associated offices. The case definition quality, the support received, the professional life changes, and the stress symptoms proved to be the main predictors for the adjustment to pandemic. The adjustment measurement questionnaire can be used in further studies to identify the most supportive public health practices in difficult epidemiological contexts. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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15 pages, 1135 KiB

Open AccessArticle

Clinical Profile, Treatment and Predictors during the First COVID-19 Wave: A Population-Based Registry Analysis from Castile and Leon Hospitals

by Eduardo Gutiérrez-Abejón, Eduardo Tamayo, Débora Martín-García, F. Javier Álvarez and Francisco Herrera-Gómez

Int. J. Environ. Res. Public Health 2020, 17(24), 9360; https://doi.org/10.3390/ijerph17249360 - 14 Dec 2020

Cited by 11 | Viewed by 2971

Abstract

The first wave of the COVID-19 pandemic collapsed the hospitals in Castile and Leon (Spain). An analysis of the clinical characteristics, drug therapies and principal outcome predictors in the COVID-19 hospitalized patients from 1 March to 31 May 2020 is presented through a [...] Read more.

The first wave of the COVID-19 pandemic collapsed the hospitals in Castile and Leon (Spain). An analysis of the clinical characteristics, drug therapies and principal outcome predictors in the COVID-19 hospitalized patients from 1 March to 31 May 2020 is presented through a population-based registry study. Hospital stay variables, ventilation mode data and clinical outcomes were observed. In Castile and Leon hospitals, 7307 COVID-19 patients were admitted, with 57.05% being male and a median of 76 years. The mortality rate was 24.43%, with a high incidence of severe acute respiratory syndrome (SARS) (14.03%) and acute kidney injury (AKI) (10.87%). The most used medicines were antibiotics (90.83%), antimalarials (42.63%), steroids (44.37%) and antivirals, such as lopinavir/ritonavir (42.63%). The use of tocilizumab (9.37%) and anti-SIRS (systemic inflammatory response syndrome) medicines (7.34%) were remarkable. Fundamentally, death occurred more likely over 65 years of age (OR: 9.05). In addition, the need for ventilation was associated with a higher probability of death (OR: 3.59), SARS (OR: 5.14) and AKI (OR: 2.31). The drug-use pattern had been modified throughout the COVID-19 first wave. Multiple factors, such as age, gender and the need for mechanical ventilation, were related to the worst evolution prognosis of the disease. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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16 pages, 7811 KiB

Open AccessArticle

International Prevalence and Correlates of Psychological Stress during the Global COVID-19 Pandemic

by Maheen M. Adamson, Angela Phillips, Srija Seenivasan, Julian Martinez, Harlene Grewal, Xiaojian Kang, John Coetzee, Ines Luttenbacher, Ashley Jester, Odette A. Harris and David Spiegel

Int. J. Environ. Res. Public Health 2020, 17(24), 9248; https://doi.org/10.3390/ijerph17249248 - 10 Dec 2020

Cited by 58 | Viewed by 6602

Abstract

This study reports perceived stress and associated sociodemographic factors from an international sample of adults, during the COVID-19 pandemic. The Perceived Stress Scale (PSS-10) along with socio-demographic questions were conducted between 8 April 2020 and 11 May 2020. The survey was translated from [...] Read more.

This study reports perceived stress and associated sociodemographic factors from an international sample of adults, during the COVID-19 pandemic. The Perceived Stress Scale (PSS-10) along with socio-demographic questions were conducted between 8 April 2020 and 11 May 2020. The survey was translated from English into five languages. Recruitment was conducted worldwide using social media. A total of 1685 survey responses were collected across 57 countries with eleven countries (≥30 responses/country) included in the sub-analyses. Overall, the mean PSS-10 score was 19.08 (SD = 7.17), reflecting moderate stress compared to previously reported norms. Female gender was associated with a higher PSS score (3.03, p < 0.05) as well as four-year degree holders (3.29, p < 0.05), while adults over 75 years (−7.46, p < 0.05) had lower PSS scores. Personal care composite score (including hours of sleep, exercise, and meditation) was associated with lower PSS scores (−0.39, p < 0.01). Increases in personal care and changes in work expectations were associated with lower PSS scores (−1.30 (p < 0.05) and −0.38 (p < 0.01), respectively). Lower total PSS scores were reported in Germany (−4.82, p < 0.01) compared to the global response sample mean. This information, collected during the initial period of global mitigation orders, provides insight into potential mental health risks and protective factors during crises. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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15 pages, 1201 KiB

Open AccessArticle

Trading Health for Wealth: The Effect of COVID-19 Response Stringency

by Megan Cross, Shu-Kay Ng and Paul Scuffham

Int. J. Environ. Res. Public Health 2020, 17(23), 8725; https://doi.org/10.3390/ijerph17238725 - 24 Nov 2020

Cited by 37 | Viewed by 5331

Abstract

International governments’ COVID-19 responses must balance human and economic health. Beyond slowing viral transmission, strict lockdowns have severe economic consequences. This work investigated response stringency, quantified by the Oxford COVID-19 Government Response Tracker’s Stringency Index, and examined how restrictive interventions affected infection rates [...] Read more.

International governments’ COVID-19 responses must balance human and economic health. Beyond slowing viral transmission, strict lockdowns have severe economic consequences. This work investigated response stringency, quantified by the Oxford COVID-19 Government Response Tracker’s Stringency Index, and examined how restrictive interventions affected infection rates and gross domestic product (GDP) in China and OECD countries. Accounting for response timing, China imposed the most stringent restrictions, while Sweden and Japan were the least stringent. Expected GDP declines range from −8% (Japan) to −15.4% (UK). While greater restrictions generally slowed viral transmission, they failed to reach statistical significance and reduced GDP (p = 0.006). Timing was fundamental: governments who responded to the pandemic faster saw greater reductions in viral transmission (p = 0.013), but worse decreases in GDP (p = 0.044). Thus, response stringency has a greater effect on GDP than infection rates, which are instead affected by the timing of COVID-19 interventions. Attempts to mitigate economic impacts by delaying restrictions or decreasing stringency may buoy GDP in the short term but increase infection rates, the longer-term economic consequences of which are not yet fully understood. As highly restrictive interventions were successful in some but not all countries, decision-makers must consider whether their strategies are appropriate for the country on health and economic grounds. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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9 pages, 607 KiB

Open AccessArticle

Simple, Low-Cost and Long-Lasting Film for Virus Inactivation Using Avian Coronavirus Model as Challenge

by Luiz Alberto Colnago, Iara Maria Trevisol, Daiane Voss Rech, Lucimara Aparecida Forato, Cirlei Igreja do Nascimento Mitre, José Paulo Gagliardi Leite, Rodrigo Giglioti and Cintia Hiromi Okino

Int. J. Environ. Res. Public Health 2020, 17(18), 6456; https://doi.org/10.3390/ijerph17186456 - 4 Sep 2020

Cited by 6 | Viewed by 2815

Abstract

The COVID-19 infection, caused by SARS-CoV-2, is inequitably distributed and more lethal among populations with lower socioeconomic status. Direct contact with contaminated surfaces has been among the virus sources, as it remains infective up to days. Several disinfectants have been shown to inactivate [...] Read more.

The COVID-19 infection, caused by SARS-CoV-2, is inequitably distributed and more lethal among populations with lower socioeconomic status. Direct contact with contaminated surfaces has been among the virus sources, as it remains infective up to days. Several disinfectants have been shown to inactivate SARS-CoV-2, but they rapidly evaporate, are flammable or toxic and may be scarce or inexistent for vulnerable populations. Therefore, we are proposing simple, easy to prepare, low-cost and efficient antiviral films, made with a widely available dishwashing detergent, which can be spread on hands and inanimate surfaces and is expected to maintain virucidal activity for longer periods than the current sanitizers. Avian coronavirus (ACoV) was used as model of the challenge to test the antivirus efficacy of the proposed films. Polystyrene petri dishes were covered with a thin layer of detergent formula. After drying, the films were exposed to different virus doses for 10 min and virus infectivity was determined using embryonated chicken eggs, and RNA virus quantification in allantoic fluids by RT-qPCR. The films inactivated the ACoV (ranging from 10^3.7 to 10^6.7 EID₅₀), which is chemically and morphologically similar to SARS-CoV-2, and may constitute an excellent alternative to minimize the spread of COVID-19. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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13 pages, 463 KiB

Open AccessArticle

Characterization of Home Working Population during COVID-19 Emergency: A Cross-Sectional Analysis

by Antimo Moretti, Fabrizio Menna, Milena Aulicino, Marco Paoletta, Sara Liguori and Giovanni Iolascon

Int. J. Environ. Res. Public Health 2020, 17(17), 6284; https://doi.org/10.3390/ijerph17176284 - 28 Aug 2020

Cited by 185 | Viewed by 23638

Abstract

Evidence about the characterization of home workers in terms of both work-related outcomes and health issues is lacking. The purpose of this cross-sectional study was to examine the impact of home working on perceived job productivity and satisfaction, work-related stress, and musculoskeletal (MSK) [...] Read more.

Evidence about the characterization of home workers in terms of both work-related outcomes and health issues is lacking. The purpose of this cross-sectional study was to examine the impact of home working on perceived job productivity and satisfaction, work-related stress, and musculoskeletal (MSK) issues. We included 51 mobile workers, collecting data about demographic characteristics, working experience, job productivity, and stress. Job satisfaction was assessed through the Utrecht Work Engagement Scale (UWES), while MSK pain was investigated by the Brief Pain Inventory (BPI) and Fear Avoidance Beliefs Questionnaire (FABQ). Moreover, a home workplace analysis had to be carried out according to current Italian regulations. Participants declared that they were less productive (39.2%) but less stressed (39.2%) and equally satisfied (51%) compared to the time of office working. Regarding MSK disorders, low back pain (LBP) was referred by 41.2% of home workers and neck pain by 23.5% of them. Neck pain worsened in 50% of home workers, while LBP did not exacerbate in 47.6% of cases. Home workers with MSK pain reported a lower job satisfaction. Depending on our data, the home environment seems to be not adequate in the mobile worker population, with an increased risk for mental health and MSK problems, particularly affecting the spine. Addressing these issues can significantly reduce risks for health, thus, improving job productivity and satisfaction and reducing cost. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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19 pages, 2313 KiB

Open AccessArticle

A Look Behind the Scenes at COVID-19: National Strategies of Infection Control and Their Impact on Mortality

by Samir Haj Bloukh, Zehra Edis, Annis A. Shaikh and Habib M. Pathan

Int. J. Environ. Res. Public Health 2020, 17(15), 5616; https://doi.org/10.3390/ijerph17155616 - 4 Aug 2020

Cited by 19 | Viewed by 5020

Abstract

(1) Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began spreading across the globe in December and, as of 9 July 2020, had inflicted more than 550,000 deaths. Public health measures implemented to control the outbreak caused socio-economic havoc in many countries. [...] Read more.

(1) Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began spreading across the globe in December and, as of 9 July 2020, had inflicted more than 550,000 deaths. Public health measures implemented to control the outbreak caused socio-economic havoc in many countries. The pandemic highlighted the quality of health care systems, responses of policymakers in harmony with the population, and socio-economic resilience factors. We suggest that different national strategies had an impact on mortality and case count. (2) Methods: We collected fatality data for 17 countries until 2 June 2020 from public data and associated these with implemented containment measures. (3) Results: The outcomes present the effectiveness of control mechanisms in mitigating the virus for selected countries and the UAE as a special case. Pre-existing conditions defined the needed public health strategies and fatality numbers. Other pre-existing conditions, such as temperature, humidity, median age, and low serum 25-hydroxyvitamin D (25(OH)D) concentrations played minor roles and may have had no direct impact on fatality rates. (4) Conclusions: Prevention, fast containment, adequate public health strategies, and importance of indoor environments were determining factors in mitigating the pandemic. Development of public health strategies adapted to pre-existing conditions for each country and community compliance with implemented policies ensure the successful control of pandemics. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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20 pages, 2492 KiB

Open AccessEditor’s ChoiceArticle

BCG Vaccination and Mortality of COVID-19 across 173 Countries: An Ecological Study

by Mitsuyoshi Urashima, Katharina Otani, Yasutaka Hasegawa and Taisuke Akutsu

Int. J. Environ. Res. Public Health 2020, 17(15), 5589; https://doi.org/10.3390/ijerph17155589 - 3 Aug 2020

Cited by 40 | Viewed by 14331

Abstract

Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests). Currently—more [...] Read more.

Ecological studies have suggested fewer COVID-19 morbidities and mortalities in Bacillus Calmette–Guérin (BCG)-vaccinated countries than BCG-non-vaccinated countries. However, these studies obtained data during the early phase of the pandemic and did not adjust for potential confounders, including PCR-test numbers per population (PCR-tests). Currently—more than four months after declaration of the pandemic—the BCG-hypothesis needs reexamining. An ecological study was conducted by obtaining data of 61 factors in 173 countries, including BCG vaccine coverage (%), using morbidity and mortality as outcomes, obtained from open resources. ‘Urban population (%)’ and ‘insufficient physical activity (%)’ in each country was positively associated with morbidity, but not mortality, after adjustment for PCR-tests. On the other hand, recent BCG vaccine coverage (%) was negatively associated with mortality, but not morbidity, even with adjustment for percentage of the population ≥ 60 years of age, morbidity, PCR-tests and other factors. The results of this study generated a hypothesis that a national BCG vaccination program seems to be associated with reduced mortality of COVID-19, although this needs to be further examined and proved by randomized clinical trials. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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8 pages, 298 KiB

Open AccessArticle

Experiential Learning Program to Strengthen Self-Reflection and Critical Thinking in Freshmen Nursing Students during COVID-19: A Quasi-Experimental Study

by Yi-Chuan Cheng, Li-Chi Huang, Chi-Hsuan Yang and Hsing-Chi Chang

Int. J. Environ. Res. Public Health 2020, 17(15), 5442; https://doi.org/10.3390/ijerph17155442 - 28 Jul 2020

Cited by 27 | Viewed by 11194

Abstract

This article focuses on the unique needs and concerns of nursing educators and nursing students in the face of the COVID-19 pandemic. During social distancing, interacting with other human beings has been restricted. This would undermine the experiential learning of nursing students. Hence, [...] Read more.

This article focuses on the unique needs and concerns of nursing educators and nursing students in the face of the COVID-19 pandemic. During social distancing, interacting with other human beings has been restricted. This would undermine the experiential learning of nursing students. Hence, it is important to develop and evaluate an experiential learning program (ELP) for nursing education. A pre-test and post-test design were used. The study was conducted in a university in Central Taiwan. A total of 103 nursing students participated in the study from February to June 2019. The study intervention was the experiential learning program (ELP), including bodily experiences and nursing activities with babies, pregnant women, and the elderly. After the intervention, the students completed the self-reflection and insight scale (SRIS) and Taiwan Critical Thinking Disposition Inventory (TCTDI) as outcome measures. An independent t-test showed that there was a significant difference between pre-test and post-test in both SRIS and TCTDI (p < 0.01). The Pearson product–moment correlation analysis showed that SRIS and TCTDI were significantly positively correlated (p < 0.01). ELP has a significant impact on the self-reflection and critical thinking of first-year nursing students, which can be used as a reference for the education of nursing students. During these turbulent times, it is especially vital for faculties to provide experiential learning instead of the traditional teaching concept. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

Review

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12 pages, 1356 KiB

Open AccessReview

Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19—Where Are We Now?

by Zbigniew Putowski, Anna Szczepańska, Marcelina Czok and Łukasz J. Krzych

Int. J. Environ. Res. Public Health 2021, 18(3), 1173; https://doi.org/10.3390/ijerph18031173 - 28 Jan 2021

Cited by 4 | Viewed by 4358

Abstract

The recent development in extracorporeal life support (ECLS) has created new therapeutic opportunities for critically ill patients. An interest in extracorporeal membrane oxygenation (ECMO), the pinnacle of ECLS techniques, has recently increased, as for the last decade, we have observed improvements in the [...] Read more.

The recent development in extracorporeal life support (ECLS) has created new therapeutic opportunities for critically ill patients. An interest in extracorporeal membrane oxygenation (ECMO), the pinnacle of ECLS techniques, has recently increased, as for the last decade, we have observed improvements in the survival of patients suffering from severe acute respiratory distress syndrome (ARDS) while on ECMO. Although there is a paucity of conclusive data from clinical research regarding extracorporeal oxygenation in COVID-19 patients, the pathophysiology of the disease makes veno-venous ECMO a promising option. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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16 pages, 13564 KiB

Open AccessReview

The History, Efficacy, and Safety of Potential Therapeutics: A Narrative Overview of the Complex Life of COVID-19

by Farah Daou, Gretta Abou-Sleymane, Danielle A. Badro, Nagham Khanafer, Mansour Tobaiqy and Achraf Al Faraj

Int. J. Environ. Res. Public Health 2021, 18(3), 955; https://doi.org/10.3390/ijerph18030955 - 22 Jan 2021

Cited by 5 | Viewed by 5131

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posed a serious public health concern and started a race against time for researchers to discover an effective and safe therapy for coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2. This review aims [...] Read more.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posed a serious public health concern and started a race against time for researchers to discover an effective and safe therapy for coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2. This review aims to describe the history, efficacy, and safety of five potential therapeutics for COVID-19, remdesivir, favipiravir, hydroxychloroquine, tocilizumab, and convalescent plasma. A literature review was conducted through October 2020 to identify published studies evaluating the efficacy and safety of these five potential therapeutics. Clinical improvement was used to assess the efficacy, while reported withdrawals from study participation and adverse events were used to evaluate the safety. In total, 95 clinical studies (6 interventional and 89 observational studies) were obtained, of which 42 were included in this review. The evaluation of the efficacy and safety profiles is challenging due to the limitations of the clinical studies on one hand, and the limited number of randomized controlled trials (RCTs) on the other. Moreover, there was insufficient evidence to support repurposing remdesivir, favipiravir, and tocilizumab for COVID-19. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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7 pages, 1009 KiB

Open AccessReview

State of Fragility Fractures Management during the COVID-19 Pandemic

by Umberto Tarantino, Ida Cariati, Virginia Tancredi, Donato Casamassima, Eleonora Piccirilli, Riccardo Iundusi and Elena Gasbarra

Int. J. Environ. Res. Public Health 2020, 17(21), 7732; https://doi.org/10.3390/ijerph17217732 - 22 Oct 2020

Cited by 14 | Viewed by 4436

Abstract

Osteoporosis is a public health concern all over the world. As a chronic condition, it generally requires prolonged medical interventions to limit the risks of further bone loss, impaired skeletal integrity and the onset of fractures. This problem is further complicated by the [...] Read more.

Osteoporosis is a public health concern all over the world. As a chronic condition, it generally requires prolonged medical interventions to limit the risks of further bone loss, impaired skeletal integrity and the onset of fractures. This problem is further complicated by the fact that the abrupt cessation of some therapies may be associated with an increased risk of harm. It is in this context that the COVID-19 pandemic has caused an unprecedented disruption to the provision of healthcare worldwide, exceeding our worst expectations in terms of the number of lives lost and the rapidity at which consolidated economies and healthcare systems are being significantly damaged. In this review, we assessed the challenges and strategies used in the management of osteoporosis and fragility fracture care during the COVID-19 pandemic. We also examined the available evidence and provided clinical recommendations that will require reassessment as the worldwide response to COVID-19 evolves. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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11 pages, 634 KiB

Open AccessReview

Clinical Presentation of COVID-19: Case Series and Review of the Literature

by Margherita Macera, Giulia De Angelis, Caterina Sagnelli, Nicola Coppola and Vanvitelli COVID-19 Group

Int. J. Environ. Res. Public Health 2020, 17(14), 5062; https://doi.org/10.3390/ijerph17145062 - 14 Jul 2020

Cited by 57 | Viewed by 9792

Abstract

COVID-19 infection has a broad spectrum of severity ranging from an asymptomatic form to a severe acute respiratory syndrome that requires mechanical ventilation. Starting with the description of our case series, we evaluated the clinical presentation and evolution of COVID-19. This article is [...] Read more.

COVID-19 infection has a broad spectrum of severity ranging from an asymptomatic form to a severe acute respiratory syndrome that requires mechanical ventilation. Starting with the description of our case series, we evaluated the clinical presentation and evolution of COVID-19. This article is addressed particularly to physicians caring for patients with COVID-19 in their clinical practice. The intent is to identify the subjects in whom the infection is most likely to evolve and the best methods of management in the early phase of infection to determine which patients should be hospitalized and which could be monitored at home. Asymptomatic patients should be followed to evaluate the appearance of symptoms. Patients with mild symptoms lasting more than a week, and without evidence of pneumonia, can be managed at home. Patients with evidence of pulmonary involvement, especially in patients over 60 years of age, and/or with a comorbidity, and/or with the presence of severe extrapulmonary manifestations, should be admitted to a hospital for careful clinical-laboratory monitoring. Full article

(This article belongs to the Special Issue COVID-19: Prevention, Diagnosis, Therapy and Follow Up)

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