From inside the country that never closed down: A qualitative research study focusing on the patient experiences of care and rehabilitation after the first wave of COVID-19 in Sweden

SARS-CoV-2 is recently emerged virus, which caused millions of deaths, all over the world. To tackle COVID-19 pandemic, there is an utmost need for in-depth analysis of viral replication. We aimed to examine viral load in SARS-CoV-2 patients during first two waves of COVID-19 in Pakistan. 225,615 suspected subjects from 75 different regions of Pakistan were selected in the study. SARS-CoV-2 RNAs were detected via real time PCR. During first wave (period of June-July, 2020) of COVID-19 the prevalence of SARS-CoV-2 was 20.38%. However, during second wave (period of November-December, 2020) of COVID-19, the rate of prevalence was 9.41%. During first wave of COVID-19 96.31% of participants remained PCR positive for 14 to 21 days, 3.39% of subjects showed positive results for 22 to 35 days, while delayed Ct values were observed among 0.26% of participants for 36 to 49 days. However, during second wave of COVID-19 89.31% of the subjects exhibited symptoms and showed real-time PCR positive results for 14 to 21 days, 9.42% showed positive results for 22 to 35 days, while significantly delayed Ct value results were observed among 1.026% of participants for 36 to 63 days (3.95 times higher than first wave). In contrast to first wave of COVID-19, the factors that were different in second wave were neither viral (different strains) nor host (same population). But treatment factors changed significantly. As during second wave besides azithromycin, corticosteroid dexamethasone consumption was increased consequently causing delayed Ct value negativity. This suggests that corticosteroid treatment might be linked with delayed Ct value or viral clearance. This study is crucial for re-considering effective therapeutic options against COVID-19.

PurposeTo investigate the impact of COVID-19 in Sweden on rates of knee and hip surgeries.MethodsWe used healthcare data for the population of the southernmost region in Sweden (1.4 million inhabitants). We did an interrupted time-series analysis to estimate changes in rates and trends of joint replacements (JR), arthroscopies, and fracture surgeries for knee or hip in April–December 2020 compared to pre-COVID-19 levels adjusting for seasonal variations.ResultsWe found a drop of 54% (95% CI 42%; 68%) and 42% (95% CI 32%; 52%), respectively, in the rate of JRs and arthroscopies in April 2020 when compared to the counterfactual scenario. This was followed by an increase that brought the rates of JRs and arthroscopies back to their predicted levels also during the beginning of the second wave (November–December 2020). Acute fracture surgeries were largely unaffected, i.e. did not show any decrease as observed for the other surgeries.ConclusionsIn southern Sweden, we observed a marked decrease in elective knee and hip surgeries following the first wave of Covid-19. The rates remained close to normal during the beginning of the second wave suggesting that important elective surgeries for patients with end-stage osteoarthritis can still be offered despite an ongoing pandemic provided adequate routines and hospital resources.

P144 Impact of major medication discontinuation during the first wave of COVID-19 pandemic on the risk of early relapse in patients with inflammatory bowel disease: a French observational retrospective study

BackgroundNational register-based studies on the influence of dementia on COVID-19 infection and outcomes are scarce. This study aims to evaluate the risk of COVID-19 infection, hospitalization, and mortality among older persons with and without dementia.MethodsThis population-based observational study utilized real-world data based on the combination of various national registries in Sweden. Outcomes included COVID-19 infection, hospitalization, and mortality between 01 March 2020 (index date) and 31 August 2020, which was usually considered as the first wave of COVID-19 in Sweden. We used flexible parametric survival regression to estimate the hazard ratios (HRs) between people with and without dementia at different time points after the index date.ResultsWe compared people with and without dementia, who were living in community dwellings (40,818 versus 1,984,503 persons) or nursing homes (31,826 versus 87,398 persons). In community dwellings, the HRs of COVID-19 infection increased from 2.08 in one month to 2.46 in two months, then decreased to 0.70 in six months after the index date. In nursing homes, the HRs declined throughout the follow-up period (from 1.89 in one month to 0.91 in six months). In community dwellings, the HRs of COVID-19 hospitalization increased from 1.40 in one month to 1.64 in six months after the index date. In nursing homes, the HRs was less than 1 in one month, and higher than 1 from four months after the index date, however, not statistically significantly. The HRs for COVID-19 mortality rose from 1.96 in one month to 2.39 in two months and dropped to 1.65 in six months in community dwellings; and declined from 2.27 in one month to 1.69 in six months in nursing homes.ConclusionsIn the first wave of COVID-19 in Sweden, higher risks of COVID-19 infection, hospitalization and mortality were observed in older persons with dementia compared to those without dementia, except for the risk of COVID-19 hospitalization in nursing homes. Further studies on the quality of care for persons with dementia are essential to prepare for future pandemics.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-025-06576-3.

The aim of the paper is to identify the impacts of the first wave of the pandemic Covid-19 in 2020 on the management and performance of the municipal agenda in the South Moravian Region in the Czech Republic. The research was conducted through the method of semi-structured interviews with ten mayors of municipalities of distinct size categories. The research questions focused on various aspects of municipal functioning (municipal management, implementation of support measures for the elderly and entrepreneurs, and communication with citizens...), on which the mayors commented based on their own experience. The results show that the municipal governments and municipal authorities in the first wave of Covid-19 played a key role in terms of providing medical supplies and support to the local population and entrepreneurs, although they faced some constraints, such as a lack of communication and information from public authorities or problematic behavior of citizens. The research also suggests that already in the first wave of the pandemic, the introduction of modern communication tools in the municipalities took place.

Aims: To know the Psychological impact of Covid-19 Pandemic on Hospital staff. Methods: The survey was conducted during the first wave of COVID-19 between 4thJune 2020 to 5th July 2020 at St. Helens & Knowsley Teaching Hospitals NHS Trust. Permission was obtained from the Audit & Information Governance Department of St. Helens & Knowsley Teaching Hospitals NHS Trust. Survey was done through Survey Monkey web site and used staff hospital e mail addressess to communicate with the hospital staff. Results: COVID-19 Pandemic has significant effects on the mental health and wellbeing of Front Line Health Workers in UK as shown in this study. Our study showed that major depressive symptoms were more common in non-doctors and doctors were more non-depressed. [Figure 3] There was a slightly higher sub-threshold depression among doctors over other staff members. Altogether among both groups of the front the line health workers 57.79% were non-depressed, 25.32% had sub-threshold depressive symptoms, and 16.88% had major depressive symptoms. [Figure 3] Conclusions: It is noted from our study that Front Line Health Workers do not give priority to their mental health wellbeing, hence there should be a system to regularly assess mental health of Front Line Health Workers and they should be encouraged to seek advice which appeared lacking in the respondents. It is important to mention that during the first wave, behavior, pathology and treatment of COVID-19 was not understood, and NHS staff at St. Helens & Knowsley Teaching Hospitals NHS Trust, like many other health care workers risked their own lives as Front Line Health Workers. It is not surprising that there was an impact on psychological wellbeing in such challenging circumstances.

AimTo integrate the quantitative and qualitative data collected as part of the PEACH (Procalcitonin: Evaluation of Antibiotic use in COVID-19 Hospitalised patients) study, which evaluated whether procalcitonin (PCT) testing should be used to guide antibiotic prescribing and safely reduce antibiotic use among patients admitted to acute UK National Health Service (NHS) hospitals.DesignTriangulation to integrate quantitative and qualitative data.Setting and participantsFour data sources in 148 NHS hospitals in England and Wales including data from 6089 patients.MethodA triangulation protocol was used to integrate three quantitative data sources (survey, organisation-level data and patient-level data: data sources 1, 2 and 3) and one qualitative data source (clinician interviews: data source 4) collected as part of the PEACH study. Analysis of data sources initially took place independently, and then, key findings for each data source were added to a matrix. A series of interactive discussion meetings took place with quantitative, qualitative and clinical researchers, together with patient and public involvement (PPI) representatives, to group the key findings and produce seven statements relating to the study objectives. Each statement and the key findings related to that statement were considered alongside an assessment of whether there was agreement, partial agreement, dissonance or silence across all four data sources (convergence coding). The matrix was then interpreted to produce a narrative for each statement.ObjectiveTo explore whether PCT testing safely reduced antibiotic use during the first wave of the COVID-19 pandemic.ResultsSeven statements were produced relating to the PEACH study objective. There was agreement across all four data sources for our first key statement, ‘During the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing reduced antibiotic prescribing’. The second statement was related to this key statement, ‘During the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing safely reduced antibiotic prescribing’. Partial agreement was found between data sources 3 (quantitative patient-level data) and 4 (qualitative clinician interviews). There were no data regarding safety from data sources 1 or 2 (quantitative survey and organisational-level data) to contribute to this statement. For statements three and four, ‘PCT was not used as a central factor influencing antibiotic prescribing’, and ‘PCT testing reduced antibiotic prescribing in the emergency department (ED)/acute medical unit (AMU),’ there was agreement between data source 2 (organisational-level data) and data source 4 (interviews with clinicians). The remaining two data sources (survey and patient-level data) contributed no data on this statement. For statement five, ‘PCT testing reduced antibiotic prescribing in the intensive care unit (ICU)’, there was disagreement between data sources 2 and 3 (organisational-level data and patient-level data) and data source 4 (clinician interviews). Data source 1 (survey) did not provide data on this statement. We therefore assigned dissonance to this statement. For statement six, ‘There were many barriers to implementing PCT testing during the first wave of COVID-19’, there was partial agreement between data source 1 (survey) and data source 4 (clinician interviews) and no data provided by the two remaining data sources (organisational-level data and patient-level data). For statement seven, ‘Local PCT guidelines/protocols were perceived to be valuable’, only data source 4 (clinician interviews) provided data. The clinicians expressed that guidelines were valuable, but as there was no data from the other three data sources, we assigned silence to this statement.ConclusionThere was agreement between all four data sources on our key finding ‘during the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing reduced antibiotic prescribing’. Data, methodological and investigator triangulation, and a transparent triangulation protocol give validity to this finding.Trial registration numberISRCTN66682918.

BackgroundCyprus addressed the first wave of SARS CoV-2 (COVID-19) by implementing non-pharmaceutical interventions (NPIs). The aims of this study were: a) to estimate epidemiological parameters of this wave including infection attack ratio, infection fatality ratio, and case ascertainment ratio, b) to assess the impact of public health interventions and examine what would have happened if those interventions had not been implemented.MethodsA dynamic, stochastic, individual-based Susceptible-Exposed-Infected-Recovered (SEIR) model was developed to simulate COVID-19 transmission and progression in the population of the Republic of Cyprus. The model was fitted to the observed trends in COVID-19 deaths and intensive care unit (ICU) bed use.ResultsBy May 8th, 2020, the infection attack ratio was 0.31% (95% Credible Interval [CrI]: 0.15, 0.54%), the infection fatality ratio was 0.71% (95% CrI: 0.44, 1.61%), and the case ascertainment ratio was 33.2% (95% CrI: 19.7, 68.7%). If Cyprus had not implemented any public health measure, the healthcare system would have been overwhelmed by April 14th. The interventions averted 715 (95% CrI: 339, 1235) deaths. If Cyprus had only increased ICU beds, without any social distancing measure, the healthcare system would have been overwhelmed by April 19th.ConclusionsThe decision of the Cypriot authorities to launch early NPIs limited the burden of the first wave of COVID-19. The findings of these analyses could help address the next waves of COVID-19 in Cyprus and other similar settings.

Objective: This study aimed to investigate the impact of the first wave of the COVID-19 pandemic on perceived working environment, including the possibility to recover, among psychiatric healthcare workers (PHCWs) in comparison with pre-pandemic measures.Method: A link to an anonymous, web-based COVID-19 related survey was sent via email to all PHCWs at a university hospital in Sweden (n = 1,618) in September 2020. The response rate was 38% (566 of 1,507 eligible participants). Working environment survey responses collected in 2019 were used as pre-pandemic comparators. Statistical analyses were performed to assess overall impact over time on work demands, support, motivation, and recovery, stratified by professional role, and considering variables such as access to personal protective equipment.Results: The percentage of individuals responding negatively to statements about working environment increased significantly for most items after the first wave. Similarly, the increase of five of the investigated factors indicated a more negative perception of recovery during the pandemic. Registered nurses reported a greater negative impact of the pandemic on perceived working conditions and ability to recover than other professional groups. PHCWs working with patients with COVID-19 (35%) who reported being worried about becoming infected (12%) or infecting others (17%), or lacking adequate personal protective equipment (22%) were more negatively impacted regarding work environment-related items than those who did not.Conclusions: PHCWs' working environment and possibility for recovery were impacted by the first wave of the COVID-19 pandemic, nurses being most affected. Although psychiatric services do not directly care for patients with severe COVID-19 infection, the results from this study suggests that mental health services should also prepare for future pandemics.

This study presents an exploratory mixed-method descriptive analysis of psychological distress, challenges encountered and coping strategies of youth during the first wave of COVID-19. A total of 4 914 Quebec youth, aged 14 to 25 recruited through social media completed an online survey on the impact of the pandemic on their daily life, psychological distress and post-traumatic growth. They were also invited to answer two open-ended questions regarding the difficulties they experienced and their coping strategies. Overall, 26.6% of youth showed serious psychological distress and 20.3% displayed probable PTSD symptoms related to the COVID-19. Comparative analyses revealed that youth identifying as gender and sexual minorities were more vulnerable to distress during the first wave of the pandemic. While few sociodemographic variables distinguish youth reporting post-traumatic growth from those who do not, the former group was more likely to seek and receive social support. Qualitative data highlighted difficulties that were common to many respondents including lack of social contacts, the lockdown itself, and problems related to disruptions of educational and academic activities. Youth also mentioned three main strategies they used to cope: maintaining social contacts, engaging in leisure activities and physical exercise. While many youths have encountered compelling challenges during the lockdown of the first wave of COVID-19, some report having relied on efficient coping strategies to deal with the situation. Support services should be implemented to help the youth cope with the pandemic while considering their diverse needs.

BackgroundIndonesia is one of the Southeast Asian countries with high case numbers of COVID-19 with up to 4.2 million confirmed cases by 29 October 2021. Understanding the genome of SARS-CoV-2 is crucial for delivering public health intervention as certain variants may have different attributes that can potentially affect their transmissibility, as well as the performance of diagnostics, vaccines, and therapeutics.ObjectivesWe aimed to investigate the dynamics of circulating SARS-CoV-2 variants over a 15-month period in Bogor and its surrounding areas in correlation with the first and second wave of COVID-19 in Indonesia.MethodsNasopharyngeal and oropharyngeal swab samples collected from suspected patients from Bogor, Jakarta and Tangerang were confirmed for SARS-CoV-2 infection with RT-PCR. RNA samples of those confirmed patients were subjected to whole genome sequencing using the ARTIC Network protocol and sequencer platform from Oxford Nanopore Technologies (ONT).ResultsWe successfully identified 16 lineages and six clades out of 202 samples (male n = 116, female n = 86). Genome analysis revealed that Indonesian lineage B.1.466.2 dominated during the first wave (n = 48, 23.8%) while Delta variants (AY.23, AY.24, AY.39, AY.42, AY.43 dan AY.79) were dominant during the second wave (n = 53, 26.2%) following the highest number of confirmed cases in Indonesia. In the spike protein gene, S_D614G and S_P681R changes were dominant in both B.1.466.2 and Delta variants, while N439K was only observed in B.1.466.2 (n = 44) and B.1.470 (n = 1). Additionally, the S_T19R, S_E156G, S_F157del, S_R158del, S_L452R, S_T478K, S_D950N and S_V1264L changes were only detected in Delta variants, consistent with those changes being characteristic of Delta variants in general.ConclusionsWe demonstrated a shift in SARS-CoV-2 variants from the first wave of COVID-19 to Delta variants in the second wave, during which the number of confirmed cases surpassed those in the first wave of COVID-19 pandemic. Higher proportion of unique mutations detected in Delta variants compared to the first wave variants indicated potential mutational effects on viral transmissibility that correlated with a higher incidence of confirmed cases. Genomic surveillance of circulating variants, especially those with higher transmissibility, should be continuously conducted to rapidly inform decision making and support outbreak preparedness, prevention, and public health response.

SummaryThe COVID-19 pandemic signalled a radical shift in health and social care services globally. In UK, many of the people with existing social care needs were identified as ‘clinically vulnerable’ to COVID-19. Those at greatest risk were encouraged to adhere to additional public health measures that inadvertently exacerbated social disadvantages. Social workers were challenged to ‘dig deep’ to continue to provide services as usual. However, problems implementing new ways of working were reported but not examined in-depth through research. Our study explored experiences and perceptions of social workers responding to the first wave (April–July 2020) of COVID-19, in England, UK. Interviews with thirteen social workers, all working in the West Midlands region, were conducted via telephone or online video. Transcripts were analysed using reflexive thematic analysis. We use ‘managing uncertainty’ as a central concept underpinning the four themes identified after analysis: (1) providing social care at a physical distance, (2) negotiating home/work boundaries, (3) managing emerging risks and (4) long-term implications for social work. We discuss our findings in the context of resilience and organisational adaptation. Social workers in our study demonstrated resilience in action and rapid adaptation to new practices, but equally expressed concern about short-term efficiencies being prioritised over individual service user needs.

Aim We evaluated time to definitive treatment of Gallstone Pancreatitis (GSP) against the BSG guidelines during the first wave of COVID-19, comparing it to data of the same time period the previous year. Did the first wave of Covid-19 impact on time to intervention for patients diagnosed with GSP? Method Data were obtained retrospectively for 40 patients identified via the hospital coding department that presented with GSP between March 2019 - June 2019 and March 2020 – June 2020. Patient demographics, length of stay, time to intervention and re-admission awaiting intervention were recorded. Results Twenty-three patients were admitted during the non-COVID period. 30% (n = 7) of the non-COVID cohort had definitive management of GSP during index admission or within 2 weeks. Seventeen patients were admitted during the first wave of Covid-19. 64.7% (n = 11) of the COVID-19 cohort had definitive management of GSP during the index admission or within 2 weeks. Conclusions Prior to COVID-19, we were not meeting guidelines for definitive management on index admission / within 2 weeks. During the first wave of COVID-19, more patients received definitive management of GSP during index admission / within 2 weeks than during the non-COVID period. A higher percentage of patients received surgical management within 2 weeks than in the non-COVID cohort. Those that did not receive management within 2 weeks, waited longer for intervention and had higher rates of re-admission than the non-COVID cohort. Despite anticipated future waves of COVID-19, prioritisation of urgent OP services is essential for those diagnosed with GSP to help reduce re-admission rates whilst awaiting intervention.

BackgroundSince the outbreak of COVID-19 has raged, large-scale measures for prevent disease transmission have been implemented worldwide. If effectively implemented, these measures may have led to a reduction of the spread of other respiratory infectious diseases at community level. The aim of the present study was to evaluate the indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in the elderly during the first epidemic wave of COVID-19 in Tuscany, Italy.MethodsA population based study was carried out on data from the Tuscany healthcare system. Hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumptions of antibacterials for CAP in people aged 65 years and older were considered as outcome measures. Percentage changes in the outcome measures were calculated considering corresponding periods of the 2020 and 2017-19. 95% confidence intervals and the statistical significance of the percentage changes were calculated using the Poisson model.ResultsA total of 3,346 new CAP hospitalizations occurred in people aged 65 years and older in the whole study time-frame. Significant reductions in the weekly hospitalization rates for CAP were observed starting from the week in which the national containment measures were imposed, this negative deviation continued even after the lift of the national lock-down until the end of the first wave of COVID-19 in July (maximum weekly decrease of 46%). All the antibacterial classes for CAP showed a significant decrease in their outpatient consumptions during the COVID-19 epidemic period.ConclusionsThe implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in the elderly during the first wave of COVID-19 pandemic. Furthermore, findings suggests that individual prevention measures that remained mandatory after the lift of the national lock-down also had a relevant role in the reducing CAP incidence.Key messages The potential benefits of pandemic containment measures can extend beyond the prevention of COVID-19 to include the reduction of the burden of respiratory infectious diseasesTaking into account the indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic.

This paper examines the geographic factors that are associated with the spread of COVID-19 during the first wave in Sweden. We focus particularly on the role of place-based factors versus factors associated with the spread or diffusion of COVID-19 across places. Sweden is a useful case study to examine the interplay of these factors because it did not impose mandatory lockdowns and because there were essentially no regional differences in the pandemic policies or strategies during the first wave of COVID-19. We examine the role of place-based factors like density, age structures and different socioeconomic factors on the geographic variation of COVID-19 cases and on deaths, across both municipalities and neighborhoods. Our findings show that factors associated with diffusion matter more than place-based factors in the geographic incidence of COVID-19 in Sweden. The most significant factor of all is proximity to places with higher levels of infections. COVID-19 is also higher in places that were hit earliest in the outbreak. Of place-based factors, the geographic variation in COVID-19 is most significantly related to the presence of high-risk nursing homes, and only modestly associated with factors like density, population size, income and other socioeconomic characteristics of places.