COVID-19 Health Emergency Research Articles

Art and Design Education in Times of COVID-19: Distance Learning and the Importance of Interaction and Empathy

At the period of worldwide public health emergency of COVID-19, the majority of educational institutions in the world have faced the forced emergency lockdown and migration into the digital, online or virtual learning and teaching environments. Basically, it must be stated up front that digital media and processes have long been part of art instruction, and the maker movement has introduced 3-D printing, especially in design classes. But distance learning presents yet another set of challenges for these subjects. This article examines how this change has affected the teaching of art and design, looks at two case studies (secondary school and university) and refers to discussions at art education conferences and papers on the post-pandemic challenges of digitization in the arts.

The Control of Administrative Inaction in the Context of the COVID-19 Health Emergency in France: an Inadequate Response from the Interim Relief Judge?

Interim remedies before administrative courts are an essential tool for the protection of individuals' fundamental rights in the French legal system. The months of Covid-19 health crisis have given the French administrative courts the opportunity to develop their role when using the so-called 'fundamental rights interim remedy'. In this context, the use of the power of injunction in the context of the fundamental rights interim remedy is not limited to a purely technical dimension. It takes place in a political context and reflects the capacity of the administrative courts, and especially of the Council of State, to play the role of a counter-power vis-à-vis the executive power. This article examines the decisions of the Council of State adopted since 16 March 2020, following fundamental rights interim remedies whose purpose was to request an injunction. It analyses how the fundamental rights interim remedy can be a means of remedying administrative inaction and, on the basis of the analysis of the cases where the requests for interim injunctions have been rejected, it draws lessons on the role of the French administrative courts in the context of the health crisis.

Mental Health Screening of Healthcare Professionals Who Are Candidates for Psychological Assistance during the COVID-19 Pandemic.

Healthcare professionals (HCPs) are among those most affected by the COVID-19 health emergency, with many presenting symptoms of anxiety and depression. Research shows that one of the factors involved in mitigating the impact of stressful situations is the use of cognitive emotional regulation mechanisms. The aims of this study were (a) to describe the functional and dysfunctional cognitive emotional regulation mechanisms (FRMs and DRMs) by gender, (b) to screen the main group of healthcare professionals who are candidates to receive psychological assistance based on FRMs and DRMs, and (c) to determine the HCP profile of candidates for psychological assistance. A cross-sectional descriptive study was conducted. Data were obtained from an adhoc questionnaire—the Cognitive Emotional Regulation Questionnaire (CERQ-18), the Generalized Anxiety Disorder scale (GAD-7), and the nine-item Patient Health Questionnaire (PHQ-9). The representative sample comprised 1452 HCPs. The results revealed significant differences between men and women in the use of DRMs. Women showed a higher use of catastrophizing (≤0.001) and rumination (0.008). The screening procedure detected that 7.5% (109 cases) of the HCPs were candidates to receive psychological support. According to the results of this study, age group (30–39 years old), professional activity (being a nurse or nursing assistant), and having psychological symptoms of anxiety and depression are variables that independently increase the probability of requiring psychological assistance. The gender variable was not found to be an independent factor when it comes to receiving psychological support. In conclusion, it is necessary to consider the influence of cognitive emotional regulation strategies employed by HCPs in the screening of candidates for psychological assistance and design effective interventions to reverse the emotional distress caused by COVID-19.

Health sciences students’ perception on stigmatization related to COVID-19

BackgroundThe current COVID-19 pandemic is a challenge for the health sector all over the world. According to WHO, stigma related to COVID-19 can lead to underreporting, increased exposure and low adherence to standard safety precautions thus complicating adequate responses to the pandemic. The purpose of our research was to analyze students' perceptions on issues related to the COVID-19 pandemic with a special focus on relevant ethical issues. Herein, we present results related to student's perceptions on stigmatization.MethodsA web-based questionnaire was distributed among 715 students; medical students from Medical University -Sofia, Bulgaria and midwifery students from the University of Western Macedonia, Greece. It included 21 questions on socio-demographic characteristics, knowledge on the transmission, symptoms and treatment of COVID-19. The study was conducted between April and July 2020. All the students participated anonymously and voluntarily.ResultsData collected show that the main reasons for stigma experience are the presence of cough or flu-like symptoms (67.4%) and travel from high-risk regions (72.6%). These perceptions were significantly higher among medical students (72.5% and 75.7%) compared to other specialties - midwives (59.1%, 67.6%). Asian origin, health professionals as first respondents and release from quarantine were also considered as significant stigma-related factors in about one-third of all participants, respectively.ConclusionsIdentification of the main public perceptions that may lead to stigmatization and discrimination of patients and vulnerable groups is important in a focused approach to counter its impact on societies. Providing up-to-date education to medical professionals, mitigating the spread of misinformation by real-time monitoring of digital resources, improving public literacy on COVID-19 and establishing a community-level dialogue through digital and social media platforms may raise awareness to reduce stigma.Key messages Long-term Public health strategies are required to combat misconceptions that perpetuate stigma, in order to achieve better outcomes and improved treatment, and protect mental health.As the global COVID-19 health emergency transforms into an unprecedented social crisis, special attention is necessary among vulnerable people to ensure social integrity.

Sport, physical activity and social health in older adults. Caring with technology in the COVID-19 pandemic.

The aim of this paper was to photograph this precise moment in history, focusing on the situation of older adults during the COVID-19 health emergency in Northern Italy. In particular, we analysed the relationship between social networks and social support, sport and recreational activity, and the use of communications technologies in December 2020. We investigated and discussed such use of technologies, wondering if and how it helped to compensate for the diminishment in social health, usually gained trough social interactions and the practice of sport and physical activity. We examined how reduction of mobility, social distancing and isolation measures imposed by the government to reduce the spread of COVID-19, affected the living conditions of the older adults, in particular their social health, and the level of sport and physical activity they were engaged in. We collected data through interviews with the subjects, assessing their social networks, the perceived social support provided by their family members, friends and caregivers, and the level of sport and physical activity they were engaged in. Moreover, we analysed the impact of technological communications devices, which were employed to help older adults to maintain their relationships with the outside world and to preserve their active life. The interview questions were formulated based on the Lubben Social Network Scale-Revised (LSNS-R), the short version of the Social Support List (SSL12-I) for the elderly and the Physical Activity Scale for the Elderly (PASE). A relationship was found between the social health related to physical activity of the older adults subjects during the COVID-19 emergency and the use of communications technologies, which played a role in mitigating the impact of the crisis on their social health by helping them to keep physically and socially active.

Preventive oral health care for mitigating the COVID-19 induced adverse maternal outcomes: View point from Sri Lanka on opportunities in crisis

Pregnancy marks a unique milestone in woman’s life cycle enriched with an array of physical, psychological, social and even spiritual needs. In this context, an optimal level of oral health status has become fundamental to overall health and well-being of a pregnant woman. This is evident more than ever before, for preventing exacerbation of poor oral health in pregnancy, possible control of adverse pregnancy outcomes whilst ensuring low risk for early childhood dental caries for the offspring. Nevertheless, pregnancy renders special oral health needs for a woman compounded by changes in dietary habits, oral hygiene practices and hormonal changes thereby increasing the risk of dental caries and periodontitis. The possible link between Periodontitis and adverse outcomes in pregnancy is well known. The pandemic caused by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compounded by emergence more virulent strains not only indelibly impacted on population, countries, economies and health systems across the globe but exposed vulnerable population groups to pervasive health catastrophes. There is accumulating concerns on periodontitis linking with severe complications of Covid-19 attributed to commonalities of exacerbated inflammatory responses. Moreover, adverse Covid-19 induced maternal and fetal outcomes has garnered attention of researchers based on the previous knowledge indicating adverse outcomes attributed to epidemics of human corona viruses. However, it is not known how maternal oral hygiene status and burden of periodontitis impact on Covid-19 induced adverse outcomes in pregnancy. However, it could be rational to argue that poor oral health of a pregnant woman could elevate her risks for adverse health outcomes. Oral health care in pregnancy has received recognition as an essential element of comprehensive antenatal health care provision. However, the persistent global public health emergency of Covid-19 has profoundly impacted on availability of and accessibility to routine oral health care services. Therefore, accessing routine oral health care services poses serious causes for concern among pregnant women. Against this backdrop, present opinion attempts to explore and expound the potential of preventive oral health care could offer to mitigate the potential risks of Covid-19 induced adverse maternal outcomes embracing the context of Sri Lanka: a developing lower middle-income country.

The Utility of Remote Inspections During the COVID-19 Health Emergency and in the Postpandemic Setting

PurposeThe COVID-19 pandemic has affected the management and operation of regulatory agencies and the pharmaceutical industry around the world. It has prompted regulatory authorities to consider new ways of working and introduced, among others, remote inspections to validate the integrity of the regulatory data submitted by companies, to evaluate the quality of production and manufacturing sites, and to ensure the conformity with Good Regulatory Practices with the overall goal of guaranteeing patient safety during the crisis.MethodThis article summarizes and discusses remote inspection guidelines and other related information made available by the Therapeutic Goods Administration (Australia), the European Medicines Agency (EMA), the Pharmaceutical and Medical Devices Agency (Japan), the Medicines and Healthcare Products Regulatory Agency (United Kingdom), and the US Food and Drug Administration (FDA). We also analyze the effect of the pandemic on inspections conducted by the inspectorates of the EMA and the FDA.FindingsThe regulatory authorities that we studied all recognized the importance of implementing regulatory policies on remote inspections in response to the COVID-19 pandemic. The remote inspection guidelines from the 5 selected regulatory authorities aimed at mitigating the impact of the pandemic but, while providing valuable advice to the pharmaceutical companies and being similar in intent, were not always aligned in terms of approach and solutions.ImplicationsOn-site inspections are likely to continue to be the norm and the preferred standard for the foreseeable future. However, health authorities will need to further adopt a risk-based inspection approach and stimulate the increased uptake of inspection reliance as proposed by the Pharmaceutical Inspection Convention and Pharmaceutical Inspection Co-operation Scheme not to overwhelm the pharmaceutical companies with repeat and redundant inspections. Remote inspections have proven to be a new inspection tool, but health authorities should align on their approach to remote inspections in terms of methods applied and documentation requested.

Governing Fake News: The Regulation of Social Media and the Right to Freedom of Expression in the Era of Emergency

Governments around the world are strictly regulating information on social media in the interests of addressing fake news. There is, however, a risk that the uncontrolled spread of information could increase the adverse effects of the COVID-19 health emergency through the influence of false and misleading news. Yet governments may well use health emergency regulation as a pretext for implementing draconian restrictions on the right to freedom of expression, as well as increasing social media censorship (ie chilling effects). This article seeks to challenge the stringent legislative and administrative measures governments have recently put in place in order to analyse their negative implications for the right to freedom of expression and to suggest different regulatory approaches in the context of public law. These controversial government policies are discussed in order to clarify why freedom of expression cannot be allowed to be jeopardised in the process of trying to manage fake news. Firstly, an analysis of the legal definition of fake news in academia is presented in order to establish the essential characteristics of the phenomenon (Section II). Secondly, the legislative and administrative measures implemented by governments at both international (Section III) and European Union (EU) levels (Section IV) are assessed, showing how they may undermine a core human right by curtailing freedom of expression. Then, starting from the premise of social media as a “watchdog” of democracy and moving on to the contention that fake news is a phenomenon of “mature” democracy, the article argues that public law already protects freedom of expression and ensures its effectiveness at the international and EU levels through some fundamental rules (Section V). There follows a discussion of the key regulatory approaches, and, as alternatives to government intervention, self-regulation and especially empowering users are proposed as strategies to effectively manage fake news by mitigating the risks of undue interference by regulators in the right to freedom of expression (Section VI). The article concludes by offering some remarks on the proposed solution and in particular by recommending the implementation of reliability ratings on social media platforms (Section VII).

A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination.

BackgroundWashing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as “Germ Defence,” and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu.ObjectiveThis study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated.MethodsThe RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations.ResultsDuring web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008).ConclusionsBy comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used “in the wild.” This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally.Trial RegistrationISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295

Feminicide Violence Before and During the COVID-19 Health Emergency

This work explores the extreme violence against women before and during the COVID-19 pandemic in Peru, considering different restriction periods. This is relevant in view of increased violence against women. The objective of this work was to identify the feminicide and attempted feminicide during different quarantine periods due to the COVID-19 health emergency in Peru, and to determine the variables related to these. Data of administrative records of the cases of feminicide and attempted feminicide were analyzed. Our results show that cases of attempted feminicide occurred in higher proportions during the prequarantine period compared to the other periods. In the case of feminicide, its highest percentage occurred during quarantine with a relationship relatively intense when the victim has suffered physical and psychological violence. Also, we find that attempted feminicide was 4.3 times more likely to happen to urban resident victims, 7.9 times more likely when women suffered physical violence, and 7.4 times when they were victims of psychological violence. During quarantine, attempted feminicide was more likely when a victim lives in an urban area (3.5 times), when the victim suffered physical and psychological violence (21.7 and 5.2 times, respectively), and 3.1 times more likely when the attempted feminicide occurred inside the household. The cases of attempted feminicide that occurred during restrictive measures are 5.0 times more likely when a victim belongs to urban areas, 23.4 times more likely when the woman suffered physical violence, and 4.3 times more likely when she was a victim of psychological violence.

Regulating fake news: The right to freedom of expression in the era of emergency

Governments around the world are strictly regulating information on social media in the interests of addressing fake news. There is, however, a risk that the uncontrolled spread of information could increase the adverse effects of the Covid-19 health emergency through the influence of false and misleading news. Yet, governments may well use health emergency regulation as a pretext for implementing draconian restrictions on the right to freedom of expression, as well as increasing social media censorship. This article seeks to challenge the stringent legislative and administrative measures governments have recently put in place in order to analyse their negative implications for the right to freedom of expression and suggest different regulatory approaches in the context of public law. These controversial government policies are discussed in order to clarify why freedom of expression cannot be allowed to be jeopardised in the process of trying to manage fake news. Firstly, an analysis of the legal definition of fake news in academia is presented in order to establish the essential characteristics of the phenomenon (Section 2). Secondly, the legislative and administrative measures implemented by governments at both international (Section 3) and EU levels (Section 4) are assessed, showing how they may undermine a core human right by curtailing freedom of expression. Then, starting from the premise of social media as a “watchdog” of democracy, and moving on to the contention that fake news is a phenomenon of “mature” democracy, the article argues that public law already protects freedom of expression and ensures its effectiveness at the international and EU levels through some fundamental rules (Section 5). There follows a discussion of the key regulatory approaches, and, as an alternative to government intervention, self-regulation and especially empowering users are proposed as strategies to effectively manage fake news by mitigating the risks of undue interference by regulators in the right to freedom of expression (Section 6). The article concludes by offering some remarks on the proposed solution and in particular by recommending the implementation of reliability ratings on social media platforms (Section 7).

"Hang in There!": Mental Health in a Sample of the Italian Civil Protection Volunteers during the COVID-19 Health Emergency.

Few studies have been conducted on civil volunteers and their emotional conditions concerning the current COVID-19 pandemic. The present study aimed to evaluate the impact of the COVID-19 emergency on the mental health (general well-being, depression level, and post-traumatic distress), coping strategies, and training needs in an Italian sample of 331 Civil Protection volunteers of the L’Aquila province, during the first nationwide “lockdown” (8 March–3 June 2020). The rate of respondents to the online survey was limited (11.5%), presumably because displaying distress would be considered a sign of “weakness”, making volunteers unable to do their jobs. More than 90% of the volunteers showed good mental health conditions and a wide utilization of positive coping strategies, with the less experienced displaying better emotional conditions compared to colleagues with 10 or more years of experience. The type of emergency, the relatively few cases of contagion and mortality in the territory compared to the rest of Italy, and the sense of helping the community, together with the awareness of their group identity, could have contributed to the reported well-being. These results may help to identify the needs of volunteers related to this new “urban” emergency to improve both their technical and emotional skills.

COVID-19 Pandemic: Current Scenario, Challenges and Future Perspectives

Background: The new public health emergency of COVID-19 caused by a novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which originated in Wuhan, Hubei province, China in December 2019, evolved into a pandemic in no time and is still in progression. The novel virus mainly targets the lower respiratory system, leading to viral pneumonia, with other associated complications of multi organ failure. Discussion: The bats, in particular Rhinolophus affinis, is a natural host of SARS-CoV-2 and the virus is considered to have spread to humans through yet controversial intermediate host pangolins. The incubation period ranges from 2-14 days and mode of person-to-person transmission is primarily via the direct contact with the infected person or through the droplets generated by the infected person during coughing or sneezing. The initiation of the infection process by SARS-CoV-2 virus is the invasion of lung type II alveolar cells via a receptor protein called angiotensin-converting enzyme 2 (ACE2) present on the cell membrane with glycosylated spike (S) viral protein that mediates host cell invasion. The main diagnostic tools employed are molecular methods based on nucleic acid detection engaging real-time quantitative polymerase chain reaction (RT-qPCR) and a new immunoassays based on antibodies IgM/IgG. Conclusion: Due to the lack of specific clinically approved anticovid-19 drugs or vaccines that could be used for its prevention or treatment, the current management approach is essentially supportive and symptomatic. The precautionary measures like, social distancing, cleaning hands with soap or sanitizers, using disinfectant solutions to decontaminate the surfaces of things and proper ventilation, wearing masks and other protective gears to curb transmission. The knowledge regarding COVID-19 therapies is still evolving and collaborative efforts are being put in to discover definitive therapies on different themes in the form of vaccines, repurposing drugs, RNA interference, docking studies, etc.

TINJAUAN YURIDIS HUBUNGAN PEMERINTAH PUSAT DAN DAERAH SAAT TERJADI WABAH VIRUS COVID-19 DALAM KARANTINA WILAYAH SESUAI DENGAN UNDANG-UNDANG NOMOR 6 TAHUN 2018 KEKARANTINAAN KESEHATAN

The determination of the status of the Covid-19 Pandemic by the World Health Organization based on the number of spread of the virus has increased significantly and sustainably globally, this has been responded by the Government of Indonesia by setting the status of the Covid-19 outbreak as a National Disaster on March 14 as stated in the Decree President Number 12 of 2020 concerning the Designation of Non-Natural Disaster for the Spread of Corona Virus Disease 2019 (COVID-19) as a National Disaster. The principle of the unitary state emphasizes the highest power over all state affairs, namely the central government without a delegation or delegation of power to the regional government (local government). Based on the results of the research that has been done, it can be concluded that, considering that there are still problems with coordination, communication and synergy that were felt at the beginning of this pandemic, it is considered to be still lacking. The government should have responded quickly to the pandemic which in turn affected the entire handling process. However, it has been seen that the government is increasingly focused and realizes that coordination is important, one of which is reflected in the existence of a task force and a study of the status of various regions in Indonesia. This is done for the common interest of handling the Covid-19 health emergency.

COVID-19 en América Latina: Perspectivas Sobre las Acciones Políticas Ante la Emergencia Sanitaria

The objective of this work is to carry out an exploratory review of some of the socioeconomic impacts derived from the health emergency of COVID-19 in Latin America and particularly in the case of Mexico. For this, some of these aspects were contrasted with respect to the political actions taken by the governments of the region. The analysis was made through the statistical review of the information published by international organizations, as well as by journalistic publications. As a result, it was obtained that, although the political actions in most Latin countries have been more than 100 in a short period of time, they have not been sufficient or adequate to curb the risks in terms of people's lives. Finally, a series of recommendations are presented to overcome this collective emergency.

El Comportamiento de la Pandemia en las Alcaldías. De cómo Contribuyen las Alcaldías para el Desarrollo de la COVID-19 en la Ciudad de México

This paper discuss the extent to which municipalities (alcaldias) in Mexico City contributed to the magnitude of the COVID-19 health emergency. To do so, we use the language of the communications to citizens to explain the behavior of the pandemic and the mobility of citizens across municipalities. We use the prevalence of confirmed cases to conjecture about active cases, particularly concerning the time until flattening the curve. The main objective is to show the behavior of the pandemic by visualizing the evolution that the pandemic (as a health phenomenon) had throughout the year. We use three important dates to show how likely (or not) citizens were to follow stay-at-home restrictions. We also discuss which municipalities' trends are likely to explain the city's trends. The main goal of this project is to help understand and explain the pandemic as a phenomenon as unexpected as it was and which may have no short or medium-run solution.

Corporate social responsibility actions and organizational legitimacy at the peak of COVID-19: a sentiment analysis

Purpose This paper aims to analyse stakeholder sentiment about the corporate social responsibility (CSR) actions implemented by Italian companies between February 20, 2020 and April 20, 2020, which was the first peak in the outbreak of the COVID-19 health emergency in Italy. Design/methodology/approach Using sentiment analysis, the impact of COVID-19 on CSR actions is analysed through reactions to the news published on Twitter by a sample of Italian news agencies. Findings The analysis indicates that the actions most appreciated are those that are more radical, e.g. where the company has converted part of its production to make goods that are useful in dealing with the COVID-19 emergency. The study identifies a new category of actions definable as “crisis-shaped CSR.” Practical implications This is one of the first studies concerning the effects of the pandemic on both CSR actions and organizational legitimacy. Originality/value This work explains which strategic approach to CSR is the most effective in supporting corporate reputation in times of crisis, this study identified which of the CSR initiatives adopted by companies in Italy were more effective in stimulating positive interactions and sentiment among the general public.

The resort to military force in the COVID-19 health emergency: A justification

The COVID-19 pandemic has been mobilizing the full capacities of societies worldwide to respond to unprecedented threats to national and human security. In many cases, emergency measures have involved military support to civil institutions, including law enforcement operations. This paper aims to understand the legality and legitimacy of these military operations better, using hermeneutic, comparative, and survey methodology. It is based on the assumptions that international human rights standards crucially determine moral requirements for domestic use of military force and that just war theory can be equally helpful in the decision-making on domestic military operations in such circumstances. This study assesses the justification of current military enforcement and recommends criteria for future emergencies.

Is the Right to Abortion at Risk in Times of COVID-19? The Italian State of Affairs within the European Context.

The COVID-19 health emergency has thrown the health systems of most European countries into a deep crisis, forcing them to call off and postpone all interventions deemed not essential or life-saving in order to focus most resources on the treatment of COVID-19 patients. To facilitate women who are experiencing difficulties in terminating their pregnancies in Italy, the Ministry of Health has adapted to the regulations in force in most European countries and issued new guidelines that allow medical abortion up to 63 days, i.e., 9 weeks of gestational age, without mandatory hospitalization. This decision was met with some controversy, based on the assumption that the abortion pill could “incentivize” women to resort to abortion more easily. In fact, statistical data show that in countries that have been using medical abortion for some time, the number of abortions has not increased. The authors expect that even in Italy, as is the case in other European countries, the use of telemedicine is likely to gradually increase as a safe and valuable option in the third phase of the health emergency. The authors argue that there is a need to favor pharmacological abortion by setting up adequately equipped counseling centers, as is the case in other European countries, limiting hospitalization to only a few particularly complex cases.

Prone position in non-intubated patients with covid-19 related acute respiratory failure

Background. Although pronation is mostly used as a treatment option in intubated patients with severe acute respiratory distress syndrome (ARDS), COVID-19 health emergency has led to a revaluation of this technique also in patients undergoing non-invasive ventilation (NIV). Objectives. The main study outcome was to assess oxygenation level for patients kept in prone position by comparing partial pressure of oxygen on fractional concentration of oxygen in inspired air (PO2/FiO2 ratio) changes before pronation and one hour after resupination. Method. In this retrospective single centre study, 20 patients over 18 years with a confirmed diagnosis of COVID-19 related pneumonia and receiving helmet-CPAP or NIV were enrolled from Villa Scassi Hospital (Genoa, Italy) between March and May 2020. Data regarding blood gas measurements, respiratory rate and dyspnoea severity were collected immediately before pronation (T0), during pronation (T1) and one hour after resupination (T2). Patients were responding if their PO2/FiO2 ratio had improved by at least 20% comparing T0 and T2. Results. In patients undergoing helmet-CPAP the PO2/FiO2 ratio improved significantly comparing data at T0 and T1 (p-value < 0.0001) and even when the supine position was resumed (p-value < 0.0001). The slopes of PO2/FiO2 ratio from T0 and T1 between the two groups of responders and not-responders also differed significantly (p-value = 0.004). Discussion. Our results show that pronation improves oxygenation in awake patients with COVID-19-related pneumonia receiving helmet-CPAP, and this effect is maintained even one hour after re-supination. The significant difference in the slope of the PO2/FiO2 ratio from T0 and T1 between the two groups shows that a lack of substantial increase in the ratio between supine and prone position could predict a failure of this technique. Conclusions. In a health emergency such a global pandemic where available resources are limited, pronation should always be attempted in patients with COVID-19 pneumonia in ARDS undergoing helmet-CPAP.