Wave Of COVID-19 Pandemic Research Articles

Differences in leucocytes and inflammation-based indices among critically ill patients owing to SARS-CoV-2 variants during several successive waves of COVID-19 pandemic

Background/AimInflammatory indices are useful informative markers in assessing the severity of the COVID-19 disease course; however, their involvements during series waves of SARS-CoV-2 virus outbreaks in critical patients with COVID-19 remain unclear. Hence, we aimed to ascertain the changing dynamics of the combined inflammatory indices (NLR, dNLR, CLR, LMR, PLR, SII, and SIRI) and their associations with clinical outcomes in severe COVID-19 patients during serial waves of SARS-CoV-2. Patients and methodsWe retrospectively enrolled 163 severe COVID-19 patients admitted to the ICU during six SARS-CoV-2 waves. ResultsWe found that most of patients admitted to the ICU were from the fourth wave. Patients in the fourth wave were considerably younger and had the highest percentage of ARDS than other waves. The highest CRP was found in the first wave, while the lowest in patients admitted in the sixth wave. Although most of the COVID-19 waves were marked with leukocytosis, neutrophilia, and lymphocytopenia, the lowest of both NLR and dNLR were found in the fourth wave “Delta wave” and the lowest of both CLR and SII were observed in “Omicron wave”. Interestingly, during most of the COVID-19 waves, the derived combined inflammatory ratio NLR, dNLR, CLR, SII and SIRI were sustained at high levels in fatal cases at the last day of hospitalization, while these indices declined in the alive group at the end of ICU hospitalization. No major difference was identified in lymphocyte count between admission and the last day of hospitalization in both deceased and recovered COVID-19 patients during Delta and Omicron waves. Moreover, patients admitted in the Omicron wave had less severe disease compared to those admitted in the Delta wave. The Kaplan-Meier analysis revealed no significant difference in survival rates or the probability of respiratory failure between six successive COVID-19 waves. ConclusionTaken together, our results showed marked differences in the alteration of nonspecific inflammation and damage in the adaptive immune response during the six serial SARS-CoV-2 waves. Considering the inflammatory response of infectious diseases, embedding inflammatory indices informative markers into routine clinical testing offers the potential to mitigate the impact of future pandemics of COVID-19 and other infectious diseases.

Practice of silence to promote coping, emotion regulation, and future planning of imprisoned individuals during the COVID-19 pandemic: a qualitative study

Recent studies have emphasized that silence is a fundamental element in meditative practices for stress relief, well-being, and stimulating faith in the future. This study describes the educational experience of implementing the Practice of Silence Device in a prison setting during the second wave of Covid-19 pandemic (May–July, 2021). Interviews with 23 adult male imprisoned individuals (average age = 48.79; 65% Italians) were analyzed through a qualitative-phenomenological method. The results revealed this technique’s positive impact on rehabilitating imprisoned individuals across 3 dimensions: coping, emotion management, and ability to plan the future. Future studies should investigate specific silence-based techniques to support imprisoned individuals’ rehabilitation.

COVID-19 Pandemic Did not Influence Number of Oncologic and Emergency Surgeries: A Retrospective Cohort Study from a Tertiary Hospital in Austria.

Many articles described a massive decline in surgical procedures during the COVID-19 pandemic waves. Especially the reduction in oncologic and emergency procedures led to the concern that delays and cancelling surgical activity might lead to a substantial increase in preventable deaths. Overall numbers and types of surgery were analysed in a tertiary hospital in Austria during the winter period (October-April) from 2015/16 to 2021/22. The half-years 2019/20, 2020/21 and 2021/22 were defined as pandemic half-years and were compared with the mean results of the previous, four, pre-pandemic half-years. A reduction was found for overall numbers and elective surgeries during 2019/20 (4.62%; p < 0.0001 and 12.14; p < 0.0001 respectively) and 2021/22 (14.94%; p < 0.0001 and 34.27; p < 0.0001 respectively). Oncologic surgery increased during 2021/22 (- 12.59%; p < 0.0001) and remained unchanged during the other periods. Emergency surgeries increased during 2019/20 (- 6.97%; p < 0.0001) and during 2021/22 (- 9.44%; p < 0.0001) and remained unchanged during 2020/21. The concern that the pandemic led to a decrease in oncologic and emergency surgeries cannot be supported with the data from our hospital. A flexible, day-by-day, resource allocation programme with central coordination adhering to hospital resilience recommendations may have helped to adapt to the impact of the COVID-19 pandemic during the first three pandemic half-years.

Explaining the U.S. rural disadvantage in COVID-19 case and death rates during the Delta-Omicron surge: The role of politics, vaccinations, population health, and social determinants

The Delta-Omicron wave of the COVID-19 pandemic (Wave 4) in the United States occurred in Fall of 2021 through Spring of 2022. Although vaccinations were widely available, this was the deadliest period to date in the U.S., and the toll was especially high in rural areas, exacerbating an existing rural mortality penalty. This paper uses county-level multilevel regression models and publicly available data for 47 U.S. states and the District of Columbia. We describe differences in COVID-19 case and mortality rates across the rural-urban continuum during Wave 4 of the COVID-19 pandemic. Using a progressive modeling approach, we evaluate the relative contribution of a range of explanatory factors for the rural disadvantage we observe, including: pre-pandemic population health composition, vaccination rates, political partisanship, socioeconomic composition, access to broadband internet rate, and primary care physicians per capita. Results show that rural counties had higher observed burdens of cases and deaths in Wave 4 compared to more urban counties. The most remote rural counties had Wave 4 COVID-19 mortality rates 52% higher than the most urban counties. Older age composition, worse pre-pandemic population health, lower vaccination rates, higher share of votes cast for Donald Trump in the 2020 Presidential election, and lower socioeconomic composition completely explained the rural disadvantage in reported COVID-19 case rates in Wave 4, and accounting for these factors reversed the observed rural disadvantage in COVID-19 mortality. In models of mortality rate, Trump vote share had the largest effect size, followed by the percentage of the population age 50 or older, the poverty rate, the pre-pandemic mortality rate, the share of residents with a 4-year college degree, and the vaccination rate. These findings add to a growing literature describing the disproportionate toll of the COVID-19 pandemic on rural America, highlighting the combined effect of multiple sources of rural disadvantage.

Impact of the COVID-19 Pandemic on the Management of Gallbladder, Biliary Tract, and Pancreatic Diseases.

Introduction Biliary diseases are a major acute general surgical burden. Laparoscopic cholecystectomy is the gold standard surgical procedure, although it was discontinued during an outbreak. Effective management permits decisive therapy, symptom alleviation, and fewer hospitalizations and complications. Throughout the initial COVID-19 situation, surgical procedures for patients were delayed. Invasive services were required to employ conservative or non-operative therapy, which could lead to increased recurring presentations and biliary-pancreatic problems. Aim Examining the impact of COVID-19 on the outcomes and hospitalizations of patients suffering from gallstone, biliary tract, and pancreatic diseases. Methods The retrospective analysis included patients with the following ICD-10 codes who presented to our unit: cholelithiasis (K80), cholecystitis (K81), and acute pancreatitis (K85). We compared the interval of the first COVID-19 pandemic wave, from March to August 2020, with the period before the pandemic, referred to as Pre-COVID-19. After applying exclusion criteria, a total of 868 patients were enrolled in the trial, having initially recruited around 1,400 individuals using these codes. Patients with inaccurate coding, cancer, or non-stone disease were excluded (e.g., alcoholic pancreatitis). The demographic information, admission details, investigations, surgical therapy, operating specifics, and postoperative complications of the patients were noted. Changes in surgical management, patient representation, and postoperative complications were the key outcomes. Results A statistically significant (p<0.05) rise was seen in repeat presentations in the COVID group, most likely due to the failure of definitive treatment. The other outcome is the distribution of presentations was comparable, patients with acute cholecystitis and gallstone pancreatitis showed statistically significant (p<0.05) lower rates of definitive therapy. Conclusion During the COVID period, all surgeries except those for cancer were halted. Unknown causes led to several consequences related to the gallbladder, biliary tract, and pancreas. Patients with cholecystitis, gallstone pancreatitis, and pancreatic inflammation experienced a lower probability of treatment. The increase in hospitalizations and self-presentations indicated that definitive therapy, designed to restrict COVID-19 exposure, actually increased patient risk. Despite this risk, we had no COVID-19 instances in our cohort. The evaluation of the long-term consequences of the pandemic on acute pancreatitis and its care will require a large-scale, multicenter investigation.

Modeling of spatial spread of COVID-19 pandemic waves in Russia using a kinetic-advection model

Objectives. COVID-19 has a number of specific characteristics that distinguish it from past pandemics. In addition to the high infection rate, the high spread rate is due to the increased mobility of contemporary populations. The aim of the present work is to construct a mathematical model for the spread of the pandemic and identify patterns under the assumption that Moscow comprises the main source of viral infection in Russia. For this purpose, a twoparameter kinetic model describing the spatial spread of the epidemic is developed. The parameters are determined using theoretical constructions alongside statistical vehicle movement and population density data from various countries, additionally taking into account the development of the first wave on the examples of Russia, Italy and Chile with verification of values obtained from subsequent epidemic waves. This paper studies the development of epidemic events in Russia, starting from the third and including the most recent fifth and sixth waves. Our twoparameter model is based on a kinetic equation. The investigated possibility of predicting the spatial spread of the virus according to the time lag of reaching the peak of infections in Russia as a whole as compared to Moscow is connected with geographical features: in Russia, as in some other countries, the main source of infection can be identified. Moscow represents such a source in Russia due to serving as the largest transport hub in the country.Methods. Mathematical modeling and data analysis methods are used.Results. A predicted time lag between peaks of daily infections in Russia and Moscow is confirmed. Identified invariant parameters for COVID-19 epidemic waves can be used to predict the spread of the disease. The checks were carried out for the wave sequence for which predictions were made about the development of infection for Russia and when the recession following peak would occur. These forecasts for all waves were confirmed from the third to the last sixth waves to confirm the found pattern, which can be important for predicting future events.Conclusions. The confirmed forecasts for the timing and rate of the recession can be used to make good predictions about the fifth and sixth waves of infection of the Omicron variant of the COVID-19 virus. Earlier predictions were confirmed by the statistical data.

Occurrence and outcome of COVID-19 in AIRD patients on concomitant treatment with Tofacitinib- results from KRA COVID COHORT (KRACC) subset

IntroductionWe assessed the risk factors and outcome of COVID-19 in patients with autoimmune rheumatic diseases(AIRD) who contracted infection while on background treatment with tofacitinib.MethodsThis is a non-interventional, cross-sectional, questionnaire based telephonic study which included consecutive AIRD patients on tofacitinib co-treatment. Data related to the AIRD subset, disease modifying anti rheumatic drugs(DMARDs) including glucocorticoids and comorbidities, was collected from 7 rheumatology centers across Karnataka during the second wave of COVID-19 pandemic. The information about COVID-19 occurrence and COVID-19 vaccination was recorded.ResultsDuring the study period (Jun-July 2021), 335 AIRD patients (80.6% female) on treatment with tofacitinib were included. The mean duration of tofacitinib use was 3.4+/-3.1months. Thirty-six(10.75%) patients developed COVID-19. Diabetes mellitus (p = 0.04 (OR 2.60 (1.13–5.99)) was identified as a risk factor for COVID-19 in our cohort. Almost half of our cohort was COVID-19 vaccinated with at least one dose, with resultant decline in incidence of COVID-19(OR 0.15 (0.06–0.39) among the vaccinated. Recovery amongst COVID-19 infection group was 91.2%.ConclusionsThe subset of AIRD patients who were on treatment with tofacitinib were found to have a higher rate of COVID-19 infection as compared to our KRACC cohort. Pre-existing comorbidity of diabetes mellitus was the significant risk factor in our cohort. This subset of the KRACC cohort shows RA patients had a lesser infection and PsA patients had a higher infection.

Pre-pandemic family resources and child self-regulation in children's internalizing problems during COVID-19: a multi-level social-ecological framework for emotional resilience.

Children's psychological adjustment to adverse events can be determined by multiple risk and resilience factors. This study explored multi-level protective factors against children's internalizing problems and investigated the mechanism regarding how diverse environmental and child-level resources influence children's mental health in the context of COVID-19. Our participants included a nationally representative sample of 2,619 young children (48.3% girls) and their primary caregivers (95.1% mothers) in Singapore. They were a subset of the participants in the Singapore Longitudinal Early Development Study (SG LEADS). Data were collected over two waves-before the outbreak of the COVID-19 pandemic (Wave 1) when these children aged 3 to 6, and during the second year of the pandemic (Wave 2). Primary caregivers completed measures of verbal cognitive ability, self-control, economic stress, and positive and negative parental control in Wave 1. Children's self-regulation was assessed by the Delay of Gratification task in Wave 1, and their internalizing problems were rated by their primary caregivers in both waves. Other pre-pandemic family and community characteristics were collected as covariates. Structural equation modeling was performed. Pre-pandemic parental resources (i.e., verbal cognitive ability, self-control, and low economic stress) predicted children's fewer internalizing problems during the pandemic and less aggravation of internalizing problems from before to during the pandemic, through more positive parental control (i.e., limit setting) and less negative parental control (i.e., harsh discipline). Moreover, children's self-regulation during early childhood was predicted by their primary caregivers' verbal cognitive ability and self-control, as well as positive parental control. Early childhood self-regulation further alleviated the aggravation of internalizing problems over time. Among the covariates, parental education, family income, parental psychological well-being, living with both parents, having a live-in domestic helper, and neighborhood quality also longitudinally predicted fewer child internalizing problems. Our findings underscore the importance of nurturing children's emotional resilience under adverse and uncertain circumstances by boosting protective factors in their social-ecological system, including community-, family-, parent-, and child-level resources.

Predictors of mechanical ventilation and mortality in critically ill patients with COVID-19 pneumonia

ObjectiveTo determine if potential predictors for invasive mechanical ventilation (IMV) are also determinants for mortality in COVID-19-associated acute respiratory distress syndrome (C-ARDS). DesignSingle center highly detailed longitudinal observational study. SettingTertiary hospital ICU: two first COVID-19 pandemic waves, Madrid, Spain. Patients or participants: 280 patients with C-ARDS, not requiring IMV on admission. InterventionsNone. Main variables of interest: Target: endotracheal intubation and IMV, mortality.Predictors: demographics, hourly evolution of oxygenation, clinical data, and laboratory results. ResultsThe time between symptom onset and ICU admission, the APACHE II score, the ROX index, and procalcitonin levels in blood were potential predictors related to both IMV and mortality. The ROX index was the most significant predictor associated with IMV, while APACHE II, LDH, and DaysSympICU were the most with mortality. ConclusionsAccording to the results of the analysis, there are significant predictors linked with IMV and mortality in C-ARDS patients, including the time between symptom onset and ICU admission, the severity of the COVID-19 waves, and several clinical and laboratory measures. These findings may help clinicians to better identify patients at risk for IMV and mortality and improve their management.

Management Orthopedic Patient With Covid 19, A Picture Of Patient Safety

This study will describe management policies to maintain hospital services by putting safety and analyze epidemiological data on orthopedic patient with covid-19 infection who were admitted during covid-19 pandemic. A retrospective descriptive study of orthopedic patients with covid-19 infection profile during 1st wave of covid-19 Pandemic (January - March 2021). Modification of patient and staff work flow were also made, based on risk of transmissions, this include rescheduling elective surgery and promoting telemedicine. For patient who were admitted for urgent surgery, transition room were made for screening covid-19 infection before operation, there also a negative pressure operation room for patient who need an emergency operation. There were 38 orthopedic patients admitted to transition room, 18 patient (47.36%) were confirmed covid-19 infection. There are slight fewer female patient with confirmed Covid-19, compare to the male patient 8 (44.4%) vs 10 (55.6%) patient. The Patient’s age ranged from 5 to 79 years old, with average of 46.27 years old (SD 20.63). With most patient were 56-65 years old. The patients’ diagnosis and demographics data were described in table 1. Five patients (27.8 %) with mild covid-19, nine patients (50 %) with moderate covid-19 and four patients (22.2 %) with severe covid-19. Among 18 patients with confirmed covid-19, seven patients (38.9%) had hypertension and three patients(16.7%) had diabetes . The Laboratory data shows 13 patients (72.7%) had abnormal NLR with all patients had increased D Dimer. Average length of stay were 12.78 days, Range 2 days to 21 days; SD 5,53) with eleven patients (61.1%) underwent operation procedure and 7 (38.9%) patients were on conservative treatment. There was 1 (1.8%0 death case recorded, among patients with confirmed COVID-19, this was a C3 Spinal Cord Injury patient with tetraplegia and respiratory failure. During this period there were 16 (2.5% from 636 staff) were diagnosed with covid-19, among them 60% in red area ( operation room, Emergency unit, polyclinics, isolation room and laboratory). There were no documented in hospital death among orthopedic patient with confirmed covid-19 who underwent surgery procedure. Covid-19 had disrupted many aspects in hospital services. Our Hospital had develop new policies and strategies to minimize covid-19 transmission during the 1st wave covid-19 pandemic. Preoperative screening, proper personal protective equipment’s, and strict transmissions control successfully minimize covid-19 transmission in our hospital. Orthopedics patient with Covid-19 infection, that require urgent surgery were admitted to isolation room. Prompt treatment according to WHO Guideline were given.

COVID-19 Biomarkers for Critically Ill Patients: A Compendium for the Physician.

SARS-CoV-2 clinical manifestation and progression are variable and unpredictable, hence the importance of considering biomarkers in clinical practice that can be useful for both diagnosis and prognostic evaluation. This review aims to summarize, for intensive care physicians, the most recent state of knowledge regarding known COVID-19 in critical patients. We searched PubMed® using the Boolean operators and identified all results on the PubMed® database of all studies regarding COVID-19 biomarkers. We selected studies regarding endothelium, cytokines, bacterial infection, coagulation, and cardiovascular biomarkers. We divided the results into four essential paragraphs: "Cytokine storm", "Endothelium dysfunction and coagulation biomarkers in COVID-19", "Biomarker of sepsis", and Cardiovascular lung and new perspectives. The assessments of the severe COVID-19 prognosis should monitor, over time, IL-6, soluble Von Willebrand factor (VWF), P-selectin, sCD40L, thrombomodulin, VCAM-1, endothelin- Troponin, D-dimer, LDH, CRP, and procalcitonin. Metabolomic alterations and ACE2 receptors represent new perspectives. Early identification of critically ill patients has been crucial in the first COVID-19 pandemic wave for the sustainability of the healthcare emergency system and clinical management. Only through the early identification of the most severe patients can they be provided with the most appropriate treatments.

Macroeconomic impacts of COVID-19 pandemic first wave in the world

The paper seeks to identify the essential global-economic macro-shocks resulting from efforts by consumers, firms, or government policies to reduce social distancing, which caused a sharp temporary change in the world economy during the pandemic outbreak in the second quarter of 2020. The purpose is fulfilled using a simple two-period real-business cycle model. The observed reaction of the global economy in the second period of 2020 is measured by the deviation of the time series of GDP and its components, labor, labor income, and average labor product in the USA and EU from the log-quadratic trend. The model can replicate the observed economic response by reducing the total factor productivity, labor demand, and labor supply—no need to assume sticky prices. As a sudden drop in performance is supposed, followed by a modest recovery already in the following period, it is not assumed that the government would be able to avert it in time with fiscal or monetary policy. Moreover, the assumption of variable prices and supply-side shocks does not support such a policy.

Predictors of Adherence to Personal Preventive Behaviors Among Nursing Students Based on Health Belief Model: Cross Sectional Study During the Second Wave of COVID-19 Pandemic in Indonesia

Introduction: Personal preventive behaviors was cited as effective strategy to prevent the SARS-CoV-2 transmissions. When vaccine become available, preventive behavior must still be implemented to significantly decreased the COVID-19 infection risk in the emergence of novel SARS-CoV-2 variants of concern with immune escape phenotype. The Health Belief Model (HBM) is the most widely recognized behaviour theory, but its capacity to predict the preventive behaviours have been inconsistent. This study aimed to assess predictors adherence to COVID-19 preventive behaviour among nursing students based on HBM during the second wave of COVID-19 in Indonesia. Methods: An online cross-sectional study was conducted from May to September 2021. Undergraduate nursing students (n=1,413) from 10 universities in Indonesia was recruited using consecutive sampling. Online self-administered questionnaire was used to collect the data. Binary logistic regression was employed to analyse the association between sociodemographic and HBM construct with adherence to preventive behaviors. Results: Most of the students (n=804; 56.9 %) had poor adherence to COVID-19 preventive behaviors, and poor physical distancing identified as the most dominant non-adherence type (n=774; 54.8 %). First year students (AOR=1.313; 95%CI: 1.020-1.690), low perceived susceptibility (AOR=1.530; 95%CI: 1.193-1.962), low perceived severity (AOR= 1.756; 95%CI: 1.337-2.307), low perceived effectiveness (AOR=1.910; 95%CI: 1.315-2.777), and low self-efficacy (AOR=4.795; 95%CI: 3.566-6.447) significantly associated with poor adherence (p&lt;0.05). Nagelkerke R square value was 0.313 suggesting that the whole model explained 31.3% of variance in adherence. Conclusion: Intervention that targeting health belief model could be useful to increased adherence level to COVID-19 preventive measures among nursing students.

Tracking the Uneven Outcomes of COVID-19 on Racial and Ethnic Groups: Implications for Health Policy.

The socioeconomic shocks of the first COVID-19 pandemic wave disproportionately affected vulnerable groups. But did that trend continue to hold during the Delta and Omicron waves? Leveraging data from the Johns Hopkins Coronavirus Resource Center, this paper examines whether demographic inequalities persisted across the waves of COVID-19 infections. The current study utilizes fixed effects regressions to isolate the marginal relationships between socioeconomic factors with case counts and death counts. Factors include levels of urbanization, age, gender, racial distribution, educational attainment, and household income, along with time- and state-specific COVID-19 restrictions and other time invariant controls captured via fixed effects controls. County-level health outcomes in large metropolitan areas show that despite higher incidence rates in suburban and exurban counties, urban counties still had disproportionately poor outcomes in the latter COVID-19 waves. Policy makers should consider health disparities when developing long-term public health regulatory policies to help shield low-income households from the adverse effects of COVID-19 and future pandemics.

Dietary Supplement Consumption and Mental Health in Indonesian Adults During Second Wave of COVID-19 Pandemic.

This study aimed to measure supplement consumption behavior and mental health status among Indonesian adults during the second year of COVID-19. Online questionnaire regarding supplement consumption, and Depression, Anxiety, Stress Scale 21 (DASS-21) was distributed from March to June 2021 and obtained 1006 valid and completed questionnaires. Descriptive and inferential analyses were conducted to determine the frequency and predictor factors of the respondents' supplement consumption behavior and mental health status. Respondents were divided into two groups, vulnerable and non-vulnerable individuals. The finding showed that 34.5% respondents were vulnerable individuals, including the elderly and those with comorbid disease(s). The vulnerable and non-vulnerable groups exhibited a high prevalence of supplement consumption, with the vulnerable group demonstrating a greater tendency for regular use. The incidence of mental health problems in both groups did not significantly differ (23-38%), where anxiety was higher than depression and stress. Supplement consumption was associated with mental health status. Several positive predicting factors for supplement consumption behavior included older age, higher economic status, and higher education. While the younger age and unmarried respondents were more likely to develop mental health problems. Taken together, given dietary supplement consumption increased during the pandemic and the potential associations between supplement consumption and mental health, controlling the correct information and regulation regarding supplements, especially their risks and benefits, was important. Additionally, support for mental health issues was necessary, since it might affect self-medication behavior.

A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England.

Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. This study is registered with the ISRCTN (14962466). This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.

Home Isolation and Online Support Strategies during Mild COVID-19 Pandemic Waves in Thailand: A Scoping Review

Objectives: In 2021, Thailand experienced its fourth and fifth waves of COVID-19, overwhelming the nation’s public health system. The significant gap between health resources and the demand for services from patients was one of the primary challenges in responding to the catastrophic COVID-19 pandemic. Hospitals were inundated with a surge in new patients, leading to a growing backlog of individuals suffering delayed care or even rejection from the healthcare system. To tackle this issue, strategies such as “outpatient self-isolation” (SI), “home-based isolation” (HI), and “community-based isolation” (CI) were implemented to stabilize COVID-19 cases with mild to moderate symptoms. This review aimed to explore the experiences in the management of COVID-19 care in patients with mild to moderate symptoms and identify challenges after the initial response of the Thailand health system to the pandemic. Methods: This study was conducted during the Delta pandemic (June–November 2021) and the Omicron pandemic (December 2021–15 March 2022). We present the lessons learned from the management of the HI system based on experiences gained at a university hospital, which provided remote professional-to-patient support during the pandemic. The study involved retrospective data from electronic medical records and qualitative analysis of responses provided during the pandemic using the HI system. Results: Data from a total of 2704 and 1912 participants were included in the analysis. The vast majority of patients were assigned to HI immediately after being diagnosed with COVID-19. This system facilitated remote consultations, provision of necessary medications, and delivery of survival kits to patients’ homes. Qualitative reviews indicated several key factors that could contribute to successful COVID-19 management under the HI system: (1) effective management and vaccine status, (2) establishment of home isolation using the find-test-trace-isolate-support system, and (3) adherence to home isolation guidelines and system support. Challenges included the digitalization of tools for securing isolation, team preparedness and adequate support system during HI, as well as hospital policies for psychological support for healthcare workers and measures to alleviate their workload. Conclusions: Our investigation suggests that the HI teleconsultation system was an effective approach to managing COVID-19. It allowed for a prompt response to patients’ needs and provided timely access to medical support, particularly for individuals with mild to moderate symptoms.

Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace

The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital’s mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.

Evaluation of Adjunctive Homoeopathy Treatment in COVID-19 Hospitalised Patients at the Gujarat State’s Dedicated COVID-19 Hospitals and Covid-Care Clinics During the First Wave of COVID-19 Pandemic: A Multicentric, Single-Arm Retrospective Data Analysis Study

This retrospective data analysis study aims to analyze the data collected during adjunctive homeopathy treatment of COVID-19 patients by the Homoeopathic medical officers (HMO) in Gujarat state-dedicated COVID-19 hospitals (DCH) during the first wave of the pandemic. The HMOs used the standard data collection forms/sheets to record each patient's demographic information, clinical symptoms, homoeopathic management, and outcome data. Data of all cases hospitalized with COVID-19 of any age, and both genders were included, and entries with missing values or incomplete/ incorrect information were excluded from the analysis. The outcome measure is the recovery duration, time to clinical improvement, worsening symptoms, and indicated homeopathic medicines. Data from 2581 cases analyzed showed clinical recovery time after adjunctive homeopathy as 05 days (IQR: 3-7); the Mean was 5.19 days (SD:4.62), with 80% of patients (2063 out of 2581) discharged between 0-7 days out of which more than 20.4% patients (419 out of 2063) having at least one of the comorbidities. Only 03 deaths of male patients above 50 years with comorbidities and 67 cases (2.6%) with worsening symptoms were reported. The homeopathic medicines used were &lt;em&gt;Arsenic album&lt;/em&gt; in 73.0% and &lt;em&gt;Bryonia alba&lt;/em&gt; in 17.6% of cases. Adjunctive Homoeopathy and standard care in COVID-19 patients had a promising role in the early relief of clinical symptoms and less progression into severity in the risk group of elderly patients with comorbidities. There were no reported adverse effects of taking the adjunctive Homoeopathy, making it a potential choice for integrated use in managing COVID-19 patients.

Risk and protective factors associated with mental health status in an Italian sample of students during the fourth wave of COVID-19 pandemic

BackgroundIt is well known that the COVID-19 pandemic has caused a global health crisis, especially for young people. However, most studies were conducted during the first waves of the pandemic. Few Italian studies specifically attempted to broadly assess young people’s mental health status during the fourth wave of the pandemic.MethodsThis study aimed at evaluating the mental health status among a group of Italian adolescents and young adults during the fourth wave of the COVID-19 pandemic. 11,839 high school students and 15,000 university students (age range 14–25) were asked to complete a multidimensional online survey, of which 7,146 (26,6%) agreed to participate. The survey also included standardized measures for depression, anxiety, anger, somatic symptoms, resilience, loneliness and post-traumatic growth. Two separate clusters were identified through cluster analysis. Random forest, classification tree and logistic regressions analyses were applied to identify factors associated to a good or a poor level of mental health and, thus, to define students’ mental health profiles.ResultsOverall, the students in our sample showed high levels of psychopathology. The clustering methods performed identified two separate clusters reflecting groups of students with different psychological features, that we further defined as "poor mental health" and "good mental health". The random forest and the logistic regressions found that the most discriminating variables among those two groups were: UCLA Loneliness Scale score, self-harm behaviors, Connor-Davidson Resilience Scale-10 score, satisfaction with family relationships, Fear of COVID-19 Scale score, gender and binge eating behaviors. The classification tree analysis identified students’ profiles, showing that, globally, poor mental health was defined by higher scores of loneliness and self-harm, followed by being of female gender, presenting binge eating behaviors and, finally, having unsatisfying family relationships.ConclusionsThe results of this study confirmed the major psychological distress caused by the COVID-19 pandemic in a large sample of Italian students, and provided further insights regarding those factors associated with a good or poor mental health status. Our findings suggest the importance of implementing programs targeting aspects that have been found to be associated to a good mental health.