Epidemic Context Research Articles

Factors related to perceived stress during the COVID-19 epidemic context among the general population in China: A cross-sectional nationwide study

BackgroundThis study aimed to investigate factors related to high stress levels among the general population in China during the novel coronavirus disease (COVID-19) pandemic when its containment measures were in place and to identify the most stressed populations. MethodsA nationwide study was conducted online among 5,039 adults in all 31 provinces in mainland China between March 1 and March 16, 2020. Bivariate analysis and multivariate logistic regressions were performed to explore the related factors of high perceived stress. ResultsAmong all respondents, 36.0% reported a high level of stress. Respondents in Hubei province (the epicenter) were more likely to report high stress levels than those in low epidemic areas. Respondents who went outside every day or every other day reported greater odds of experiencing a high level of stress than those who went outside every 8–14 days. People with higher risk perceptions were more prone to report high stress levels. Respondents aged 16–35 were more likely to report high stress than respondents aged 46 or older. Lower household income and lower health literacy were related to increased odds of reporting high stress levels. LimitationsWe used a convenience sample and self-reported survey data. ConclusionsWe identified risk factors for high stress levels related to the epidemic (epidemic intensity in residential areas, risk perception, and frequency of going outside) and other vulnerabilities (younger age, low household income, low health literacy). Our findings can directly inform interventions and policies for mitigating stress among the general population for this or future epidemics.

Zoonoses and global epidemics.

The purpose of the review is to summarize recent advances in understanding the origins, drivers and clinical context of zoonotic disease epidemics and pandemics. In addition, we aimed to highlight the role of clinicians in identifying sentinel cases of zoonotic disease outbreaks. The majority of emerging infectious disease events over recent decades, including the COVID-19 pandemic, have been caused by zoonotic viruses and bacteria. In particular, coronaviruses, haemorrhagic fever viruses, arboviruses and influenza A viruses have caused significant epidemics globally. There have been recent advances in understanding the origins and drivers of zoonotic epidemics, yet there are gaps in diagnostic capacity and clinical training about zoonoses. Identifying the origins of zoonotic pathogens, understanding factors influencing disease transmission and improving the diagnostic capacity of clinicians will be crucial to early detection and prevention of further epidemics of zoonoses.

Changing readiness to mitigate SARS-CoV-2 steered long-term epidemic and social trajectories

Societal responses crucially shape the course of a pandemic, but are difficult to predict. Mitigation measures such as social distancing are here assumed to minimize a utility function that consists of two conflicting sub-targets, the disease related mortality and the multifaceted consequences of mitigation. The relative weight of the two sub-targets defines the mitigation readiness H, which entails the political, social, and psychological aspects of decision making. The dynamics of social and behavioral mitigation thus follows an adaptive rule, which in turn is mediated by a non-adaptive dynamics of H. This framework for social dynamics is integrated into an epidemiological model and applied to the ongoing SARS-CoV-2 pandemic. Unperturbed simulations accurately reproduce diverse epidemic and mitigation trajectories from 2020 to 2021, reported from 11 European countries, Iran, and 8 US states. High regional variability in the severity and duration of the spring lockdown and in peak mortality rates of the first SARS-CoV-2 wave can be explained by differences in the reconstructed readiness H. A ubiquitous temporal decrease of H has greatly intensified second and third waves and slowed down their decay. The unprecedented skill of the model suggests that the combination of an adaptive and a non-adaptive rule may constitute a more fundamental mode in social dynamics. Its implementation in an epidemic context can produce realistic long-term scenarios relevant for strategic planning, such as on the feasibility of a zero-infection target or on the evolutionary arms race between mutations of SARS-CoV-2 and social responses.

Deep Learning on Chest X-ray Images to Detect and Evaluate Pneumonia Cases at the Era of COVID-19.

Coronavirus disease 2019 (COVID-19) is an infectious disease with first symptoms similar to the flu. COVID-19 appeared first in China and very quickly spreads to the rest of the world, causing then the 2019-20 coronavirus pandemic. In many cases, this disease causes pneumonia. Since pulmonary infections can be observed through radiography images, this paper investigates deep learning methods for automatically analyzing query chest X-ray images with the hope to bring precision tools to health professionals towards screening the COVID-19 and diagnosing confirmed patients. In this context, training datasets, deep learning architectures and analysis strategies have been experimented from publicly open sets of chest X-ray images. Tailored deep learning models are proposed to detect pneumonia infection cases, notably viral cases. It is assumed that viral pneumonia cases detected during an epidemic COVID-19 context have a high probability to presume COVID-19 infections. Moreover, easy-to-apply health indicators are proposed for estimating infection status and predicting patient status from the detected pneumonia cases. Experimental results show possibilities of training deep learning models over publicly open sets of chest X-ray images towards screening viral pneumonia. Chest X-ray test images of COVID-19 infected patients are successfully diagnosed through detection models retained for their performances. The efficiency of proposed health indicators is highlighted through simulated scenarios of patients presenting infections and health problems by combining real and synthetic health data.

Anthropology of Infectious Death

RésuméComment s'adaptent les rituels funéraires lorsque le décès est d'origine infectieuse, ou lorsque la mort survient en contexte épidémique? Quelles modifications sont nécessaires? Quels fondamentaux anthropologiques sont écornés, détournés ou pris à contre sens? On verra, dans les exemples pratiques de terrain et historiques choisis, comment la communauté des vivants s'arrange avec ses peurs et ses exigences métaphysiques vis-à-vis de la communauté des défunts, composant avec les codes et les croyances. Bref, comment s'établissent des rituels parallèles permettant de contenter les deux parties.

Collective Critical Care Ambulance: an innovative transportation of critical care patients by bus in COVID-19 pandemic response

BackgroundDuring the COVID-19 pandemic, as the number of available Intensive Care beds in France did not meet the needs, it appeared necessary to transfer a large number of patients from the most affected areas to the less ones. Mass transportation resources were deemed necessary. To achieve that goal, the concept of a Collective Critical Care Ambulance (CCCA) was proposed in the form of a long-distance bus re-designed and equipped to accommodate up to six intensive care patients and allow Advanced Life Support (ALS) techniques to be performed while en route.MethodsThe expected benefit of the CCCA, when compared to ALS ambulances accommodating a single patient, was to reduce the resources requirements, in particular by a lower personnel headcount for several patients being transferred to the same destination. A foreseen prospect, comparing to other collective transportation vectors such as airplanes, was the door-to-door capability, minimalizing patients’ handovers for safety concerns and time efficiency.With the project of a short-distance transfer of several Intensive Care Unit (ICU) patients together, the opportunity came to test the CCCA under real-life conditions and evaluate safely its technical feasibility and impact in time and resources saving, before it could be proposed for longer distances.ResultsFour COVID-19 patients were transported over 37 km. All patients were intubated and under controlled ventilation. One of them was under Norepinephrine support. Mean loading time was 1 min 39 s. Transportation time was 29 min. At destination, the mean unloading time was 1 min 15 s. No serious adverse effect, in particular regarding hemodynamic instability or ventilation disorder, has been observed. No harmful incident has occurred.ConclusionsIt was a very instructive test. Collective medical evacuation by bus for critically ill patients under controlled ventilation is suitable and easy to implement. Design, ALS equipment, power autonomy, safety and resources saving, open the way for carrying up to 6 ICU-patients over a long distance. The CCCA could bring a real added-value in an epidemic context and could also be helpful in many other events generating multiple victims such as an armed conflict, a terrorist attack or a natural disaster.

Retour d’expérience de la mise en place d’une ligne de régulation psychiatrique au SAMU 62 dans le contexte Covid-19

The epidemic context of Covid-19 and the containment measures, put in place since 16 March 2020, has significantly increased the number of emergencies calls in call center (SAMU). In the department of Pas-de-Calais, one step of the crisis measures was setting up a psychiatric regulation line, which aims to manage calls with strong emotional valence (in connexion with containment, anxiety related to the epidemic context, or break in psychiatric cares for people suffering of mental disorders). This psychiatric hotline was provided from 20 March 2020 to 15 May 2020 by fifteen psychiatric careers (psychiatrists, psychologists and psychiatric nurses) from the network of the medical-psychological emergency unit (unit of the emergency call center which aims to manage people involved in psychotraumatic events). In total, 556 calls were answered, i.e. an average of 9,8 calls per day. The typology of calls was in a quarter of the cases anxiety related to the fear of being infected, in the second quarter, adjustment disorders related to containment, and for about half of the calls, psychiatrics symptoms whether it was preexisting and increased by the discontinuation of care, or context-induced. The benefits identified by this device were as follows: -the discharge of time-consuming calls for the medical dispatcher assistant, -the expertise of a mental health professional, knowing the mental health network, to make the decision more fluid. Last but not least, it is interesting to note that the presence of the psychiatric regulator in the regulation room allowed a transfer of calls and a reciprocal acculturation. In view of the relevance of the establishment of a psychiatric regulation line in the epidemic context of Covid-19, it seems interesting to consider the sustainability of this system, which is part of a global context of evolution of the provision of emergency care.

“Locked down outside”: Perception of hazard and health resources in COVID-19 epidemic context among homeless people

While social inequality is widely recognised as being a risk factor for COVID-19 infection or serious forms of the disease, many questions still remain concerning the perception of hazard and protective measures by the most vulnerable populations.This mixed-methods study aimed (1) to describe the self-perceived health and protective measures linked to COVID-19 of homeless people in one of the largest and poorest cities in France, and (2) to assess which skills and resources they used to address the COVID-19 pandemic. The quantitative survey addressed these questions among a sample of 995 homeless people living either on the streets, in homeless shelters or in squats/slums, whereas the qualitative survey was constructed from 14 homeless interviewees. Both data collections were carried out between June and July 2020.Results showed that COVID-19 infection was clearly perceived by homeless people as a risk, but the experience of being homeless placed this risk among several others. Different practices of protection were observed according to the type of living place. Lockdown of the general population severely impacted the survival systems of the populations furthest from housing, with alarming rates of people without access to water or food. 77% of homeless participants reported that they encountered significant financial difficulties. All interviewees were particularly attentive to their health, with awareness and even a familiarity with the risks of infectious diseases long before the pandemic.Using a capability framework, our study showed a predominant lack of external health-related resources for homeless people, while internal health-related resources were more developed than expected. None of the places and lifestyles studied was favourable to health: collective shelters due to a greater restriction of people's choices, slums and street life due to a greater lack of basic resources.

Role and Tasks of the Occupational Physician during the COVID-19 Pandemic.

Background and Objectives: The first clusters of SARS-CoV-2 infection were identified in an occupational setting, and to date, a significant portion of the cases may result from occupational exposure; thus, COVID-19 should also be considered a new occupational risk that both directly and indirectly impacts the health of workers. Given the significance of occupational-exposure-related infections and deaths, this study aims to assess the roles and tasks of occupational physicians (OPs) in countering the spread of the infection. Indeed, despite the OP’s centrality in risk management in the workplace, its activity in the current epidemic context has rarely been mentioned. Materials and Methods: Three different databases (PubMed, Google Scholar, and Embase) were questioned using the main keywords “COVID-19” and “SARS-CoV-2” that were crossed, according to different needs, with the terms “occupational medicine”, “occupational physician”, “workplace”, and “risk assessment” using, when possible, the MeSH database research. Additionally, a systematic research of the regulatory changes of workplaces health surveillance was performed on reference sites of international, European, and Italian authorities. Results: Fundamental tasks and duties of OPs in the current COVID-19 outbreak are highlighted by examining their clinical activity and technical action. A risk assessment and management workflow is proposed, and medico-legal implications in case of infection at work are also discussed in the light of recent regulatory changes that clearly attribute to OPs an important role in safeguarding public health. Conclusion: The proposed approach can provide new instruments to contrast the spread of the infection as part of a comprehensive system response to the current pandemic, for which OPs are called to assume full responsibility.

Cardiac Safety of Hydroxychloroquine-Azithromycine for COVID-19 Patients: Pandemic Experience of Military Teaching Hospital of Rabat

Introduction: While recent studies are still arguing the efficacy of Hydroxychloroquine and Azithromycin to heal patients with SARS-CoV-2 infection, Moroccan’s ministry of health has decided to maintain the protocol using these drugs. The main objective of this study is to characterize the degree and risk of QT prolongation in patients with COVID-19 in association with their use. Methods: This study is a cohort performed at Mohammed V Military Hospital of Rabat, of patients hospitalized with at least 1 positive COVID-19 nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) test result, and who received 10 day of hydroxychloroquine with 7 days of azithromycin from May9 through May26, 2020. Hydroxychloroquine was given orally at 200 mg TID. Azithromycin was given at a dose of 500 mg the first day followed by 250 mg daily for 6 days. Electrocardiogram was performed before the prescription, 2 days after and at the end of treatment. Results: During this period, 327 ECGs were studied, representing 109 unique patients. Their median age was 30 [25.5-44] years and 100% were male. All patients developed a paucisymptomatic form of the virus. Tisdale score varied between 6 and 8 points (89.9%-10.1%). The difference ΔQTc was significant (p<0.01) from day 0 to 10 with a ΔQTc of 16.15 ms. However, the maximal QTc hadn’t exceed 500 milliseconds. None of the patients developed torsades de pointes or any other ventricular arrhythmias. Conclusion: Moroccan experience can reassure the prescribers on the safety of use of this drug combination in the threatening epidemic context.

CD169 and CD64 could help differentiate bacterial from CoVID-19 or other viral infections in the Emergency Department.

The identification of a bacterial, viral, or even noninfectious cause is essential in the management of febrile syndrome in the emergency department (ED), especially in epidemic contexts such as flu or CoVID‐19. The aim was to assess discriminative performances of two biomarkers, CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), using a new flow cytometry procedure, in patients presenting with fever to the ED during epidemics. Eighty five adult patients presenting with potential infection were included during the 2019 flu season in the ED of La Timone Hospital. They were divided into four diagnostic outcomes according to their clinical records: no‐infection, bacterial infection, viral infection and co‐infection. Seventy six patients with confirmed SARS‐CoV‐2 infection were also compared to 48 healthy volunteers. For the first cohort, 38 (45%) patients were diagnosed with bacterial infections, 11 (13%) with viral infections and 29 (34%) with co‐infections. mCD169 was elevated in patients with viral infections, with a majority of Flu A virus or Respiratory Syncytial Virus, while nCD64 was elevated in subjects with bacterial infections, with a majority of Streptococcus pneumoniae and Escherichia coli. nCD64 and mCD169 showed 90% and 80% sensitivity, and 78% and 91% specificity, respectively, for identifying patients with bacterial or viral infections. When studied in a second cohort, mCD169 was elevated in 95% of patients with SARS‐CoV‐2 infections and remained at normal level in 100% of healthy volunteers. nCD64 and mCD169 have potential for accurately distinguishing bacterial and acute viral infections. Combined in an easy and rapid flow cytometry procedure, they constitute a potential improvement for infection management in the ED, and could even help for triage of patients during emerging epidemics.

Genome Sequencing of Sewage Detects Regionally Prevalent SARS-CoV-2 Variants.

Viral genome sequencing has guided our understanding of the spread and extent of genetic diversity of SARS-CoV-2 during the COVID-19 pandemic. SARS-CoV-2 viral genomes are usually sequenced from nasopharyngeal swabs of individual patients to track viral spread. Recently, RT-qPCR of municipal wastewater has been used to quantify the abundance of SARS-CoV-2 in several regions globally. However, metatranscriptomic sequencing of wastewater can be used to profile the viral genetic diversity across infected communities. Here, we sequenced RNA directly from sewage collected by municipal utility districts in the San Francisco Bay Area to generate complete and nearly complete SARS-CoV-2 genomes. The major consensus SARS-CoV-2 genotypes detected in the sewage were identical to clinical genomes from the region. Using a pipeline for single nucleotide variant calling in a metagenomic context, we characterized minor SARS-CoV-2 alleles in the wastewater and detected viral genotypes which were also found within clinical genomes throughout California. Observed wastewater variants were more similar to local California patient-derived genotypes than they were to those from other regions within the United States or globally. Additional variants detected in wastewater have only been identified in genomes from patients sampled outside California, indicating that wastewater sequencing can provide evidence for recent introductions of viral lineages before they are detected by local clinical sequencing. These results demonstrate that epidemiological surveillance through wastewater sequencing can aid in tracking exact viral strains in an epidemic context.

Intersensorial translation of coughing-and-sneezing in an epidemic social context

The British Ministry of Health’s poster campaign Coughs and Sneezes Spread Diseases brought World War II to the British home front by making it personal and served as a visual call to arms for civilians. Although involving visual materials, the campaign provides a case for examining how posters engage people’s extra-visual senses in responding to this call. By using the concepts of intersensoriality and synaesthetic metaphor, we discuss the possibility of enhancing the audience experience of print posters by associating verbal and visual language with the rest of the senses. Premised on the assumption that it is possible to establish an interrelation between the senses related to sneezing, we argue that, once synchronized, all associated senses may increase the perception of propaganda experienced in the poster campaign.

P163 Effects of the SARS-CoV-2 pandemic on attendance at the cystic fibrosis centre and the definition of the microbiological status of cystic fibrosis patients in Tuscany

Objectives: The SARS-CoV-2 pandemic and the consequent lockdown periods have profoundly changed the health habits of patients. The fear of the viral infection as well as the reorganisation of staff within the health services due to the pandemic caused a drop in patients’ attendance at CF centres. This resulted in a decrease in cultures performed, on which the definition of microbiological status is based. The ECFS definition of patients’ microbiological status (mainly the definition of chronic P. aeruginosa infection) is based on the modified Leeds criteria (>50% of the samples positive, at least 4 samples collected) or significantly raised anti-Pa antibodies. Following the different lockdown periods imposed in Tuscany in 2020 (March 9th – May 18th) we verified: • the number of outpatient visits to the Centre • the number of cultures performed compared with previous years • compliance with the criteria suggested by disease registries/standards of care for the definition of chronic infection • the utility of anti-Pa serology in the correct definition of chronic Pain the epidemic context Methods: Retrospective study on data regarding outpatient examinations, number of cultures performed and serology tests. Results: Outpatients’ attendance at the Centre (2020) [Table presented] % of patients with at least 4 cultures performed yearly. [Table presented] In 2020 we observed a significant reduction (p <0.05) in the mean number of cultures per patient and in the percentage of patients who performed at least 4 cultures. During 2020, 108 (29.2%) patients with fewer than 4 cultures performed Pa serology, 25 (23.1%) tested positive, completing the definition required by the ECFS. Conclusions: The SARS-CoV-2 infection caused a drop in patients’ attendance at the centre, compromising the correct definition of Pa chronic infection based on the number of cultures. In the pandemic context, serology could be a useful complementary test to correctly fulfill the ECFS definition. Funding: Regione Toscana K38

Ethical considerations of the dynamics of clinical trials in an epidemic context: Studies on COVID-19

The COVID-19 epidemic has led to the intense mobilization of all health professionals, including those involved in research. From the very beginning, research ethics committees (RECs) have been called upon and mobilized to carry out the scientific and ethical evaluations of research projects to achieve a sound analysis of their risk/benefit balance. The aim of this article is to present an ethical reflection on the challenges and consequences of the fast-track procedure for the evaluation of COVID-19 research projects in the context of a public health emergency. Indeed, a large number of protocols of reduced rigor were hastily prepared without collaboration between researchers and in the absence of national regulation. As a result, a number of ethical dilemmas have emerged concerning the opposing needs of pragmatism imposed by the emergency context and the ethical principles that should govern the conduct of research. Moreover, the dispersion of these individual projects, aggravated by excessive media coverage of specific treatments, has resulted in a weakened impact of the research in the epidemic context. This article provides suggestions for the ethical management of ongoing and upcoming research, giving RECs the opportunity to adapt their evaluations to avoid allowing the pragmatism of the emergency context to subvert the inviolability of the epistemological and ethical principles of research on humans. This reflection may strengthen the ethical basis for the formulation of their decisions.

Birth experience during COVID-19 confinement (CONFINE): protocol for a multicentre prospective study

IntroductionThe absence of companionship during childbirth is known to be responsible for negative emotional birth experience, which can increase the risk of postpartum depression and post-traumatic stress disorder. The context...

Multi-source information fusion and deep-learning-based characteristics measurement for exploring the effects of peer engagement on stock price synchronicity

By combining financial information from the financial market with social textual information from social media, we apply a two-level information fusion approach to examine the effects of peer engagement on social media on stock price synchronicity and compare the effects between epidemic and non-epidemic contexts. On the first level, single pieces of information are fused at the firm-year level and deep learning models are used to measure the characteristics of peer engagement – informativeness, diversity, information diffusion degree, and expert proportion – which are constructed grounded in the theory of the wisdom of crowds (WoC). On the second level, all measurements at the firm-year level are fused into a full sample to conduct regression analysis. The experimental results show that peer engagement reduces stock price synchronicity. This suggests that high synchronicity could be mitigated through effective guidance from peer engagement activities. We also find that during epidemics, synchronicity is much higher, and group diversity and experts have stronger effects in lowering synchronicity, while the effects of informativeness and information diffusion are hampered. This has implications for combatting the adverse effects of epidemic outbreaks on financial markets.

COVID-19 Australia: Epidemiology Report 29: Fortnightly reporting period ending 8 November 2020.

Nationally, there was a continuing downward trend in notifications of COVID-19. The daily average number of cases for this reporting period was nine, compared to an average of 14 cases per day in the previous fortnight. There were 123 cases of COVID-19 and two deaths this fortnight, bringing the cumulative case count to 27,743 and 904 deaths. New South Wales reported the highest proportion of cases this fortnight (56%; 69/123), the majority of which were overseas acquired (54). Locally-acquired cases accounted for 15% (18/123) of all cases reported this fortnight. Victoria has seen a continuing decline of cases: at the end of this reporting period, 10 days had passed since the last locally-acquired case was reported in this jurisdiction. Testing rates increased during the reporting period and remain high overall at 11.0 tests per week per 1,000 persons. There was variability in the testing rate by jurisdiction, with testing rates depending on the epidemic context. The overall positivity rate for the reporting period was 0.03%, with the Northern Territory reporting a positivity rate of 0.12% for this reporting period. In all other jurisdictions the positivity rate was ≤ 0.06%.

Integrated multi-item packaging and vehicle routing with split delivery problem for fresh agri-product emergency supply at large-scale epidemic disease context

Fresh agri-product emergency supply is crucial to secure the basic livelihood of residents at large-scale epidemic disease context. Considering the massive demand and limited transportation resources, this study integrates multi-item packaging and vehicle routing with split delivery to improve the emergency supply capacity. Firstly, three specific objectives of fresh agri-product emergency supply at large-scale epidemic disease context are formulated, i.e., average response time, infectious risk possibility and transportation resource utilization. Then, a multi-item packaging strategy is proposed to consolidate different categories of fresh agri-products according to the food cold chain temperatures. An optimization model integrating multi-item packaging and vehicle routing with split delivery is developed to jointly decide the optimal packaging scheduling, vehicle assignment and delivery routing. Next, an improved genetic algorithm based on solution features (IGA-SF) is designed to solve the integrated model with multiple decision variables. Finally, a case on fresh agri-product emergency supply of Huangpi District, Wuhan in the context of the Corona Virus Disease 2019 (COVID-19) is carried out to illustrate the efficiency and feasibility of the proposed model. The numerical results of medium-to-largescale cases demonstrate that the proposed IGA-SF could save 23.91% CPU time and 37.80% iteration number on average than genetic algorithm. This study could satisfy different emergency scenario requirements flexibly, and provide scientific decision support for provincial and national governments on fresh agri-product emergency supply.

COVID-19 Australia: Epidemiology Report 28: Fortnightly reporting period ending 25 October 2020.

Nationally, there was a continuing downward trend in notifications of COVID-19. The daily average number of cases for this reporting period was 13 compared to an average of 18 cases per day in the previous fortnight. There were 176 cases of COVID-19 and 7 deaths this fortnight, bringing the cumulative case count to 27,582 and 905 deaths. New South Wales reported the highest proportion of cases this fortnight (42%; 74/176), the majority of which were overseas acquired (52). Locally-acquired cases accounted for 31% (54/176) of all cases reported this fortnight. While the majority of these were reported from Victoria (33/54), there continues to be a decrease in new cases in this state resulting from public health interventions. Testing rates increased during the reporting period and remain high overall at 10.3 tests per week per 1,000 persons. There was variability in the testing rate by jurisdiction, with testing rates depending on the epidemic context. The overall positivity rate for the reporting period was 0.05%, with Western Australia reporting a positivity rate of 0.21% for this reporting period. In all other jurisdictions the positivity rate was ≤ 0.06%.