International Emergency Research Articles

Emergence of SARS-CoV-2 Alpha lineage and its correlation with quantitative wastewater-based epidemiology data

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gave rise to an international public health emergency in 3 months after its emergence in Wuhan, China. Typically for an RNA virus, random mutations occur constantly leading to new lineages, incidental with a higher transmissibility. The highly infective alpha lineage, firstly discovered in the UK, led to elevated mortality and morbidity rates as a consequence of Covid-19, worldwide. Wastewater surveillance proved to be a powerful tool for early detection and subsequent monitoring of the dynamics of SARS-CoV-2 and its variants in a defined catchment. Using a combination of sequencing and RT-qPCR approaches, we investigated the total SARS-CoV-2 concentration and the emergence of the alpha lineage in wastewater samples in Vienna, Austria linking it to clinical data. Based on a non-linear regression model and occurrence of signature mutations, we conclude that the alpha variant was present in Vienna sewage samples already in December 2020, even one month before the first clinical case was officially confirmed and reported by the health authorities. This provides evidence that a well-designed wastewater monitoring approach can provide a fast snapshot and may detect the circulating lineages in wastewater weeks before they are detectable in the clinical samples. Furthermore, declining 14 days prevalence data with simultaneously increasing SARS-CoV-2 total concentration in wastewater indicate a different shedding behavior for the alpha variant. Overall, our results support wastewater surveillance to be a suitable approach to spot early circulating SARS-CoV-2 lineages based on whole genome sequencing and signature mutations analysis.

Clinical Characteristics of Patients Returning to Emergency Department With Initial False-Negative Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-Based COVID-19 Test.

The coronavirus disease 2019 (COVID-19) outbreak is an international public health emergency. Early identification of COVID-19 patients with false-negative RT-PCR tests is paramount in the ED to prevent both nosocomial and community transmission. This study aimed to compare clinical characteristics of repeat emergency department (ED) visits among coronavirus disease 2019 (COVID-19) patients with initial false-negative reverse transcriptase-polymerase chain reaction (RT-PCR)-based COVID-19 test. This is a retrospective, multi-center, cohort study conducted at 12 hospitals affiliated with Baylor Scott & White Health system. Patients visiting the EDs of these hospitals between June and August 2020 were screened. Patients tested negative for viral RNA by quantitative RT-PCR in the first ED visit and positive in the second ED visit were included. The primary outcome was the comparison of clinical characteristics between two consecutive ED visits including the clinical symptoms, triage vital signs, laboratory, and chest X-ray (CXR) results. A total of 88 confirmed COVID-19 patients with initial false-negative RT-PCR COVID-19 test in the ED were included in the final analyses. The mean duration of symptoms in the second ED visit was significantly higher (3.6 ± 0.4 vs. 2.6 ± 0.3 days, p = 0.020). In the first ED visit, lymphocytopenia (35.2%), fever (32.6%), nausea (29.5%), and dyspnea (27.9%) are the most common signs of COVID-19 infection during the window period. There were significant increases in the rate of hypoxia (13.6% vs. 4.6%, p = 0.005), abnormal infiltrate on CXR (59.7% vs. 25.9%, p < 0.001), and aspartate aminotransferase (AST) elevation (26.1% vs. 9.1%, p < 0.001) in the second ED visit. Early COVID-19 testing (less than 3 days of symptom duration) could be associated with a false-negative result. In this window period, lymphocytopenia, fever, nausea, and dyspnea are the most common early signs that can potentially be clinical hints for COVID-19 diagnosis.

Embedded Social Science and the British Government COVID-19 Response

The complex and evolving nature of the SARS-CoV-2 pandemic poses significant challenges to national and international emergency preparedness and response. Governments must navigate streams of emerging data in real time, synthesising knowledge from diverse sources to inform policy. The UK government drew on experiences from earlier pandemics to bridge perceived gaps between social science research and policy through the secondment of early-career academics as embedded scientists. In this article, we present comparative ethnographic data describing embedded social scientists’ contributions to UK COVID-19 preparedness and response. We find that the liminal position, loose identities, and high degree of autonomy of embedded scientists allowed these individuals to navigate multiple networks to strengthen and legitimise the role of social science within policy debates.

Effect of SARS-CoV-2 Entry Factors on Myeloid Cancers.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel, highly pathogenic coronavirus that has spread rapidly worldwide and caused an international public health emergency. Patients with hematological cancers are regarded as a high-risk group for coronavirus disease 2019 (COVID-19). However, few reports have investigated factors that might account for the differential severity of COVID-19 disease in these patients. Gene expression of SARS-CoV-2 entry-promoting factors and entry-restricting factors and the associated effects on myeloid malignancies were evaluated. Gene expression levels of 11 SARS-CoV-2 entry-promoting factors and 4 SARS-CoV-2 entry-restricting factors were analyzed in patients with myelodysplastic syndromes (MDS), chronic myeloid leukemia (CML), and acute myeloid leukemia and its subtypes. Expression levels of promoting and restricting factors were most affected in MDS. Specifically, 4 of the 11 analyzed SARS-CoV-2 entry-promoting factors were significantly increased (TMPRSS4, CD209, CLEC4G, and CTSB), and 2 of the 4 analyzed SARS-CoV-2 entry-restricting factors were significantly decreased (IFITM1 and IFITM2) in MDS. Patients with CML also exhibited a pattern of significant changes in SARS-CoV-2 entry-promoting and entry-restricting factors. Five of the 11 analyzed SARS-CoV-2 entry-promoting factors were significantly increased (ACE2, TMPRSS2, TMPRSS4, ANPEP, CD209), and 1 of the 4 analyzed SARS-CoV-2 entry-restricting factors was significantly decreased (LY6E) in CML. The present and past results highlight the importance of investigating SARS-CoV-2 entry-promoting factors and entry-restricting factors, because of their crucial role in determining the differential severity of COVID-19 disease.

Moxibustion for anorexia in COVID-19: A protocol for systematic review and meta-analysis.

Background:As the outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread over the world, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Besides typical respiratory symptoms and signs of COVID-19, digestive symptoms and liver injury have been frequently reported during the course of the disease. The purpose of this study was to evaluate the efficacy and safety of moxibustion in the treatment of anorexia in patients with COVID-19.Methods:According to the retrieval strategies, randomized controlled trials on moxibustion therapies for C19-A will be obtained from the China National Knowledge Infrastructure, WanFang Data, Chinese Scientific Journals Database, PubMed, Embase, and Cochrane Library, regardless of publication date or language. Studies will be screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed with the Markov chain Monte Carlo method and carried out with Stata 14.2 and WinBUGS 1.4.3 software. Ultimately, the quality of the evidence obtained from the results will be evaluated.Results:This study will evaluate whether moxibustion therapy can effectively treat anorexia in patients with COVID-19.Conclusion:This study will provide evidence for whether moxibustion therapy is beneficial to the treatment of anorexia in patients with COVID-19.Trial registration number:CRD42022302499

Abstracts from International Emergency Medicine Journals

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will...

Psychological Problems among Young Adults Due to Covid-19

Introduction: Covid-19 is an international public health emergency unprecedented in modern history and it causes several health and psychological problems among general population including high level of anxiety, depression and stress. The study was aimed to assess the psychological problems among young adults due to Covid 19. Research Methodology: A descriptive study was conducted at selected Panchayath of Alappuzha District, with the sample size of 50. Samples were selected through Non probability sampling technique using convenient sampling method. Data’s were collected by structured questionnaire, which comprises socio demographic variables, questions to assess the psychological well-being. Results: The study findings reveals that among 50 samples, majority of the subjects have moderate psychological problems (62%), remaining 38% percentage have mild psychological problems and none were affected severely. Conclusion: The current study findings concluded that there is high prevalence of psychological problems among young adults due to Covid 19 which emphasize the need for the health professionals including nurses to plan for the strategies to help the young adults to cope with the problems effectively.

Burnout Among First-Year Medical Students During COVID-19 Pandemic in Mexico: A Cross-sectional Study

Background: The coronavirus pandemic is an international public health emergency without precedence in modern history. It represents a challenge to the academic and psychological stability of students due to the changes it can cause in daily life. This study aimed to evaluate the prevalence and level of burnout in medical students caused by the academic and psychological instability that the pandemic represents. Methods: A cross-sectional prospective study was designed using the Maslach Burnout Inventory-Student Survey (MBI-SS). This evaluated the emotional exhaustion due to study demands, cynicism, and negative self-academic efficacy. This study was based in the school of medicine of the Universidad Autonoma de Nuevo Leon (UANL), in Monterrey, Mexico during the Spring semester 2020. Results: A total of 154 (93 women and 61 men) first-year medical students participated (response rate 36.4%). Burnout was identified in 14.9% (n=23), and high emotional exhaustion in 53.9% (n=83). Burnout was almost 4 times more likely to develop in men than in women (aOR = 4.8; 95% Confidence Interval=1.7-13.3) when considering age as a covariable in the multivariable model. Conclusion: Further epidemiological studies of burnout syndrome in medical students are needed, and schools should consider promoting mental health and making programs available for their students to help overcome the emotional and social challenges during the pandemic.

Bridging the gap between science and policy in global health governance

Over the past decades, the political tensions that regularly plague WHO have undermined its authority. Every time an international public health emergency has arisen, WHO has faced internal political gridlock.1 Confidence in the UN agency has dwindled with every health crisis. Today, no one disputes that the political functioning of WHO is an impediment to fulfilling its role as a global health crisis coordinator and promoter of science-based standards. The UN system is still dependent on world politics,2 the failings of which were far too evident during the first months of the COVID-19 crisis.

Knowledge, attitude, and practice of artificial intelligence in emergency and trauma surgery, the ARIES project: an international web-based survey

AimWe aimed to evaluate the knowledge, attitude, and practices in the application of AI in the emergency setting among international acute care and emergency surgeons.MethodsAn online questionnaire composed of 30 multiple choice and open-ended questions was sent to the members of the World Society of Emergency Surgery between 29th May and 28th August 2021. The questionnaire was developed by a panel of 11 international experts and approved by the WSES steering committee.Results200 participants answered the survey, 32 were females (16%). 172 (86%) surgeons thought that AI will improve acute care surgery. Fifty surgeons (25%) were trained, robotic surgeons and can perform it. Only 19 (9.5%) were currently performing it. 126 (63%) surgeons do not have a robotic system in their institution, and for those who have it, it was mainly used for elective surgery. Only 100 surgeons (50%) were able to define different AI terminology. Participants thought that AI is useful to support training and education (61.5%), perioperative decision making (59.5%), and surgical vision (53%) in emergency surgery. There was no statistically significant difference between males and females in ability, interest in training or expectations of AI (p values 0.91, 0.82, and 0.28, respectively, Mann–Whitney U test). Ability was significantly correlated with interest and expectations (p < 0.0001 Pearson rank correlation, rho 0.42 and 0.47, respectively) but not with experience (p = 0.9, rho − 0.01).ConclusionsThe implementation of artificial intelligence in the emergency and trauma setting is still in an early phase. The support of emergency and trauma surgeons is essential for the progress of AI in their setting which can be augmented by proper research and training programs in this area.

Covid-19 and energy sector: Unique opportunity for switching to clean energy

The novel coronavirus (2019-nCoV) was extended to 213 countries globally by August 2021. The world has been threatened by rising infection rates and emerged as the catastrophic event in the field of health triggering the international emergency panic button. COVID-19′s sudden arrival wreaked havoc on the world economic picture, particularly in the energy sector. A steep drop in oil prices, as well as an imbalance in energy, was the result of strict travel restrictions, fewer transportation options, and people's fears of a flu pandemic. However, confined mobility and a drop in energy demand coated the environment with a silver line and drowned the nation's economic opportunities. Industrial transport, and not to mention every conventional energy-related thing, is completely devastated, but renewables were immunized. Wind, solar, hydrothermal, hydrogen, biomass-based energy systems were on high gear yielding maximum results in counterbalancing the demand–supply chain.Moreover, the pandemic created an opportunity to showcase the importance of renewable energy and tackle the difficult emergency like now. In addition to this, the mindset of the investors was slowly fading away from conventional fuels and shifting towards renewable energy. However, it is too early to state the booming renewables at the moment, and no idea about its long-time survival. Thus, the present review gives a clear picture of the current status of fossils and renewables, the impact of a pandemic, energy investments, government policy standings, threats, and opportunities, and finally, the key takeaways avoiding energy scarcity in once a lifetime disaster situation.

How the ARCH Project Could Contribute to Strengthening ASEAN Regional Capacities on Disaster Health Management (DHM).

The Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) developed Regional Collaboration Drills (RCDs) and is proposing an ASEAN Academic Network to strengthen capacity in disaster health management (DHM) in ASEAN Member States (AMS), as well as developing a standard training curriculum in DHM. This study aims to clarify the impacts and sustainability of the ARCH Project. The four previous RCDs and the enhancement of academic activities were reviewed. The ARCH Project developed the RCDs with simulation exercises based on possible disaster scenarios in each host country to test and validate the capacity of AMS International Emergency Medical Teams (I-EMTs), the Standard Operating Procedure (SOP) for I-EMT coordination, and regional tools, as well as the relevant domestic SOPs of the host countries for receiving international assistance. Following the RCD in Thailand, three AMS: Viet Nam, Philippines, and Indonesia, all of which are considered disaster-prone, successfully hosted RCDs with significant improvements. The project also established a sub-working group (SWG) to develop a standard curriculum in DHM. Two curricula developments, the Basic Course on DHM and In-Country Course for Coordination on EMTs, are on-going as part of the project activity. The establishment of the ASEAN Academic Network and the ASEAN Institute for DHM (AIDHM) are currently in the endorsement process of the ASEAN health sector. The RCDs are very effective to test and to validate the SOP and regional tools developed, providing opportunities for AMS I-EMT to familiarize the tools, as well as for host countries to assess their coordination capacity for receiving international assistance and identifying the country's specific challenges, and verifying ASEAN regional coordination mechanism. The development of the standard curriculum can enhance regional capacity both in supporting disaster-affected countries and in receiving international assistance. A sustainable capacity development mechanism in DHM is envisaged through the establishment of the ASEAN Academic Network and AIDHM toward the goal of One ASEAN One Response.

How the ARCH Project has Contributed to the Development of the ASEAN Regional Collaboration Mechanism on Disaster Health Management.

This paper aims to clarify how the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) strengthened regional collaboration mechanisms on disaster health management (DHM) in ASEAN. The political process and the relevant documents of the ARCH Project were reviewed. The ARCH Project established the Regional Coordination Committee as a coordination platform for providing strategic direction to the project and strengthening the regional coordination of DHM. Also, the Project Working Groups and Sub-Working Groups were set up as implementation bodies for the project activities with representatives of ASEAN Member States (AMS). With support from DHM experts of Japan and Thailand, a series of discussions were conducted for the development of a Standard Operating Procedure (SOP) for the Coordination of International Emergency Medical Teams (I-EMTs), regional tools, and collective measures supporting AMS to overcome challenges, and thereby meeting the minimum requirements set by the WHO EMT Initiative. The progress and outputs of the ARCH Project are subsequently elevated to the ASEAN Health Sector for endorsement, the updates are further shared to the Joint Task Force to Promote Synergy with Other Relevant ASEAN Bodies on Humanitarian Assistance and Disaster Relief (JTF-HADR) for the implementation of the ASEAN Declaration on One ASEAN One Response. The initiation of the ARCH Project in July 2016 has resulted in the development of the ASEAN regional collaboration framework, including the establishment of the Regional Coordination Committee on Disaster Health Management (RCCDHM), the SOP for ASEAN I-EMT coordination, and regional tools, such as forms for Medical Record for Emergency and Disaster and Health Needs Assessment. Moreover, further discussions on ASEAN Collective Measures that aim to support AMS to meet the WHO EMT minimum standards and strengthening I-EMT coordination capacity were also conducted. As adopted by the ASEAN Health Ministers Meeting (AHMM) in 2019, the RCCDHM was established as one of the mechanisms to operationalize the Plan of Action to implement the ASEAN Leaders' Declaration on DHM. The contribution of the ARCH Project to strengthen the ASEAN regional capacity in DHM has enhanced the regional coordination platform, with a formalization of RCCDHM as ASEAN's official regional mechanism, and of the on-going integration process of the SOP for EMT coordination into the ASEAN SASOP.

Beyond Dialogue

Beyond Dialogue is a subtheme of Levinas’ work of alterity &amp; transcendence. It is his philosophical deliberation and reflection on the Judea-Christian discord. In his philosophy of dialogue Levinas takes a deep look at the core points of Seelisberg Conference of 1947 – International Emergency Conference on Anti-Semitism. He reflects on why dialogue has not ceased the contention between the Jews and the Christians. Through this article I am going to elucidate Levina’s philosophical notions of dialogue. There are two principal questions I put on the table of discourse: Why does Levinas emphasize the principle of ‘beyond dialogue’ in his notion of philosophy of dialogue? What is the ‘ethical foundation’ of dialogue in the face of conflicts of identity? This article aims to examine Levinas’ ideas of philosophy of dialogue, and also to invite the readers to draw out the insights relevant in comprehending as well as in responding to social conflicts in nowdays that Levinas contributes through his philosophical reflection.

Contribution in the scientific production of Peruvian universities against COVID-19

Humankind is living more than a year in a COVID-19 pandemic. Faced with this international health emergency situation, scientific research is a tool to combat it. Universities, which must contribute human knowledge, are called upon to do research to combat COVID-19 in different aspects. This work analyses which Peruvian universities have contributed the most to developing projects and publications related to COVID-19. The results show that it is mainly the universities in the capital, Lima, that have won funds from the government to develop projects Keywords: COVID-19, Coronavirus, SARS-Cov2, Scientific Research, Peru, Funding, Research projects.

Abstracts from international emergency medicine journals

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will...

Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section.

Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.

Effects of the Covid-19 Pandemic on the Environment and Proposals for Sustainable Strategies

The outbreak of the coronavirus pandemic (COVID-19) first occurred in late December 2019 at the Hunan Seafood Market in Wuhan, China, and was declared an international public health emergency in a matter of weeks by the World Health Organization. The coronavirus disease (COVID-19) affects every area of human life, including the environment. Measures are taken to control the spread of the virus and the slowdown in economic activities have significant positive effects on the environment. Through this study, the authors intend to track the impact caused by the COVID-19 pandemic on the environment by analyzing the available scientific literature. The study indicates that the pandemic situation significantly improves air quality in various cities around the world, reduces greenhouse gas emissions, reduces water pollution and noise, and reduces pressure on tourist destinations, which can help restore ecological systems. It is noted that there are some negative consequences of the pandemic, such as the increase in medical waste through the use and disposal of disinfectants, masks, and gloves but also the burden of untreated waste that endangers the environment continuously. It seems that shortly after the pandemic the economic activities will return and the situation could change. Therefore, this study highlights the potential positive impacts of the pandemic on the environment in the long term. It is expected that the correct implementation of the proposed strategies can be useful for the global sustainability of the environment.

Assessment of indicators on drinking water, sanitation, and hygiene (WASH) practices from rural schools of Kathua.

Safe and adequate water supply and sanitation in schools are prerequisites for right to basic education for school children. The provision of water, sanitation, and hygiene (WASH) facilities has been linked to the achievement of Sustainable Development Goals. The objective of this study is to assess the indicators of WASH in schools falling under the Rural Health and Training Centre (RHTC), Budhi, GMC Kathua. A cross-sectional study was conducted during a period of two months in the month of September 2019 to October 2019. It was done in the rural area under CHC Nagri Parole Kathua. The total number of schools under CHC is 981. Interview of the head of the school was done using world health organization (WHO) and united nations international children's emergency fund (UNICEF) Standardized Questionnaire for WASH Practices. The Questionnaire includes core and expanded questions on drinking water, sanitation, and hygiene practices. Data were entered in Microsoft Excel and descriptive statistics was analyzed in the form of number and percentages. Out of total 139 schools, 57.72% schools had basic drinking water facilities. Only 29.11% schools have basic hand-washing facilities with soap and water; 81.29% of the schools have improved toilets. Political will and financing and effective delivery of interventions will be required to ensure universal access to WASH in schools.

A cross-sectional study on socio-ecological and socio-anthropological determinants of COVID-19 in Lusaka Province of Zambia

The COVID-19 disease constitutes a pandemic that has created an international public health emergency. Besides the significant health challenges, the impact of the COVID-19 disease has been the restriction of movements that have heavily affected the global economy. The first case of COVID-19 in Zambia was identified on March 18th, 2020. By the end of November 2020, the number of districts reporting COVID-19 infections had increased from 68 to 96, with reports of the highest transmission in the capital city, Lusaka, the Copperbelt, and Ndola districts. As COVID-19 spread across the nation of Zambia, several factors are responsible for the spread of the virus. Despite the extensive collection of research done on determinants of COVID-19 disease, the spatial distribution of the disease along socio-demographical and socio- ecological domains remains speculative and infectious diseases have been less looked into in the areas of anthropological dynamics. This study used a cross-sectional design to investigate the ecological and anthropological determinants of COVID-19 disease in four compounds in the Lusaka district of Zambia. A guided questionnaire was used to collect data from 301 participants. A descriptive analysis of all independent variables was done. Analysis for associations of dependent and independent variables and multivariate analysis of the independent variables significant at the bi-variate level was conducted to investigate the association between the dependent variable (Knowledge of anyone infected with COVID-19 virus) and the independent variables. The bi-variate analysis results showed that 14 independent variables with odds ratios greater than one were significantly associated with the spread of COVID-19. Two variables were found to be highly significant in the multivariable logistic regression analysis model. These included beliefs about COVID-19 (odds = 3.0; p = 0.003; CI 1.2-3.3), and participants area of residence (odds = 2.6; p = 0.003; CI = 1.2-5.5). Other significant multivariate variables were ecological variable; climate and anthropological variables; hand hygienic practices. The current research provides further insight into the potential role ecology and anthropology contribute to the spread of communicable diseases. The study recommends awareness of the population to enhance preparedness and response to reduce the spread of COVID-19.