Public Health Prevention Measures Research Articles

Pathogenic Mechanisms of the Severe Acute Respiratory Syndrome Coronavirus 2 and Potential Direct and Indirect Counteractions by Intermittent Fasting.

The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented burden on human health and on the function and interaction of societies across the globe. Public health preventive measures, vaccines, and antivirals were key components of the world-wide response to the health emergency. Due to the uncoordinated and variably successful response to COVID-19 and the ability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to rapidly mutate, SARS-CoV-2 continues to create considerable difficulty for humanity today. Additional preventive or therapeutic modalities are needed to help people to achieve the best possible health outcomes in the context of the evolving COVID-19 threat. Intermittent fasting is a potential complementary therapy that not only impacts chronic disease risk but also has good evidence of an impact on infectious diseases. While the data regarding fasting and COVID-19 outcomes are very limited, the conceptual connection of fasting to better outcomes includes a variety of mechanisms in human biology. This paper reviews the known mechanisms of disease impacted by SARS-CoV-2 infection and the potential or likely direct or indirect counteractions that fasting may provide that may reduce the severity of COVID-19 and help to realize the best possible health outcomes. Furthermore, fasting adds no financial cost to a care plan and, when practiced safely, is available to most adults without limitation. Further research is needed on the impact of intermittent fasting on human health in the fight against infectious diseases including COVID-19.

COMMUNITY MOBILITY PATTERNS OF OLDER ADULTS DURING THE COVID-19 PANDEMIC

Abstract The COVID-19 pandemic has had appreciative impacts on the lives of older adults. At various times during the pandemic, Canadian provinces put in place public health measures to prevent the spread of the virus, including closures of non-essential businesses and services. The Candrive Driving Cessation sub-study is a 12-year, mixed methods, longitudinal study. During the COVID-19 pandemic, participants from four sites (n=124, mean age=85.5 years) were asked to report how their community mobility patterns during the pandemic compared with before the pandemic. They also completed the COVID-19 Anxiety Syndrome Scale and the Assessment of Readiness for Mobility Transition (ARMT) tool. The results indicated that during the pandemic, participants were less likely to drive (χ2=7.11, p=.004) or ride a public bus (χ2=20.05, p<.001) when leaving their home. During the pandemic, they reported fewer trips to the supermarket (χ2=99.00, p<.001) and fewer visits with family (χ2=68.00, p=.001). We observed a statistically significant relationship between COVID-19 Anxiety Syndrome Scale scores and ARMT (Anticipatory Anxiety subscale; r= .810, p<.001), such that higher COVID-19-related anxiety was associated with greater anxiety related to anticipating changes in mobility. These results emphasize the impacts of the COVID-19 pandemic on the mobility patterns of older adults. Promoting community mobility for older adults alongside preventative public health measures is essential.

2195. Etiologies of medically attended acute respiratory infections among young Ecuadorian children prior to the start of the 2020 SARS-CoV-2 pandemic

Abstract Background Data regarding respiratory pathogen epidemiology in the tropical country of Ecuador are limited. Here, we describe the temporal patterns and etiologies of medically attended acute respiratory infections among Ecuadorean children during the 20-month period preceding the onset of the 2020 SARS-CoV-2 pandemic. Methods Children < 5 years old presenting to a designated outpatient clinic with at least 2 new symptoms consistent with an acute respiratory infection are eligible for enrollment. Informed consent is obtained. Demographic and clinical details are collected. A nasopharyngeal sample is collected for diagnostic testing of 22 target pathogen groups using Biofire’s Respiratory Panel v1.7 multiplex polymerase chain reaction assay. Results Of the 820 subjects enrolled between July 15, 2018 and March 15, 2020, 655 (80%) tested positive for at least one pathogen. The detection of pathogens was more likely from samples collected from children enrolled in Quito (85%) compared to Machala (76%) (p < 0.05). The most frequently detected pathogen groups were rhinovirus/enterovirus (46%), parainfluenza virus (14%), respiratory syncytial virus (RSV) (12%), and influenza virus (10%). Two or more pathogen groups were co-detected in 174 (27%) of the respiratory samples. Pathogen specific seasonal patterns were not observed for rhinovirus/enterovirus, adenovirus, or atypical bacteria at either site. Samples collected in Quito were positive for the detection of RSV spanning a 32-week period between November and June. In contrast, detection of RSV from samples collected in Machala spanned only a 17- week period between February and May. In Quito, influenza viruses were detected between August and February, with influenza A activity preceding that of influenza B. In Machala, the detection of influenza B virus coincided with the dry season, while detection of influenza A virus was clustered in the rainy period between January and March. Conclusion The specific etiologies and seasonality of acute respiratory tract infections among Ecuadorean children < 5 years of age differ by site of enrollment. Such differences in regional data can be used to optimize regional implementation of existing and soon-to-be available public health prevention measures. Disclosures Manika Suryadevara, MD, Janssen: Grant/Research Support|Merck: Grant/Research Support|Roche: Grant/Research Support.

Knowledge, Attitude, and Practice in a Sample of the Lebanese Population Regarding Cholera

The evaluation of knowledge, attitude, and practices towards an emerging disease is an essential component of public health preventive measures during an outbreak. In October 2022, an outbreak of cholera was reported in Lebanon, which is the first to be reported in the Middle Eastern country for 30 years. This study aimed to explore the level of knowledge as well as attitude and practice of the general public in Lebanon towards cholera. A self-administered structured questionnaire was distributed via an online link to individuals living in Lebanon during October-November 2022. The survey instrument comprised items to assess the sociodemographic data; questions on knowledge about cholera symptoms, transmission, and prevention; as well as attitude and practice questions. Our study involved 553 participants, with a median age of 24 years and a majority of females (72.5%). The results showed that the majority of respondents correctly identified diarrhea as a symptom of cholera and recognized the spread via contaminated water and food. Having a university level education compared with secondary school or less (adjusted odds ratio (aOR) = 2.09), being married compared with single (aOR = 1.67), and working in the medical field compared with unemployed (aOR = 4.19) were significantly associated with higher odds of having good cholera knowledge. Having good knowledge compared with having a poor level of cholera knowledge (aOR = 1.83) and older age (aOR = 1.03) were significantly associated with higher odds of having a good attitude towards cholera. The current study showed an overall high knowledge score on cholera among the Lebanese population. Nevertheless, gaps in cholera knowledge were identified and should be addressed, particularly among workers in the medical field. Thus, we recommend targeted health education to the general population that aims to strengthen the health resilience in the community.

COVID-19 challenges and management of human resource in health, Bhutan’s unique approach: Medical University’s contribution

In March 2020, the country saw its first case when a foreign tourist tested positive for COVID-19 at Thimphu. There was immediate activation of national preparedness and response plan including the requirements for surge in human resource capacity to handle the novel infection. One key emphasis of the national response was to support the existing 3500 health care workforce by partnering with community in sharing pandemic-related activities. One such initiative was training a pool of people to shoulder basic responsibilities at quarantine and non-hospital isolation facilities. Therefore, Khesar Gyalpo University of medical Sciences of Bhutan was tasked to develop a training program and thus the De-suup plus program was designed with focus on people from non-medical background. This article attempts to describe the development and implementation of the training. The training constituted basic nursing competencies, personal protective equipment and essential public health preventive measures with the purpose of serving at quarantine and non-hospital isolation facilities in the Country.

Impact of COVID-19 Pandemic on Disease Control Status and Quality of Life of Patients with Acromegaly.

Background and Objectives: Despite the best efforts of healthcare workers and the deployment of alternative healthcare delivery solutions through telemedicine, the pandemic has disrupted standard care for patients with chronic conditions. The long-lasting pandemic has also had a profound impact on the quality of life (QoL) of the majority of patients with chronic illnesses. The management of rare diseases has been particularly challenging. We aimed to evaluate the impacts that the long-lasting pandemic had on the disease control status and QoL in patients with acromegaly. Materials and Methods: Our prospective study included 34 patients from a national referral centre. The baseline SAGIT and AcroQoL results were obtained in October 2020 during the lockdown period of the SARS-CoV2 pandemic. The follow-up results were assessed during the summer of 2022 in a period without any public health restrictions. All the patients were additionally evaluated for their attitude towards preventative public health measures against SARS-CoV2 spread and required mask wearing during the pandemic. Results: By comparing assessments in 2020 during the lockdown period and 2022 post-lockdown, we observed some improvement in SAGIT subscores T and I, most likely reflecting treatment changes in a small number of patients. The global SAGIT score remained stable. QoL measurement by AcroQoL did not demonstrate any changes. There was a negative correlation between SAGIT subscore S and the AcroQoL results. We also noted that the group of patients with the most negative attitude toward public health measurements for preventing SARS-CoV2 spread had higher AcroQoL results than others. Conclusion: Our results showcase that the SARS-CoV2 pandemic, lasting over two years, did not impact the disease control status and QoL in patients with acromegaly. The cohort continued to be well controlled and without changes in QoL. We measured a relatively favourable attitude towards the public health measures to prevent the spread of SARS-CoV2; in particular, patients who had a lower QoL had more positive attitudes towards these measures.

The impact of COVID-19 and masking practices on pertussis cases at a large academic medical center (2019-2021)

We reviewed cases of Bordatella pertussis (B. pertussis) cases in ambulatory clinics at a large academic health care institution in Los Angeles from 2019-2021. Public health prevention measures during the Coronavirus disease 19 (COVID-19) pandemic impacted the number of pertussis cases identified.

Spatial Distribution of Canine Sporotrichosis in Rio de Janeiro, Brazil (1998-2018) and Its Correlation with Socioeconomic Conditions.

Canine sporotrichosis is a poorly described global disease and a spatial approach has not yet been used to assess the disease in dogs. Therefore, this study aimed to describe the occurrence of canine sporotrichosis in the state of Rio de Janeiro, Brazil, from 1998 to 2018 and its correlation with socioeconomic characteristics using exploratory spatial data analysis. A total of 295 cases of canine sporotrichosis were identified and 249 were georeferenced. There was a higher concentration of cases in the municipality of Rio de Janeiro, as well as along the border of the city and the adjacent municipalities in the great metropolitan area. The cases occurred in areas where most of the dwellings are houses. Moreover, no focus of disease density was found in the southern part of Rio de Janeiro city over the period studied, possibly due to better socioeconomic conditions. Areas with a high concentration of canine sporotrichosis cases coincided with regions that possessed a low proportion of households without paving, suggesting that the disease is not necessarily linked to extreme poverty. The mapping of areas with a greater density of cases is fundamental to formulate targeted and strategic plans in order to implement effective public health prevention and control measures.

Change and Continuity in Preventive Practices Across the COVID-19 Pandemic Among Rural and Urban Latinx Immigrant Worker Families.

(1)The COVID-19 pandemic has put essential workers at high risk for contracting the disease. This study documents situational compliance with public health recommendations such as masking and social distancing among rural and urban Latinx families, with the goal of understanding change over time in COVID-19 risk reduction behaviors. (2)Respondents for 67 rural families and 44 urban families responded to repeated telephone surveys at three time points in the first year of the pandemic, providing data on use of masks and social distancing by themselves and family members while interacting with others at home, work, and in the community. Cumulative logistic regression models were employed to compare changes in risk behaviors between rural and urban groups over time. (3)While group descriptive results indicated behaviors that posed low risk at each time point, regression models revealed greater change between time points for rural than urban residents. Rural residents also had gendered patterns. (4)Patterns of change appear to reflect structural issues such as seasonal labor demand and gender roles more than pandemic fatigue or changing public health recommendations. The findings suggest that structural factors play a role in individuals complying with public health prevention measures for COVID-19.

Emergency Department Utilization for Substance Use DisorderDuring Pregnancy and Postpartum in the United States (2006-2016).

We aimed to better understand emergency department (ED) use, admission patterns, and demographics for substance use disorder in pregnancy and postpartum (SUDPP). In this longitudinal study, the United States Nationwide Emergency Department Sample was queried for all ED visits by 15- to 50-year-old women with a primary diagnosis defined by International Classification of Diseases, 9th or 10th edition Clinical Modification, codes of SUDPP between 2006 and 2016. Patterns of ED visit counts, rates, admissions, and ED charges were analyzed. Annual national estimated ED visits for SUDPP increased from 2,919 to 9,497 between 2006 and 2016 (a 12.4% annual average percentage change), whereas admission rates decreased (from 41.9% to 32.0%). ED visits were more frequent among women who were 20-29years old, using Medicaid insurance, in the lowest income quartile, living in the South, and in metropolitan areas. Compared with the proportion of ED visits, 15- to 19-year-olds had significantly lower admission rates, whereas women with Medicaid and in the lowest income quartile had higher admission rates (p<.001). Opioid use, tobacco use, and mental health disorders were most commonly associated with SUDPP. The ED average inflation-adjusted charges for SUDPP increased from $1,486 to $3,085 between 2006 and 2016 (7.1% annual average percentage change; p<.001), yielding total annual charges of $4.02 million and $28.53 million. Despite the decrease in admissions, the number and charges for ED visits for SUDPP increased substantially between 2006 and 2016. These increasing numbers suggest a continuous need to implement preventive public health measures and provide adequate outpatient care for this condition in this population specifically.

90 An analysis of COVID-19 public health measure adherence among parents and children and the corresponding effects of lockdowns and school closures

Abstract Background Public health preventive measures have been a necessary intervention in preventing COVID-19 transmission. Objectives The objectives of this study were 1) To investigate how the adherence to COVID-19 public health measures among parents and children in Ontario changed over time; 2) To determine if provincial lockdowns were associated with higher adherence to public health measures among parents; 3) To determine if school closures were associated with higher adherence to public health measures among children. Design/Methods A longitudinal study was conducted in children aged 0-10 years and their parents through the TARGet Kids! COVID-19 Study of Children and Families in the Greater Toronto Area, Canada (April 2020 -May 2021). Parents completed weekly questionnaires on sociodemographics and public health practices. The primary exposure was calendar date. Secondary exposures were provincial lockdowns and school closures. The primary outcome was adherence to public health preventive measures (staying home, limiting visitors in the home, avoiding contact with others, socially distancing, and handwashing, measured as number of days practicing per week) measured separately for parents and children. Linear mixed effects regression and piecewise linear splines mixed effects models were conducted. Results 819 children and their parents contributed 13,220 observations to the study over 13 months. Mean age was 5.6 years (SD=2.7) and 373 were female (45.5%). 273 children (35.1%) had a parent who worked as an essential worker and 254 (35.4%) of families lived in a COVID-19 ‘hotspot’. The number of days per week that parents adhered to all 5 public health measures decreased by 0.029 days (p&amp;lt;0.001), and by 0.146 days for children (p&amp;lt;0.001) over the study duration. For parents, adherence to the five public health measures decreased over time during the first lockdown (β=-0.06, p&amp;lt;0.001) and first reopening (β=-0.01, p&amp;lt;0.001), but increased again during the second lockdown (β=0.01, p&amp;lt;0.001). For children, adherence to the five public health measures decreased over time during the first school closure, increased during the second closure, and decreased during second reopening (β=-0.04, p&amp;lt;0.01). See Figure 1. Conclusion Parents and children both decreased in their adherence to social distancing, staying at home, and avoiding contact with others over time. Lockdown after a period of reopening increased parent adherence to public health measures and school closures increased adherence in children. Supports may be necessary to help children and parents maintain adherence to public measures over prolonged periods of lockdown and school closure.

Attitudes and personal beliefs about the COVID-19 vaccine among people with COVID-19: a mixed-methods analysis

BackgroundLittle research is available regarding vaccination attitudes among those recently diagnosed with COVID-19. This is important to investigate, particularly among those experiencing mild-to-moderate illness, given the ongoing need to improve uptake of both initial vaccine series and booster doses, and the divergent ways such an experience could impact attitudes.MethodsFrom September 3 – November 12, 2021, all patients enrolled in Baylor Scott & White’s “COVID-19 Digital Care Journey for Home Monitoring” were invited to participate in an online survey that included questions about vaccination status and attitudes/opinions regarding COVID-19 and the COVID-19 vaccines. Following an item asking about accordance of COVID-19 vaccination with religious/personal beliefs, participants were asked to describe those beliefs and how they relate to taking/not taking the vaccine.ResultsOf 8,075 patients age ≥ 18 years diagnosed with COVID-19 and invited to join the survey during the study period, 3242 (40.2%) were fully vaccinated. In contrast, among the 149 who completed the questionnaire, 95(63.8%) reported full vaccination. Responses differed significantly between vaccination groups. The vaccinated group strongly agreed that COVID-19 is a major public health problem, the vaccines are safe and effective, and their decision to vaccinate included considering community benefit. The unvaccinated group responded neutrally to most questions addressing safety and public health aspects of the vaccine, while strongly disagreeing with statements regarding vaccine effectiveness and other preventative public health measures. The vaccinated group strongly agreed that taking the vaccine accorded with their religious/personal beliefs, while the unvaccinated group was neutral. In qualitative analysis of the free text responses “risk perception/calculation” and “no impact” of religious/personal beliefs on vaccination decisions were frequent themes/subthemes in both groups, but beliefs related to the “greater good” were a strong driver among the vaccinated, while statements emphasizing “individual choice” were a third frequent theme for the unvaccinated.ConclusionOur results show that two of the three factors that drive vaccine hesitancy (complacency, and lack of confidence in the vaccines) are present among unvaccinated adults recently diagnosed with COVID-19. They also show that beliefs emphasizing the importance of the greater good promote public health participation.

Association of Age and Gender with the BMI of Obese Subjects in Pakistan

Obesity is a rapidly increasing public health concern which is globally associated with chronic diseases, such as type II diabetes and cardiovascular diseases. The aim of the current study was to find the association among age, gender, and Body Mass Index (BMI) of obese individuals residing in Lahore, Pakistan. This cross-sectional study was carried out in January 2021. Data was collected through an electronic questionnaire. A total of 868 individuals (84.3% female and 15.7% male) of ages between 18 to 60 years participated in the current study. Convenient sampling method was used. Anthropometrics including weight, height, and age were taken in kilograms (kg), centimeters (cm) and years, respectively. The standard equation to calculate BMI was used (weight in kg/height in m²). WHO BMI cut-points for Asians were used to assess the BMI status of the selected individuals. Statistical analysis was carried out through Microsoft Excel and SPSS. It was found that the prevalence of obesity was 17.2% (12% type I obesity, while 2.6% type II and type III obesity), while 15.1% participants were found to be overweight, 22.7% were underweight, and 44.9% were determined to be normal. It was also determined that the prevalence of underweight, overweight, type I, type II, and type III obesity is more common among women (20.6%, 12.3%, 9.2%, 2.3%, and 2%, respectively) than men (2.1%, 2.8%, 2.8%, 0.3%, and 0.7%, respectively) (p-value &lt;0.05). The highest prevalence of underweight, overweight, type I, type II, and type III obesity was observed in age group 19-21 years (11.1%, 7.3%, 7.4%, 1.5%, and 2.1%, respectively) (p-value &lt;0.05). These results would help to develop public health programs and preventive measures to reduce the prevalence of the above risk factors for obesity and other non-communicable diseases.&#x0D; &#x0D;

Analysis of the effect of temperature on tuberculosis incidence by distributed lag non-linear model in Kashgar city, China.

The aim of this study was to explore the effect of temperature on tuberculosis (TB) incidence using the distributed lag non-linear model (DLNM) from 2017 to 2021 in Kashgar city, the region with higher TB incidence than national levels, and assist public health prevention and control measures. From January 2017 to December 2021, a total of 8730 cases of TB were reported, with the higher incidence of male than that of female. When temperature was below 1 °C, it was significantly correlated with TB incidence compared to the median observed temperature (15 °C) at lag 7, 14, and 21, and lower temperatures showed larger RR (relative risk) values. High temperature produced a protective effect on TB transmission, and higher temperature from 16 to 31 °C has lower RR. In discussion stratified by gender, the maximum RRs were achieved for both male group and female group at − 15 °C with lag 21, reporting 4.28 and 2.02, respectively. At high temperature (higher than 20 °C), the RR value of developing TB for female group was significantly larger than 1. In discussion stratified by age, the maximum RRs were achieved for all age groups (≤ 35, 36–64, ≥ 65) at − 15 °C with lag 21, reporting 3.20, 2.07, and 3.45, respectively. When the temperature was higher than 20 °C, the RR of the 36–64-year-old group and the ≥ 65-year-old group was significantly larger than 1 at lag 21, while significantly smaller than 1 for cumulative RR at lag 21, reporting 0.11, 95% confidence interval (CI) (0.01, 0.83) and 0.06, 95% CI (0.01, 0.44), respectively. In conclusion, low temperature, especially in extreme level, acts as a high-risk factor inducing TB transmission in Kashgar city. Males exhibit a significantly higher RR of developing TB at low temperature than female, as well as the elderly group in contrast to the young or middle-aged groups. High temperature has a protective effect on TB transmission in the total population, but female and middle-aged and elderly groups are also required to be alert to the delayed RR induced by it.

Comparative inequalities in child dental caries across four countries: Examination of international birth cohorts and implications for oral health policy

Child dental caries (i.e., cavities) are a major preventable health problem in most high-income countries. The aim of this study was to compare the extent of inequalities in child dental caries across four high-income countries alongside their child oral health policies. Coordinated analyses of data were conducted across four prospective population-based birth cohorts (Australia, n = 4085, born 2004; Québec, Canada, n = 1253, born 1997; Rotterdam, the Netherlands, n = 6690, born 2002; Southeast Sweden, n = 7445, born 1997), which enabled a high degree of harmonization. Risk ratios (adjusted) and slope indexes of inequality were estimated to quantify social gradients in child dental caries according to maternal education and household income. Children in the least advantaged quintile for income were at greater risk of caries, compared to the most advantaged quintile: Australia: AdjRR = 1.18, 95%CI = 1.04-1.34; Québec: AdjRR = 1.69, 95%CI = 1.36-2.10; Rotterdam: AdjRR = 1.67, 95%CI = 1.36-2.04; Southeast Sweden: AdjRR = 1.37, 95%CI = 1.10-1.71). There was a higher risk of caries for children of mothers with the lowest level of education, compared to the highest: Australia: AdjRR = 1.18, 95%CI = 1.01-1.38; Southeast Sweden: AdjRR = 2.31, 95%CI = 1.81-2.96; Rotterdam: AdjRR = 1.98, 95%CI = 1.71-2.30; Québec: AdjRR = 1.16, 95%CI = 0.98-1.37. The extent of inequalities varied in line with jurisdictional policies for provision of child oral health services and preventive public health measures. Clear gradients of social inequalities in child dental caries are evident in high-income countries. Policy related mechanisms may contribute to the differences in the extent of these inequalities. Lesser gradients in settings with combinations of universal dental coverage and/or fluoridation suggest these provisions may ameliorate inequalities through additional benefits for socio-economically disadvantaged groups of children.

The second year of pandemic in the Arctic: examining spatiotemporal dynamics of the COVID-19 “Delta wave” in Arctic regions in 2021

ABSTRACT The second year of the COVID-19 pandemic in the Arctic was dominated by the Delta wave that primarily lasted between July and December 2021 with varied epidemiological outcomes. An analysis of the Arctic’s subnational COVID-19 data revealed a massive increase in cases and deaths across all its jurisdictions but at varying time periods. However, the case fatality ratio (CFR) in most Arctic regions did not rise dramatically and was below national levels (except in Northern Russia). Based on the spatiotemporal patterns of the Delta outbreak, we identified four types of pandemic waves across Arctic regions: Tsunami (Greenland, Iceland, Faroe Islands, Northern Norway, Northern Finland, and Northern Canada), Superstorm (Alaska), Tidal wave (Northern Russia), and Protracted Wave (Northern Sweden). These regionally varied COVID-19 epidemiological dynamics are likely attributable to the inconsistency in implementing public health prevention measures, geographical isolation, and varying vaccination rates. A lesson remote and Indigenous communities can learn from the Arctic is that the three-prong (delay-prepare-respond) approach could be a tool in curtailing the impact of COVID-19 or future pandemics. This article is motivated by previous research that examined the first and second waves of the pandemic in the Arctic. Data are available at https://arctic.uni.edu/arctic-covid-19.

Asia Pacific perspectives on the second year of the COVID-19 pandemic: A follow-up survey.

BackgroundThe Coronavirus disease 2019 (COVID‐19) pandemic is currently in its third year. This follow‐up survey was commissioned by the Asia Pacific Association of Allergy Asthma and Clinical Immunology (APAAACI) Task Force on COVID‐19 to compare and contrast changes in the epidemiology, clinical profile, therapeutics and public health measures of the pandemic in the Asia Pacific region.MethodsA questionnaire‐based survey comprising 32 questions was electronically sent out to all 15 member countries of APAAACI using Survey Monkey® from 1 December 2021 to 28 February 2022.ResultsSeventeen responses were received from 14/15 (93.4%) member countries and 3 individual members. Mild‐to‐moderate COVID‐19 predominated over severe infection, largely contributed by COVID‐19 vaccination programmes in the region. The incidence of vaccine adverse reactions in particular anaphylaxis from messenger ribonucleic acid (mRNA) vaccines was no longer as high as initially anticipated, although perimyocarditis remains a concern in younger males. Novel therapeutics for mild‐to‐moderate disease including neutralizing antibodies casirivimab/imdevimab (REGEN‐COV®) and sotrovimab (Xevudy®), anti‐virals Paxlovid® (nirmatrelvir and ritonavir) and Molnupiravir pre‐exposure prophylaxis for high‐risk persons with Tixagevimab and Cilgavimab (Evusheld) are now also available to complement established therapeutics (e.g., remdesivir, dexamethasone and baricitinib) for severe disease. In the transition to endemicity, public health measures are also evolving away from containment/elimination strategies.ConclusionsWith access to internationally recommended standards of care including public health preventive measures, therapeutics and vaccines among most APAAACI member countries, much progress has been made over the 2‐year period in minimizing the morbidity and mortality from COVID‐19 disease.

Frailty Prevalence, Incidence, and Association with Incident Disability in the Italian Longitudinal Study on Aging

Introduction: Data on frailty frequency are heterogeneous and mostly based on cross-sectional studies. Little is known about frailty development and progression over time. Our aim was to conduct a systematic analysis of frailty prevalence and incidence in a large cohort of older adults and to evaluate the association with incident disability, in order to tackle the current paucity and fragmentation of longitudinal data on frailty. Methods: As secondary analysis of the Italian Longitudinal Study on Aging (ILSA) population-based cohort (n = 5,632, 65–84), frailty status was operationalized according to Fried criteria (n = 2,457). Weighted prevalence and incidence rates were calculated at each ILSA wave (T0 1992–1993, T1 1995–1996, T2 2000–2001). The association with incident disability in Activities of Daily Living (ADL) or Instrumental Activities of Daily Living (IADL) was investigated through Cox proportional hazard models, controlling for possible confounders. Results: Prevalence of frailty and pre-frailty at baseline (mean age 71.6 years; women 58.9%) were 4.0% (95% confidence interval [CI]: 3.4–4.6) and 44.6% (95% CI: 43.1–46.1), respectively. Incidence rates per 1,000 person-years for the T0–T1 interval were 7.3 (95% CI: 5.2–9.3) for frailty and 83.7 (95% CI: 73.6–93.8) for pre-frailty. Prevalence and incidence of frailty, and to a lesser degree of pre-frailty, were overall higher for women and increased with age, yet no increasing trend with advancing age was detected for pre-frailty incidence. Frailty incidence rates were significantly higher among pre-frail than non-frail individuals at follow-up entry. After full adjustment, being frail markedly increased the risk of incident disability in ADL (hazard ratio [HR] 3.58, 95% CI: 1.97–6.52) and IADL (HR 2.56, 95% CI: 1.58–4.16) over a 4-year period. Discussion/Conclusion: According to our findings, frailty is common among older people and is a strong and independent predictor of disability. Further research on factors and characteristics related to frailty progression, and especially remission, over time is crucial to calibrate effective public health preventive measures.

Understanding the "Sometimes Masker": Political Orientation and Trust in the Media During the COVID-19 Pandemic.

ObjectivesThe COVID-19 pandemic in the United States has brought to light the problematic way partisan politics interferes with public health prevention and control measures. This study aims to investigate how Americans responded to the novel coronavirus with respect to their sociopolitical identity and masking habits.Study DesignThis mixed-methods study incorporated three ethnographic projects and surveys together, from two rural areas (in Iowa and California) and one suburban community in California.MethodsWe interviewed 156 Americans about how masking habits related to six themes: participants’ perceived risk level, concern for themselves and others, support for President Trump, trust in scientific organizations, and confidence in major news outlets. We conducted content analysis of qualitative interviews and evaluated survey questions to understand how and why people masked or engaged in public health prevention practices.ResultsGreater perceived risk, concern for others, and trust in health and media institutions was correlated with increased masking, while support for Trump was predictive of anti-masking sentiments. Participants who diverged from these trends, specifically those who sometimes wore masks, but not always were called “sometimes maskers”. These sometimes maskers often identified as politically moderate and were more likely to mask due to concern for a vulnerable person or group in their lives.ConclusionsSince one in three Americans are political moderates, understanding what promotes their adherence to public health guidelines is essential for policy makers interested in pandemic containment. Relatedly, the conservative tendency to distrust mainstream media is what separated those who reported sometimes masking from those who reported always masking.

Knowledge, Attitudes, and Practices of/towards Covid-19 among Cameroonians in the Bamenda Health District: A Cross-Sectional Study during the Second Wave of the Pandemic

The Coronavirus Disease 2019 (Covid-19) pandemic has and is greatly affecting the global community. This study aimed to assess knowledge, attitudes, and practices towards Covid-19 among a convenient sample of the general public in the Bamenda Health District (BHD) of Cameroon. A community-based cross-sectional study was conducted in the BHD, from 1st March to 30th April 2021. Participants were sampled from three Health Areas in Bamenda. Data collection was performed using a self-administered questionnaire. The Pearson Chi square (χ2) and regression analysis were used to determine associations between KAP and demographic characteristics. We studied 404 participants with the following demographic characteristics: 237 (58.7%) aged 25 – 49 years, 233 (57.7%) females, and 197 (48.8%) with tertiary level of education. Of the 404 participants, 182 (45.0%) were knowledgeable about Covid-19 (79 males and 103 females), 42.5% had positive attitudes towards Covid-19 (63 males and 109 females), and 122 (30.2%) were adherent to practicing public health preventive measures (48 males and 74 females). Compared to females, males were more adherent to practicing public health preventive measures (OR, 1. 3; 95% CI, 0.8 – 2.1), and had positive attitudes towards directives and guidelines (OR, 1.7; 95% CI, 1.1 – 2.8). This study shows that public health prevention efforts should be directed to closing the identified gaps in KAP among residents to halt the spread of Covid-19 in the health district as well as the Region.