Wave Of Pandemic Research Articles

Importations of SARS-CoV-2 lineages decline after nonpharmaceutical interventions in phylogeographic analyses

During the early stages of the SARS-CoV-2 pandemic, before vaccines were available, nonpharmaceutical interventions (NPIs) such as reducing contacts or antigenic testing were used to control viral spread. Quantifying their success is therefore key for future pandemic preparedness. Using 1.8 million SARS-CoV-2 genomes from systematic surveillance, we study viral lineage importations into Germany for the third pandemic wave from late 2020 to early 2021, using large-scale Bayesian phylogenetic and phylogeographic analysis with a longitudinal assessment of lineage importation dynamics over multiple sampling strategies. All major nationwide NPIs were followed by fewer importations, with the strongest decreases seen for free rapid tests, the strengthening of regulations on mask-wearing in public transport and stores, as well as on internal movements and gatherings. Most SARS-CoV-2 lineages first appeared in the three most populous states with most cases, and spread from there within the country. Importations rose before and peaked shortly after the Christmas holidays. The substantial effects of free rapid tests and obligatory medical/surgical mask-wearing suggests these as key for pandemic preparedness, given their relatively few negative socioeconomic effects. The approach relates environmental factors at the host population level to viral lineage dissemination, facilitating similar analyses of rapidly evolving pathogens in the future.

Seroprevalence of SARS-CoV-2 and humoral immune responses to COVID-19 mRNA vaccines among people who use drugs - in the light of tailored mitigating strategies

BackgroundDuring the initial wave of the COVID-19 pandemic, there was a surprisingly low incidence of SARS-CoV-2 among People Who Use Drugs (PWUD) in Oslo, Norway, despite their heightened vulnerability regarding risk of infection and severe courses of the disease.This study aims to investigate the seroprevalence of SARS-CoV-2 antibodies among PWUD, their antibody responses to relevant virus infections and COVID-19 mRNA vaccines, and their vaccination coverage compared to the general population.MethodsConducted as a prospective cohort study, data was collected from residents in six institutions for homeless PWUD and users of a low-threshold clinic for opioid agonist treatment. Ninety-seven participants were recruited for SARS-CoV-2 seroprevalence analysis. Additional two participants with known positive SARS-CoV-2 test results were recruited for further analyses. Twenty-five participants completed follow-up. Data included questionnaires, nasal swabs and blood samples. Data on vaccination coverage was obtained from the National Vaccine Register. Serologic methods included detection of antibodies to relevant virus proteins, neutralizing antibodies to SARS-CoV-2, antibodies to the full-length spike protein, and receptor-binding domain from SARS-CoV-2.ResultsAmong PWUD, antibodies to SARS-CoV-2 were detected in 2 out of 97 samples before vaccines against SARS-CoV-2 were available, comparable to a 2.8% frequency in population-based screening. Levels of serum antibodies to seasonal coronaviruses and Epstein-Barr-Virus (EBV) in PWUD were similar to population-based levels. After the second vaccine dose, binding and neutralizing antibody levels to SARS-CoV-2 in PWUD were comparable to controls. Eighty-four of PWUD received at least one dose of COVID-19 mRNA vaccine, compared to 89% in the general population.ConclusionResults indicate that PWUD did not exhibit increased SARS-CoV-2 seroprevalence or elevated serum antibodies to seasonal coronaviruses and EBV. Moreover, vaccine responses in PWUD were comparable to controls, suggesting that vaccination is effective in conferring protection against SARS-CoV-2 also in this population.

Neurological Manifestations of Acute SARS-CoV-2 Infection in Pediatric Patients: A 3-Year Study on Differences between Pandemic Waves.

This study analyzed the neurological manifestation profiles of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across pandemic waves in pediatric patients. The study collected data on patients aged between 0 and 18 years, diagnosed with acute SARS-CoV-2 infection, admitted to a pediatric tertiary hospital between 1 March 2020 and 28 February 2023. This study included 1677 patients. Neurological manifestations were noted in 10% (n = 168) of patients with a median age of 3.2 years (interquartile range: 1-11.92). Neurological manifestations were significantly associated with the pandemic waves (p = 0.006) and age groups (p < 0.001). Seizures were noted in 4.2% of cases and reached an increasing frequency over time (p = 0.001), but were not associated with age groups. Febrile seizures accounted for the majority of seizures. Headache was reported in 2.6% of cases and had similar frequencies across the pandemic waves and age groups. Muscular involvement was noted in 2% of cases, reached a decreasing frequency over time (p < 0.001), and showed different frequencies among the age groups. Neurological manifestations of acute SARS-CoV-2 infection exhibit distinct patterns, depending on the pandemic wave and patient age group. The Wuhan and Omicron waves involved the nervous system more often than the other waves.

Navigating pandemic waves: Consensus, polarisation and pluralism in the Finnish parliament during COVID-19

This article studies how the COVID crisis affected polarisation, politicisation and consensus in Finnish parliamentary discourse, a case in which we expect pluralist political institutions and culture to mitigate polarisation. In addition to the empirical contribution, we add to the theory of polarisation by drawing from Chantal Mouffe’s theory of plural democracy to argue that the opposite of polarisation may take the form of a depoliticised consensus or a pluralism of legitimate positions (‘agonism’). Furthermore, we apply Norman and Isabela Fairclough’s political discourse analysis to studying polarisation qualitatively, arguing that scrutiny of argumentative premises enables assessment of how profound certain political conflicts are. Studying 485 parliamentary speeches given in 2020–2021, we argue that a morally charged consensus imperative with nationalistic overtones quickly developed in Spring 2020, and pluralism gradually re-emerged later. The article highlights that while polarisation can threaten democracy, so can moralisation and enforced consensus.

Comparing lagged impacts of mobility changes and environmental factors on COVID-19 waves in rural and urban India: a Bayesian spatiotemporal modelling study.

Previous research in India has identified urbanisation, human mobility and population demographics as key variables associated with higher district level COVID-19 incidence. However, the spatiotemporal dynamics of mobility patterns in rural and urban areas in India, in conjunction with other drivers of COVID-19 transmission, have not been fully investigated. We explored travel networks within India during two pandemic waves using aggregated and anonymized weekly human movement datasets obtained from Google, and quantified changes in mobility before and during the pandemic compared with the mean baseline mobility for the 8-week time period at the beginning of 2020. We fit Bayesian spatiotemporal hierarchical models coupled with distributed lag non-linear models (DLNM) within the integrated nested Laplace approximate (INLA) package in R to examine the lag-response associations of drivers of COVID-19 transmission in urban, suburban, and rural districts in India during two pandemic waves in 2020-2021. Model results demonstrate that recovery of mobility to 99% that of pre-pandemic levels was associated with an increase in relative risk of COVID-19 transmission during the Delta wave of transmission. This increased mobility, coupled with reduced stringency in public intervention policy and the emergence of the Delta variant, were the main contributors to the high COVID-19 transmission peak in India in April 2021. During both pandemic waves in India, reduction in human mobility, higher stringency of interventions, and climate factors (temperature and precipitation) had 2-week lag-response impacts on the R t of COVID-19 transmission, with variations in drivers of COVID-19 transmission observed across urban, rural and suburban areas. With the increased likelihood of emergent novel infections and disease outbreaks under a changing global climate, providing a framework for understanding the lagged impact of spatiotemporal drivers of infection transmission will be crucial for informing interventions.

Serum cytokine dysregulation signatures associated with COVID-19 outcomes in high mortality intensive care unit cohorts across pandemic waves and variants

The aim of this study was to characterize the systemic cytokine signature of critically ill COVID-19 patients in a high mortality setting aiming to identify biomarkers of severity, and to explore their associations with viral loads and clinical characteristics. We studied two COVID-19 critically ill patient cohorts from a referral centre located in Central Europe. The cohorts were recruited during the pre-alpha/alpha (November 2020 to April 2021) and delta (end of 2021) period respectively. We determined both the serum and bronchoalveolar SARS-CoV-2 viral load and identified the variant of concern (VoC) involved. Using a cytokine multiplex assay, we quantified systemic cytokine concentrations and analyzed their relationship with clinical findings, routine laboratory workup and pulmonary function data obtained during the ICU stay. Patients who did not survive had a significantly higher systemic and pulmonary viral load. Patients infected with the pre-alpha VoC showed a significantly lower viral load in comparison to those infected with the alpha- and delta-variants. Levels of systemic CTACK, M-CSF and IL-18 were significantly higher in non-survivors in comparison to survivors. CTACK correlated directly with APACHE II scores. We observed differences in lung compliance and the association between cytokine levels and pulmonary function, dependent on the VoC identified. An intra-cytokine analysis revealed a loss of correlation in the non-survival group in comparison to survivors in both cohorts. Critically ill COVID-19 patients exhibited a distinct systemic cytokine profile based on their survival outcomes. CTACK, M-CSF and IL-18 were identified as mortality-associated analytes independently of the VoC involved. The Intra-cytokine correlation analysis suggested the potential role of a dysregulated systemic network of inflammatory mediators in severe COVID-19 mortality.

Etiology of Four Waves of the COVID-19 Pandemic in Ukraine according to the SARS-CoV-2 Virus Genome Sequencing Data: A Pilot Study

The COVID-19 pandemic in Ukraine, from March 2020 to June 2022, witnessed distinct waves, each characterized by an increase in cases and fatalities. Next-generation sequencing has been used to understand the impact of viral variants on the pandemic situation in Ukraine. We analyzed SARS-CoV-2 genome sequencing data to identify viral variants circulating during each wave. By integrating epidemiological information, we established associations between viral variants and disease spread. The adoption of next-generation sequencing for SARS-CoV-2 surveillance in Ukraine, despite limited resources, yielded adequate and trustworthy results, reflecting the pandemic situation. After the Russian military invasion of Ukraine in February 2022, a large number of refugees crossed the border with neighboring countries. Mutation analysis on sequencing data from Ukraine and Poland was used to estimate the exchange of SARS-CoV-2 variants between the countries during this period. Omicron subvariants detected in both countries were similar. The analysis of SARS-CoV-2 sequences from Poland and Ukraine revealed shared nucleotide mutations that can be used to identify the directions of spreading.

Police-referred psychiatric emergency presentations during the first and second wave of COVID-19 in Berlin, Germany: a retrospective chart review

BackgroundLiterature on psychiatric emergency services (PES) presentations during the COVID-19 pandemic showed heterogeneous results regarding patients brought in by police (BIBP). This is the first study primarily focusing on patients BIBP in a PES during the COVID-19-period.MethodsCase documentation records during the first and second wave of the COVID-19 pandemic in a PES in Berlin, Germany were analyzed using descriptive data analysis and binomial logistic regression analysis to detect factors that predict presentations BIBP.Results5440 PES presentations: 20.4% BIBP during the first wave vs. 16.3% during its control period; second wave: 17.6% BIBP vs. 14.9% during its control period. In both waves, absolute increases in presentations BIBP were seen compared to control (p = .029, p = .028, respectively). COVID-19-period was a predictor for presentations BIBP during the first and the second wave. The following factors also predicted presentations BIBP: younger age, male gender, aggressive behavior, suicide attempt prior to presentation and diagnosis of psychotic or substance use disorders; depressive disorders were negatively associated.ConclusionsDuring the two first waves of the COVID-19 pandemic, there was an increase in presentations BIBP in a PES in Berlin. Regression analysis shows that the pandemic itself was a predictor of presentations BIBP. The underlying factors of this association need to be further elucidated in future research. Additionally, general factors predicting PES presentations BIBP are reported that replenish the present literature.

Effective emotion regulation as a protective factor of depression symptoms in Slovak adolescents during a COVID-19 pandemic

The aim of our study was to verify relationships between individual difficulties in emotion regulation (ER), ER strategies (cognitive reappraisal and expressive suppression), and compassion (to self and others) with the presence of depressive symptomatology in a sample of Slovak adolescents during the second wave of the COVID-19 pandemic. In the sample of 140 Slovak adolescents (age between 17–19 years) was administrated The Beck Depression Inventory- II. (Beck et al., 1996), The Overall Depression Severity and Impairment Scale (Bentley et al., 2014), The Emotion Regulation Questionnaire (Gross &amp;amp; John, 2003), The Difficulties in Emotion Regulation Scale (Gratz &amp;amp; Roemer, 2004), The Sussex-Oxford Compassion for the Self Scale and The Sussex-Oxford Compassion for Others Scale (Gu et al., 2019). Results revealed that difficulties in ER (all subscales) and expressive suppression were in positive relationships with depression symptoms. Cognitive reappraisal and self-compassion were in negative relationships with depression symptoms. Lack of ER strategies and cognitive reappraisal (inversely) were the strongest predictors of depressive symptoms. These findings suggest that ER strategies (mainly cognitive reappraisal) could be assumed as protective factors in adolescent depression symptoms development in stressful circumstances of the COVID-19 pandemic.

Single-Facility Analysis of COVID-19 Status of Healthcare Employees during the Eighth and Ninth Pandemic Waves in Japan after Introducing Regular Rapid Antigen Testing.

Community infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have increased rapidly since the emergence of the Omicron strain. During the eighth and ninth pandemic waves-when movement restrictions in the community were eased-the all-case registration system was changed, and the actual status of infection became uncertain. We conducted regular rapid antigen tests (R-RATs) once or twice a week as self-testing to examine the actual state of coronavirus disease (COVID-19) diagnosis among healthcare employees. Overall, 320 (1.42/day) and 299 (1.76/day) employees were infected in the eighth and ninth pandemic waves. During both periods, 59/263 doctors (22.4%), 335/806 nurses (41.6%), 92/194 administrative employees (47.4%), and 129/218 clinical laboratory technicians (59.2%) were infected. In the eighth wave, 56 of 195 employees were infected through close contact; in the ninth wave, 26 of 62 employees were infected. No significant difference was observed in the number of vaccinations between infected and non-infected employees. The positivity rate of R-RATs was 0.41% and 0.45% in the eighth and ninth waves. R-RATs detected infection in 212 and 229 employees during the eighth and ninth waves, respectively; the ratio of R-RAT-detected positive employees to those who reported infection was significantly higher during the ninth wave (odds ratio: 1.67, 95% confidence interval: 1.17-2.37, p < 0.001). The number of infected healthcare employees remained high during the eighth and ninth pandemic waves in Japan. The R-RAT is considered effective for detecting mild or asymptomatic COVID-19 at an early stage and at a high rate in healthcare employees.

Working from home, work/life conflict and mental wellbeing in Europe during the COVID-19 pandemic.

The COVID-19 pandemic has pushed many employees away from their offices into their homes. During the first wave of the COVID-19 pandemic, in early spring 2020, most countries recommended or required that employees work remotely from home to reduce the spread of infection at workplaces and during travel to and from these workplaces. The main aim of this study was to investigate the relationships between working from home, work/life conflict and mental wellbeing in Europe during the pandemic. The study was based on a large-scale, online survey that was conducted during the COVID-19 pandemic three times, in 2020, 2021 and 2022, in 27 EU countries, and included 53 214 respondents that were employed at the time of the study. The results showed that working from home, work-to-life conflict and life-to-work conflict has increased and that mental wellbeing has decreased during the pandemic. Our regression analyses showed that the number of hours worked from home was negatively associated with work-to-life conflict and positively associated with life-to-work conflict. These results indicate that working from home can have both positive and negative consequences for employees' work/life conflict. The regression results showed that hours worked from home, work-to-life conflict and life-to-work conflict were negatively associated with mental wellbeing. It is important to consider different work situations for different working life groupings when implementing work-from-home measures. Organizations must consider how work is supervised and help managers understand how to support employees to achieve work-life balance when working remotely.

SpatialWavePredict: a tutorial-based primer and toolbox for forecasting growth trajectories using the ensemble spatial wave sub-epidemic modeling framework

BackgroundDynamical mathematical models defined by a system of differential equations are typically not easily accessible to non-experts. However, forecasts based on these types of models can help gain insights into the mechanisms driving the process and may outcompete simpler phenomenological growth models. Here we introduce a friendly toolbox, SpatialWavePredict, to characterize and forecast the spatial wave sub-epidemic model, which captures diverse wave dynamics by aggregating multiple asynchronous growth processes and has outperformed simpler phenomenological growth models in short-term forecasts of various infectious diseases outbreaks including SARS, Ebola, and the early waves of the COVID-19 pandemic in the US.ResultsThis tutorial-based primer introduces and illustrates a user-friendly MATLAB toolbox for fitting and forecasting time-series trajectories using an ensemble spatial wave sub-epidemic model based on ordinary differential equations. Scientists, policymakers, and students can use the toolbox to conduct real-time short-term forecasts. The five-parameter epidemic wave model in the toolbox aggregates linked overlapping sub-epidemics and captures a rich spectrum of epidemic wave dynamics, including oscillatory wave behavior and plateaus. An ensemble strategy aims to improve forecasting performance by combining the resulting top-ranked models. The toolbox provides a tutorial for forecasting time-series trajectories, including the full uncertainty distribution derived through parametric bootstrapping, which is needed to construct prediction intervals and evaluate their accuracy. Functions are available to assess forecasting performance, estimation methods, error structures in the data, and forecasting horizons. The toolbox also includes functions to quantify forecasting performance using metrics that evaluate point and distributional forecasts, including the weighted interval score.ConclusionsWe have developed the first comprehensive toolbox to characterize and forecast time-series data using an ensemble spatial wave sub-epidemic wave model. As an epidemic situation or contagion occurs, the tools presented in this tutorial can facilitate policymakers to guide the implementation of containment strategies and assess the impact of control interventions. We demonstrate the functionality of the toolbox with examples, including a tutorial video, and is illustrated using daily data on the COVID-19 pandemic in the USA.

Nurses Lived Experiences, Burdens and Coping Strategies During COVID-19 Pandemic

This is a qualitative phenomenological study that was designed to navigate through nurses’ lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses’ lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses’ eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

Sick Leave and Absence Rate of Hospital Workers During the Sixth to Eighth Wave of COVID-19 in Japan

Abstract Background There are several reports of breakthrough infections of severe acute respiratory syndrome coronavirus 2 in vaccinated individuals and reinfections in previously infected individuals. Although the coronavirus disease (COVID-19) pandemic has increased the incidence of infections at healthcare facilities, the association between the increase in community spread and absence rate of hospital workers due to COVID-19 infection-related sick leave has not yet been fully elucidated. Method We reviewed the case files of patients with COVID-19 diagnosed at the Jikei University Katsushika Medical Center, Tokyo, Japan, between January 1, 2022, and February 28, 2023. The obtained data was used to determine the number of COVID-19 admissions and absence rate of hospital workers due to COVID-19 infection-related sick leave during the sixth to eighth wave of the COVID-19 pandemic. Results Of 1899 patients with confirmed COVID-19, 397 (20.9%) were hospital workers. Of the 397 patients, 71, 156, and 119 contracted the infection during the sixth (January–March 2022), seventh (July–September 2022), and eighth wave (November 2022–February 2023), respectively. The absence rate of hospital workers due to COVID-19 was 6.3%, excluding leaves of absence due to close contact in the seventh wave, which had the highest number of infections. Conclusions Given the difficulty of maintaining a usual work schedule during the COVID-19 outbreak, it may be necessary to re-evaluate the backgrounds of healthcare workers at high risk of contracting COVID-19 and to make aggressive adjustments to their work schedules by distributing assignments and restricting leave.

The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study.

Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK. Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping. People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups' 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon. Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty.

Genetic analysis of SARS-CoV-2 spike gene using Next Generation Sequencing from COVID-19 patients in Erbil/Iraq.

SARS-CoV-2 has been identified by the WHO as a new virus causing mild to severe respiratory illnesses that belong to the Coronavirus family. The virus underwent rapid and continuous changes in the genetic material, especially the S gene, during COVID-19 pandemic and generated a number of new variants announced by WHO in late 2020. Mutations in the S gene have greatly affected virus pathogenesis as the spike protein is responsible for many critical processes. Delta and Omicron variants were studied extensively due to increased mortality and morbidity rates associated with their pandemic waves. This study aimed to analyse the S gene through NGS in an attempt to identify and characterize the circulating variants among the infected population in Erbil/Iraq. Nasopharyngeal and throat swab samples were collected from hospitalized and non-hospitalized patients with COVID-19 symptoms in Erbil City/Iraq from the 1st of November 2021 to the 28th of February 2022. Following confirmation of SARS-CoV-2 infection by RT-PCR, 15 samples were selected and sent to Intergen Lab (Ankara/Turkey) for NGS and analysis. Following analysis and alignment of the received sequences with the Wuhan-Hu-1 strain (wild-type), Delta variant was identified in 13 samples, and Omicron in two. On the whole, different mutation classes have been observed including nonsynonymous, synonymous, non-frameshift deletions and a non-frameshift insertion. The Delta-specific set of mutations, L452R, T478K and P681R, was detected in all Delta isolates. Both Omicron variants appeared to have 35 mutations. D614G variation was conserved in both variants.

The gray zone: How not imposing a strict lockdown at the beginning of a pandemic can cost many lives

The public debate on the effectiveness of lockdown measures is far from being settled. We estimate the impact of not having implemented a strict lockdown in the Bergamo province, during the first wave of the COVID-19 pandemic, despite observing an infection rate in this area similar to the one observed in nearby municipalities where a strict lockdown was instead promptly implemented. We estimate the causal effect of this policy decision on daily excess mortality using the synthetic control method (SCM). We find that about two-thirds of the reported deaths could have been avoided had the Italian government declared a Red Zone in the Bergamo province. We also clarify that, in this context, SCM and difference-in-differences implicitly restrict effect heterogeneity. We provide a way to empirically assess the credibility of this assumption in our setting.

COVID-19 and nurses' ethical issues: Comparisons between two European countries.

The global pandemic raised ethical issues for nurses about caring for all patients, not just those with COVID-19. Italy was the first European country to be seriously affected by the first wave, while Estonia's infection and death rates were among the lowest in Europe. Did this raise different ethical issues for nurses in these two countries as well? The aim was to describe and compare ethical issues between nurses working during the first wave of the COVID-19 pandemic in Estonia and Italy. A cross-sectional survey study with a self-administered questionnaire. The impact of COVID-19 emergency on nursing care questionnaire was used. Convenience sampling was used to recruit 1098 nurses working during the first wave of the pandemic in 2020: 162 from Estonia and 936 from Italy. Research ethics approvals were obtained, and the nurses provided informed consent. The most frequent ethical issues for Estonian nurses were professional communication and ensuring access to care for patients without COVID-19, and for Italian nurses, the end-of-life care and the risk of them getting the virus and transmitting it to their loved ones. There were no statistically significant differences in the frequency of ethical issues between Estonian nurses working with patients with and without COVID-19. Italian nurses caring for COVID-19 patients faced statistically significantly more (both p < .001) issues around prioritising patients and end-of-life. Nurses working with patients without COVID-19 faced more issues about access to care in both countries (both p < .001). Estonian and Italian nurses, working in different clinical contexts during the first wave of the pandemic, faced different ethical issues. Local contextual aspects need to be considered to support nurses' ethical decision-making in providing care during future crises and to ensure ethical care for patients.

COVID-19-related temporary disability in healthcare workers in Spain during the four first pandemic waves

Healthcare workers (HCW) have been the professional category most exposed to SARS-CoV-2. The pandemic’s impact on HCW was analyzed in terms of COVID-19-related temporary disability (TD) between February 15th, 2020 and May 1st, 2021. TDs in HCW for COVID-19 infection or quarantine were described. TD quarantine/infection ratios and TDs per 100,000 affiliated HCW were compared with the cumulative incidence (CI) of COVID-19 cases notified to the National Network of Epidemiological Surveillance. TDs rates by economic activity and occupation were computed. A total of 429,127 TDs were recorded, 36,6% for infection. Three-quarters (76%) were women. The median TD quarantine/infection ratio was 2.5 (Interquartile range [IQR] 1.5–3.9). TDs rates in HCW were always above the CI except for the last two months of the fourth wave. Hospital activities accounted for 84% of TDs and showed the highest TD rate for infection (8,279/100,000). Nursing professionals and midwifery, Physicians, and Nursing assistants accounted for 26, 18 and 17 % of the conceded TD respectively, whereas the highest TDs rates were registered among Nursing assistants, Nursing professionals and Physicians: 7,426, 6,925 and 5,508/100,000, respectively. The results indicate the high impact of COVID-19 on HCW in Spain and it’s inequalities. They also confirm that TDs represent a complementary source of information for epidemiological and public health surveillance and could provide an early warning of new emerging infections.

A comparative study between first three waves of COVID-19 pandemic with respect to risk factors, initial clinic-demographic profile, severity and outcome

ABSTRACT Introduction: During the 2 years and 9 months from March 2020 to December 2022, the SARS-CoV-2 virus raged across the country. Cases occurred in three particular time clusters recognised by World Health Organisation as coronavirus disease 2019 (COVID-19) waves. In this study, we compare the clinical parameters of adult non-obstetric COVID-19 patients admitted to our rural tertiary care hospital during the three distinct waves of the pandemic. Materials and Methods: Retrospective chart analysis of 272, 853 and 97 patients admitted with SARS-CoV-2 infection to the only rural medical tertiary care centre in the Sunderbans of West Bengal in the first, second and third waves, respectively, was done after obtaining ethical and scientific clearance. Clinical [vital parameters, oxygen requirement, mental status, risk factor assessment, duration of hospital stay, modified-emergency warning score (m-EWS), quick Sequential Organ Failure Assessment (qSOFA), confusion, uraemia, respiratory rate, blood pressure, age ≥ 65 years (CURB65)], epidemiological variables (age, gender, and vaccination status), laboratory parameters and in-hospital outcome were recorded and analysed statistically. Results: Statistically significant (P &lt; 0.05) m-EWS and qSOFA scores were recorded during the second wave of the pandemic. The second wave also recorded the highest mortality (14.89%) compared to the first (12.87%) and third (11.96%) waves, though this was not statistically significant. The highest duration of hospital stay was recorded in the first wave of the pandemic (mean = 9.99 days, P &lt; 0.01). The difference in mortality rates between patients with and without co-morbidity (P &lt; 0.05) was observed during Wave-1, across any pandemic wave, and overall but not in Wave-2 and Wave-3. Conclusion: The second wave of the COVID-19 pandemic was the most severe in comparison with the other two waves, while the outcome was poorer in those with co-morbidities, especially in the first wave.