COVID, Volume 4, Issue 1 (January 2024) – 10 articles

Background: Antimicrobial resistance (AMR), a major global public health threat that has caused 1.2 million deaths, calls for immediate action. Antimicrobial stewardship (AMS) promotes judicious antibiotic use, but the COVID-19 pandemic increased AMR by 15%. Although there are paramount data on the impact of COVID-19 on AMS, empirical data on AMS implementation during the pandemic are lacking. This study aimed to investigate antibiotic prescribing and AMS implementation prior to the pandemic (PP) in 2019 and during the pandemic (DP) in 2020 at one NHS Foundation Trust in England. Method: This cross-sectional study involved adult patients admitted to one NHS Foundation Trust in England, focusing on those prescribed antibiotics for respiratory tract infections (RTIs). This included cases of pneumonia in both years under study and COVID-19 cases in 2020. Data were retrospectively extracted from medical records using a validated data extraction tool, which was developed based on the ‘Start Smart, Then Focus’ (SSTF) approach of the AMS Toolkit. Results: This study included 640 patients. The largest age group in the study was 66–85 years, comprising 156 individuals (48.8%) PP in 2019 and 148 (46.3%) DP in 2020. CAP was the predominant diagnosis, affecting approximately 126 (39.4%) PP and 136 (42.5%) DP patients. Regarding the timing of antibiotic review post-admission, reviews were typically conducted within 48–72 h, with no significant difference between 2019 and 2020, with an odds ratio of 1.02 (95% CI 0.97 to 1.08, p-Value = 0.461). During the pandemic, there was a significant difference in both AMS interventions, ‘Continue Antibiotics’ and ‘De-escalation’, with odds ratios of 3.36 (95% CI 1.30–9.25, p = 0.015) and 2.77 (95% CI 1.37–5.70, p = 0.005), respectively. Conclusion: This study emphasises the need for robust AMS to ensure adherence to guidelines. It acknowledges the impact of comorbidities and advocates for sustained stewardship efforts to combat resistance both during and after the pandemic era. Full article

While the impact of the pandemic has varied between and within countries, there are few published data on the relationship between social determinants of health (SDoH) and COVID-19 in Africa. This ecological cross-sectional study examines the relationship between COVID-19 risk and SDoH among 28 African countries. Included were countries with a recent demographic and health survey (years 2010 to 2018). The response variables were COVID-19 case rates and death rates (reported as of 15 August 2020); and the covariates comprised eight broad topics common to multiple SDoH frameworks aggregated to the country level: geography (urban residence), wealth index, education, employment, crowding, and access to information. A negative binomial regression was used to assess the association between aspects of SDoH and COVID-19 outcomes. Our analysis indicated that 1 in 4 (25.1%) households in study countries are without safe and clean water and a space for handwashing. The odds of COVID-19 morbidity and deaths were higher in countries with a high proportion of households without access to safe and clean water. Having a high proportional of educated women (1.003: 95% CI, 1.001–1.005) and living in a less crowded home (0.959: 95% CI, 0.920–1.000) were negatively associated with COVID-19 deaths, while being insured and owning a mobile phone predicted illness. Overall, aspects of SDoH contribute either negatively or positively to COVID-19 outcomes. Thus, addressing economic and environmental SDoH is critical for mitigating the spread of COVID-19 and re-emerging diseases on the African continent. Full article

Two years ago, MDPI launched an "Instant Journal" entitled COVID with the intention of raising awareness of research into a new disease originating from the SARS-CoV-2 infection that has affected more than 700 million individuals, with over 6 million deaths in total worldwide [...] Full article

Popular theories that explain or predict behavioural intentions are based on people’s attitudes and subjective norms. Their application is based on the (often implicit) assumption that people regard a subject (e.g., preventing the spread of COVID-19) as sufficiently important for them to formulate stable attitudes and subjective norms about it. As this assumption rarely holds for all people, the influence of attitudes and subjective norms in determining behavioural intentions changes depending on the importance of the subject. In other words, importance has a moderating effect on the relationship between intentions, attitudes, and subjective norms. We hypothesise that, as importance declines, the influence on intentions of attitudes decreases and the influence of subjective norms increases. This has important implications for efforts to encourage the adoption of preventative behaviours in relation to COVID-19 because promotional strategies designed to modify attitudes differ markedly from those designed to modify subjective norms. We test this hypothesis by analysing three different large-scale surveys about people’s intentions, involvement, attitudes, and subjective norms regarding the spread of COVID-19 in New Zealand. The results support our hypothesis and highlight the importance of distinguishing between when the formation of behavioural intentions depends mainly on attitudes and when it depends mainly on subjective norms. Full article

Background: Although sedentary behavior (SB) before and during COVID-19 has been studied, mental activity-based SB patterns have been overlooked. This secondary analysis investigated the patterns of mentally active vs. passive SB in adults post-COVID-19 pandemic and examined sex differences. Methods: Adults (n = 1255; 45% males; 50% aged between 20 and 29 years old) self-reported general characteristics, anthropometric and socioeconomic variables, and mentally active and passive SB (weekdays and weekend days) using a structured web-based survey. Adjusted ANCOVA on Ranks tests assessed differences between mentally active and mentally passive SB during the day, on weekdays, and weekend days. Adjusted Quade Nonparametric ANCOVA tests evaluated these differences in males vs. females. Results: Adults significantly spent greater time in mentally active vs. passive SB (5.61 ± 4.57 vs. 2.50 ± 3.25; p < 0.001). Mentally active SB was more prevalent on weekdays than on weekends (6.00 ± 5.00 vs. 5.00 ± 5.00; p < 0.001). No significant difference was observed for mentally passive SB (p > 0.05). Males significantly accumulated more mentally active SB compared to females (p < 0.001 for all). Females significantly spent more time in mentally passive SB on weekdays than males (p < 0.05). Conclusion: Our results highlight the need for individualized SB reduction strategies based on mental activity to obtain the most benefits of SB reduction interventions and promoting overall health post-COVID-19 pandemic. Full article

This work is a response to the appeal of various international health organizations and the Automatic Control Community for collaboration in addressing Coronavirus/COVID-19 challenges during the initial stages of the pandemic. Specifically, this study presents scientific evidence supporting the efficacy of three primary non-pharmacological strategies for pandemic mitigation. We propose a control system to aid in formulating a public decision policy aimed at managing the spread of COVID-19 caused by the SARS-CoV-2 virus, commonly known as coronavirus. The primary objective is to prevent overwhelming healthcare systems by averting the saturation of intensive care units (ICUs). In the context of COVID-19, understanding the peak infection rate and its time delay is crucial for preparing healthcare infrastructure and ensuring an adequate supply of intensive care units equipped with automatic ventilators. While it is widely recognized that public policies encompassing confinement and social distancing can flatten the epidemiological curve and provide time to bolster healthcare resources, there is a dearth of studies examining this pivotal issue from the perspective of control system theory. In this study, we introduce a control system founded on three prevailing non-pharmacological tools for epidemic and pandemic mitigation: social distancing, confinement, and population-wide testing and isolation in regions experiencing community transmission. Our analysis and control system design rely on the susceptible-exposed–infected–recovered–deceased (SEIRD) mathematical model, which describes the temporal dynamics of a pandemic, tailored in this research to account for the temporal and spatial characteristics of SARS-CoV-2 behavior. This model incorporates the influence of conducting tests with subsequent population isolation. An On–off control strategy is analyzed, and a proportional–integral–derivative (PID) controller is proposed to generate a sequence of public policy decisions. The proposed control system employs the required number of critical beds and ICUs as feedback signals and compares these with the available bed capacity to generate an error signal, which is utilized as input for the PID controller. The control actions outlined involve five phases of “Social Distancing and Confinement” (SD&C) to be implemented by governmental authorities. Consequently, the control system generates a policy sequence for SD&C, with applications occurring on a weekly or biweekly basis. The simulation results underscore the favorable impact of these three mitigation strategies against the coronavirus, illustrating their efficacy in controlling the outbreak and thereby mitigating the risk of healthcare system collapse. Full article

The spread of COVID-19 led to a lockdown in New York in March of 2020. Nonemergent surgeries were postponed, including oncologic procedures. The backlog of surgeries was addressed starting May 2020. Our goal was to examine the change in waiting times for endometrial cancer surgeries during the COVID-19 pandemic in our institution. Data on surgery incidence and waiting time was gathered for patients diagnosed with endometrial intraepithelial neoplasia and endometrial cancer. The association between days from diagnosis to surgery was adjusted for age, obesity, presence of comorbid conditions, race, smoking history and diagnosis and was examined using a general linear model. A total of 190 patients were identified for this retrospective study. Five subjects were missing information on race and were excluded from all analyses, resulting in 185 subjects in the final analyses. Mean waiting time during COVID-19 was 70.9 days (95%CI 55.0, 91.3), compared to 49.3 (95%CI 49.8, 63.8) days during the reference period. No significant associations were seen between the time and any of the clinical or demographic factors. Full article

Although the impact of the SARS-CoV-2 pandemic on major metropolitan areas is broadly reported and readily available, regions with lower populations and more remote areas in the United States are understudied. The objective of this study is to determine the progression of SARS-CoV-2 sequence variants in a frontier and remote intermountain west state among university-associated communities. This study was conducted at two intermountain west universities from 2020 to 2022. Positive SARS-CoV-2 samples were confirmed by quantitative real-time reverse transcription-polymerase chain reaction and variants were identified by the next-generation sequencing of viral genomes. Positive results were obtained for 5355 samples, representing a positivity rate of 3.5% overall. The median age was 22 years. Viral genomic sequence data were analyzed for 1717 samples and phylogeny was presented. Associations between viral variants, age, sex, and reported symptoms among 1522 samples indicated a significant association between age and the Delta variant (B 1.167.2), consistent with the findings for other regions. An outbreak event of AY122 was detected August–October 2021. A 2-month delay was observed with respect to the timing of the first documented viral infection within this region compared to major metropolitan regions of the US. Full article

Several comorbid conditions have been observed to be associated with an increased risk of poor outcomes following a diagnosis of COVID-19. The purpose of this investigation was to assess associations between Centers for Medicare and Medicaid Services (CMS) designated priority conditions and an inability to access care, treat ongoing conditions, and obtain prescription medications among Medicare beneficiaries in the United States during the COVID-19 pandemic. Nationally representative CMS Medicare Current Beneficiary Survey (MCBS) COVID-19 Supplement Public Use Files (PUF) were analyzed via bivariable, binomial generalized linear models across three time periods: (1) Summer 2020; (2) Fall 2020; and (3) Winter 2021. Across an estimated 55.3–57.4 million Medicare beneficiaries, approximately one-fifth reported an inability to access at least one type of care at the onset of the pandemic. Significantly worse odds of an ability to get care across various time periods was observed among several priority conditions including immune disorders, cancer, depression, osteoporosis, diabetes, arthritis, and numerous cardiovascular and pulmonary conditions. Among those reporting an inability to access care, approximately one-third involved treatment of an ongoing condition, and under one-tenth involved prescription medications. To identify modifiable risk factors and to develop active interventions, future work should continue to assess the complex associations between outcomes, access to care, comorbidities, evolving healthcare infrastructures, computerization, and various public health initiatives. Full article

The COVID-19 pandemic forced the authorities to take an unprecedented measure in history: the house confinement of millions of people worldwide. Video games, especially open-world video games (OWVGs), became meeting spaces, a digital places to play, chat, learn and socialize due to the context of the health crisis, respecting the rules of social distancing. This article analyses the role of video games and, more specifically, OWVGs, as playgrounds and training spaces during the pandemic. Statistical data and analyses carried out by consulting companies and civil associations show the definitive insertion of these video games in our routine and social relations. The challenge is to take advantage of the skills and abilities that these video games develop within a new framework of individual and community learning. The conclusions of the research show that the virtual worlds of video games are for the new digital society, safe and comfortable meeting spaces, and that since the confinement, these digital places have greatly expanded their reach, previously only limited to the gamer community. Full article