COVID, Volume 4, Issue 8 (August 2024) – 19 articles

Amid the array of challenges prompted by the COVID-19 pandemic, the policy response of governments proved vital. Different states in the U.S. pursued varied policy approaches that demonstrated distinct divergences in impact. Particularly, contrasting state contexts produced markedly assorted frameworks for the delivery of public health services, which indicate potential effects for COVID-19 policy implementation. Using the rates of COVID-19 vaccination as a measure of policy execution, the purpose of this study is to examine the political and administrative influences contributing to differences in COVID-19 public health policy outcomes among the states in the U.S. Ordinary least squares (OLS) regression models included data sources of nationally representative information pertaining to state public health attributes of politics and administration during the height of the pandemic and vaccine campaign. The findings suggest that state political leadership and fiscal capacity display significant associations with COVID-19 vaccination disparities, while other administrative indicators did not. The results signal important policy implications for the politics–administration dynamic within the COVID-19 pandemic and offer further understanding toward the roles of federalism and governance in future public health emergencies. Full article

Background: Accurate and rapid testing for COVID-19 is critical for effective disease management and control. The One-Step-COVID-2019-Test was developed as a rapid serological test to detect antibodies against SARS-CoV-2. Objective: To estimate the accuracy of the rapid serological test for COVID-19 using One-Step-COVID-2019. Methods: We conducted a population-based serological survey with a stratified sampling of 593 adults between October and December 2020, prior to mass vaccination and during a period of limited availability of rapid tests. Participants provided 7.5 mL of serum, which was tested using the One-Step-COVID-2019-Test for IgM-IgG antibodies without distinction, as well as an in-house ELISA for IgG against the spike protein. Statistical analysis accounted for sampling weights, with accuracy assessed through sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Youden index, and kappa coefficient, using ELISA as the reference standard. McNemar’s test identified significant differences between the test results. Results: The ELISA-based prevalence of infection was 11.1%. The One-Step-COVID-2019-Test showed low sensitivity (27.0–30.8%) but high specificity (89.9–96.6%), with poor agreement (kappa: 0.290–0.337), particularly among asymptomatic individuals. Conclusions: The One-Step-COVID-2019 rapid test for COVID-19 demonstrated inadequate performance, characterized by low sensitivity and poor reliability, making it unsuitable for effective serological surveillance. Full article

This study offers an in-depth analysis of the COVID-19 pandemic’s trajectory in several member countries of the European Union (EU) in order to assess similarities in their crisis experiences. We also examine data from the United States to facilitate a larger comparison across continents. We introduce our new approach, which uses a spatiotemporal algorithm to identify five distinct and recurring phases that each country underwent at different times during the COVID-19 pandemic. These stages include: Comfort Period, characterized by minimal COVID-19 activity and limited impacts; Preventive Situation, demonstrating the implementation of proactive measures, with relatively low numbers of cases, deaths, and Intensive Care Unit (ICU) admissions; Worrying Situation, is defined by high levels of concern and preparation as deaths and cases begin to rise and reach substantial levels; Panic Situation, marked by a high number of deaths relative to the number of cases and a rise in ICU admissions, denoting a critical and alarming period of the pandemic; and finally, Epidemic Control Situation, distinguished by limited numbers of COVID-19 deaths despite a high number of new cases. By examining these phases, we identify the various waves of the pandemic, indicating periods where the health crisis had a significant impact. This comparative analysis highlights the time lags between countries as they transitioned through these different critical stages and navigated the waves of the COVID-19 pandemic. Full article

The emergence of COVID-19 has evolved into a global pandemic, causing an unprecedented public health crisis marked by unprecedented levels of morbidity never seen in the recent past. Considerable research efforts have been made in the scientific community to establish an optimal method to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and to understand the induced immune response. This review examined the development of serological tests during the COVID-19 pandemic, considering the factors affecting sensitivity and specificity, which are key to promote an efficient vaccination strategy for public health. The market has witnessed the introduction of various serological tests for the detection of SARS-CoV-2, such as the chemiluminescence immunoassay (CLIA), which emerged as a powerful and rapid tool to monitor the antibody response before and after vaccination or infection. Therefore, developing serological tests by studying antibody trends and persistence is essential for creating long-term strategies. Our analysis underscores the multifaceted applications of serological tests in pandemic management with a focus on the critical insights they provide into antibody dynamics that help in managing the ongoing pandemic and shaping future public health initiatives, providing a basis for optimizing the future response to viral threats. Full article

COVID-19 has had unprecedented effects on construction markets globally due to supply chain disruptions and workforce restrictions, etc. However, construction industries in developing countries are more vulnerable to the obstacles associated with the pandemic. As such, the goal of this paper is to capture the impact of COVID-19 on construction projects’ performance in developing countries by taking the Pakistani construction sector into perspective. A multistep project-based research methodology was adopted, including a literature analysis and questionnaire survey with 20 construction professionals to assess factors affected by COVID-19; formulation of open-ended questions against each factor; collecting data using semi structured interviews; and presenting challenges and adopted mitigation strategies to examine the perceived impact. Results showed that the pandemic has caused a total of 13 factors to impact the project performance, which are grouped under four construction groups, including material and equipment, human resource, occupational health and safety, and financial and contracts. The factors impacted the most by the pandemic are cash flow management, supply chain disruptions, increased overheads, construction safety measures, material shortage, contractual issues, and construction workforce. This research contributes to the body of knowledge by providing a foundation for researchers to enhance investigating the impact of the COVID-19 in developing countries. Full article

The coronavirus disease 2019 (COVID-19) pandemic has significantly affected older adults. Identifying host COVID-19 susceptibility genes in elderly populations remains a challenge. Here, we aimed to identify host genetic factors influencing the susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We genotyped 12 single-nucleotide polymorphisms (SNPs) previously associated with the innate immune response in a total of 97 elderly (age > 65 years) residents of three long-term care facilities located in Barcelona, Spain. Individuals were PCR-tested during the SARS-CoV-2 outbreaks between September and November 2020. SARS-CoV-2 PCR tests revealed infections in 81 residents. Importantly, the 16 uninfected residents remained SARS-CoV-2 seronegative until vaccination (January and February 2021). After adjusting for sex and age, we found that two SNPs were significantly associated with SARS-CoV-2 infection susceptibility—MMS19 nucleotide excision repair protein homolog (MMS19)/rs2236575 (p = 0.029) and interferon-induced helicase C domain-containing 1 (IFIH1)/rs1990760 (p = 0.034). No association with SARS-CoV-2 infection was found for 10 additional genotyped SNPs, which included 4 SNPs on chromosome 12 in the gene encoding oligoadenylate synthetase (OAS). Our results indicate that MMS19/rs2236575_A and IFIH1/rs1990760_TC genetic variants were associated with a resistance to SARS-CoV-2 infection in a cohort of institutionalized seniors. Full article

In the pursuit of advancing COVID-19 diagnosis through imaging, this paper introduces a novel approach utilizing adaptive Fourier neural operators (AFNO) for the analysis of high-resolution computed tomography (HRCT) chest images. The study population comprised 395 patients with 181,106 labeled high-resolution COVID-19 CT images from the HRCTCov19 dataset, categorized into four classes: ground glass opacity (GGO), crazy paving, air space consolidation, and negative for COVID-19. The methods included image preprocessing, involving resizing and normalization, followed by the application of the AFNO model, which enables efficient token mixing in the Fourier domain independent of input resolution. The model was trained using the Adam optimizer with a learning rate of 1 × 10⁻⁴ and evaluated using metrics such as accuracy, precision, recall, and F1 score. The results demonstrate AFNO’s superior performance in few-shot segmentation tasks over traditional self-attention mechanisms, achieving an overall accuracy of 94%. Specifically, the model showed high precision and recall for the GGO and negative classes, indicating its robustness and effectiveness. This research has significant implications for the development of AI-powered diagnostic tools, particularly in environments with limited access to high-quality imaging data and those where computational efficiency is critical. Our findings suggest that AFNO could serve as a powerful model for analyzing HRCT images, potentially leading to improved diagnosis and understanding of COVID-19, representing a critical step in combating the pandemic. Full article

Aim: This study aimed to identify self-compassion among staff nurses after the COVID-19 pandemic in Qatar. Design: Descriptive cross-sectional survey design. Methods: Anonymous data were collected through an online survey using Microsoft Forms from 300 nurses in 14 health facilities in Qatar. The organization had almost 10,000 nursing staff working in different facilities. Data were gathered using a structured online questionnaire and included socio-demographic information, and the Self-Compassion Scale—Short Form was used to collect the remaining data. Correlation, t-test, and ANOVA analyses were conducted. Results: Nurses in the study showed high self-compassion. Among the sub-domain ‘mindfulness’, they showed comparatively high scores (7.96 ± 1.55), and the lowest score was for ‘isolation’ (6.15 ± 1.99). The score for ‘self-kindness’ was 7.29 ± 1.55, that for ‘self-judgement’ was 6.79 ± 2.01, that for ‘common humility’ was 6.62 ± 1.47, and that for the sub-domain ‘over-identified’ was 6.47 ± 1.91. Mindfulness scores were high among the nurse leaders. Moreover, over-identified scores were high among the nurses who were currently working under COVID-19 at the time of data collection. Conclusions: Nurses faced many difficulties while working during the COVID-19 pandemic, including a heavy workload and tension. The current study’s findings add to our understanding of how COVID-19 affected the development of self-compassion. A rise in mindfulness, which aids nurses in managing stress at work and building resilience, further underscores an increase in nurses’ acceptance of the COVID-19 pandemic. The findings also highlight how crucial it is to encourage self-compassion in individuals and offer them emotional support at such times, especially when there is a significant risk factor for mental health, such as COVID-19. Full article

Understanding the factors that influence the intention to use vaccines is crucial for implementing effective public health policies. This study examined the impact of various cognitive, affective, normative, and sociodemographic variables on the intention to be vaccinated against COVID-19 with the first-generation AstraZeneca vaccine. A survey of 600 residents of Spain was used to assess the influence and hierarchy of the drivers of the intention to vaccinate via least-squares and quantile regressions. The most significant factors were the perceptions of efficacy and social influence, both of which had positive impacts (p < 0.0001). The positive influence of fear of COVID-19 and the negative influence of fear of the vaccine were also significant in shaping the central tendency toward vaccination. However, these fear-related variables, particularly the fear of COVID-19, lost importance in quantile adjustments outside the central tendency. Among the sociodemographic variables, only the negative impact of income was statistically significant. These results are valuable for the development of vaccination policies because they measure the sensitivity of attitudes toward vaccination to exogenous variables not only in the central values, as is common in similar studies, but also across the entire range of responses regarding the intention to vaccinate. This additional analysis, which is not commonly performed in studies on vaccine acceptance, allows us to distinguish between variables which are consistently related to the intention to vaccinate and those that influence only expected responses. Full article

Objective: To evaluate how access to an office-based laboratory (OBL) and ambulatory surgery center (ASC) impacted vascular care during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Vascular procedures performed by our group during the 6-week period before COVID-19 restrictions (group 1) and in the first 6-week period during the COVID-19 restrictions (group 2) were reviewed. The number of procedures performed was categorized as hospital inpatient (HIP), hospital outpatient (HOP), OBL, ASC, and vein center (VC). The procedures were also grouped by type: aneurysm (AAA), carotid (CAR), peripheral arterial disease (PAD), amputation/wound care (AMP), vascular access (VA), deep vein thrombosis (DVT), and venous reflux (CVI). The number of healthcare provider contact points for each patient undergoing care at the HOP, OBL, and ASC were also collected and compared between groups 1 and 2. Differences between groups were determined using the two-way ANOVA. Results: There were no statistically significant differences between groups 1 and 2 for procedure location or type of procedure (p > 0.05). Patient contact with healthcare providers decreased between groups 1 and 2 for ambulatory care. However, projecting the number of contacts for patients in group 2 if they had to have ambulatory care in the HOP setting (913) compared to contacts in the OBL and ASC setting (588) was statistically significant (p < 0.05). No patient or staff member at the OBL or ASC developed COVID-19 infection because of the care received at these venues. Conclusions: The ability to provide essential care for patients in an ambulatory environment was enhanced using our OBL and ASC without compromising safety, efficacy, or transmission of the virus to patients or staff during the height of the COVID-19 pandemic and limited their contact with healthcare workers and therefore reduced the consumption of personal protective equipment by healthcare personnel. Full article

Background: The rising incidence of COVID-19 cases is undeniably having a profound impact on the physiological and psychological welfare of individuals. The incident had the potential to significantly affect an individual’s quality of life, social interactions, and occupational performance. The study explored the experiences of individuals who recovered from COVID-19 and the impact of their illness on their psychological and overall well-being. Methods: A qualitative, phenomenological study was conducted in Oman among 15 patients aged 20 to 60 years, who had been hospitalized at Royal Hospital with moderate to severe symptoms and signs of COVID-19. An in-depth interview was used to collect data. Thematic analysis was carried out to analyze the data using the Braun and Clarke model framework for the analysis. Results: Three themes emerged from the study: (1) The impact of COVID-19 on the survivors; (2) factors that improved patients’ recovery; (3) lessons learned from COVID-19 pandemic. A recent study found important intrinsic and extrinsic factors that helped COVID-19 patients recover quickly. Conclusions: COVID-19 impacted the individuals’ physiological and psychological health. The findings can inform Oman’s psychological support services and raise awareness of the virus’s psychological impact on mental health. The study may help to design a tailored psychological intervention to improve the mental well-being of COVID-19 survivors for better experience and quality of life. Full article

The COVID-19 pandemic constituted an important watershed for modern society. The experience of the pandemic influenced all economic and social activities, suggesting the need to review and rethink new ways of managing and controlling zoonotic infections. The book provides a complete and accurate analysis of the pandemic event, providing answers to many questions about its origin, spread, and management by government systems, and finally proposes some solutions to prevent and help us be better prepared for the recurrence of new pandemic crises. Above all, it provides methods to manage pandemics more effectively. Full article

Patients who survive critical COVID-19 frequently report post-acute sequelae of COVID-19 (PASC) such as psychosomatic and neurocognitive health problems. The goal of this study was to identify clinical risk factors and other predictors for such long-term consequences in severely ill COVID-19 patients. Adult COVID-19 intensive care unit (ICU) survivors from August 2020 to May 2021 were enrolled. A broad range of clinical, laboratory and chest computed tomography (CT) data was collected during their ICU stays. The association between ICU predictors and psychosomatic, respiratory, and neurocognitive assessments 12 months after ICU discharge was analyzed using univariate regression analysis. In 17 patients (mean age 58.9 ± 11.4 years), laboratory markers (CRP, lymphocytes, hemoglobin), ICU severity (SOFA, SAPS II, need for mechanical ventilation), complications (ARDS), and lung CT data (ground-glass opacity) were promising predictors of depressive and anxiety symptoms, fatigue, and sleep problems. Recovery of psychosomatic health such as fatigue, depression, and anxiety correlated with lower levels of inflammation and high hemoglobin levels. ARDS, mechanical ventilation, and worse SOFA and SAPS II scores were further risk factors for depressive and anxiety symptoms. Our study identified novel associations such as pulmonary ground-glass opacity being positively associated with depression, anxiety, fatigue, and insomnia levels. Full article

Background: The COVID-19 pandemic has brought about widespread effects on communities on a global scale, with impacts varying among different demographics. This study focuses on a unique cohort of COVID-19-positive patients from Arunachal Pradesh, a region in northeast India with a substantial indigenous population. This study aims to delve into the features and consequences of COVID-19 in this indigenous population within this distinct demographic region, with a special focus on assessing the effects on tribal communities. Out of a total of 1627 COVID-19 positive cases, 1392 belonged to various tribes of Arunachal Pradesh, categorized as the indigenous population of the region. Our research primarily focuses on examining the biochemical and inflammatory indicators that forecast the clinical results of COVID-19 patients, specifically within both indigenous and non-indigenous groups. Methods: Biochemical markers, including hematological parameters, liver and kidney function biomarkers, D-DIMER, and inflammatory markers, were assessed along with immune-inflammatory ratios: neutrophil-to-lymphocyte ratio (NLR) and lymphocyte-to-monocyte ratio (LMR). Differences in biomarker levels and ratios across disease severities were analyzed, and significant data were observed using descriptive statistics. Results: Elevated levels of Ferritin (CRP, IL-6, D-DIMER, Creatinine, Urea, AST/SGOT, and ALT/SGPT) were associated with increasing disease severity in COVID-19 cases, reflecting increased inflammation, multi-organ dysfunction, and coagulopathy in the severe COVID-19 category amongst the indigenous population. The data showed an aligned report with the non-indigenous population of India when compared with various other studies (using a Spearman rank correlation test). Similarly, an increase in the neutrophil-to-lymphocyte ratio (NLR) and a declining shift in the lymphocyte-to-monocyte ratio (LMR) indicated deregulated immune responses and systemic inflammation in the severe category of COVID-19. Conclusion: This population-based study from northeast India offers important perspectives into the pathophysiology of COVID-19 and its link with disease severity among indigenous and non-indigenous populations. Full article

Introduction: COVID-19, caused by the SARS-CoV-2 virus, has been associated with oligosymptomatic cases or severe acute respiratory syndrome, with multiple organ failure and death. One of the most significant events for clinical outcomes is Acute Kidney Injury (AKI). It is known that AKI in COVID-19 is multifactorial, and the main mechanisms are cytokine storm, metabolic stress, use of nephrotoxic drugs, rhabdomyolysis, viral tropism to kidney tissues, and multiple organ failure. However, little is known about the impact of AKI clinical presentation and pathophysiological mechanisms on the outcome of patients affected by COVID-19. Objectives: To identify AKI clinical presentation and etiology, also known as phenotypes, and pathophysiological mechanisms, also known as subphenotypes, in patients affected by COVID-19 and associate them with death. This cohort and retrospective study evaluate the medical records of patients with SARS-CoV-2 infection admitted to a tertiary public hospital from 1 June 2020, to 31 July 2021, from admission to clinical outcome (hospital discharge or death). Clinical and laboratory data were analyzed during the hospitalization. Renal function was estimated by urine output and serum creatinine; therefore, the diagnosis and AKI classification were based on the 2012 KDIGO criteria. The occurrence of AKI was the inclusion criterion. According to clinical and laboratory presentations, we recognized two phenotypes of AKI (the direct and indirect impact of SARS-CoV-2 on the kidney) and several pathophysiological mechanisms. Subphenotypes of the direct impact of SARS-CoV-2 on kidneys were associated with Kidney Viral Tropism, Cytokine Storm, COVID-19-Related Multiple Organ Failure, and Mixed (more than one mechanism associated with COVID-19). Subphenotypes of indirect impact of SARS-CoV-2 on kidney phenotypes were Ischemic, Nephrotoxic due to rhabdomyolysis, and Septic. Univariate and multivariate analyses were performed to identify risk factors associated with death. Result: In total, 372 patients were included; 55.6% were male, 82.3% were Caucasians, and the mean age was 61.4 years. The majority of patients were admitted to the ICU (88.2%) and required mechanical ventilation (86.3%). AKI was predominantly KDIGO 3 (65.6%). When classifying our patients’ AKI in two kidney phenotypes based on their clinical presentation, the direct impact of the SARS-CoV-2 phenotype was predominant (71,5%) and associated with higher mortality (83.8 vs. 46.3%, p = 0.001). Among the AKI pathophysiological mechanisms, Mixed—synergism of viral mechanisms—was the most prevalent (23.4%), followed by Viral Tropism (19.9%), Multiple Organ Failure—MOF (18%), Septic (15.6%), Ischemic (12.9%), and Cytokine Storm (10.2%). Mortality was high (73.1%). Logistic regression identified APACHE II, ATN-ISS, and the direct impact of SARS-CoV-2 on the kidney as factors associated with death, while ischemic AKI was associated with lower mortality. Conclusions: We can conclude that APACHE II and ATN-ISS scoring are clinical predictions of hospital mortality in COVID patients with AKI, as well as AKI etiology involving the direct impact of SARS-CoV-2 on the kidney, while ischemic pathophysiological mechanisms of AKI are associated with lower mortality. Full article

Few studies have reported nationwide changes in dental visit patterns during the COVID-19 pandemic. This study aimed to clarify the impact of the COVID-19 pandemic on the type of dental treatment in Japan based on trends in the frequency of dental clinic visits per month and dental expenses per month or day. An interrupted time-series analysis was performed to examine changes in data from the national database before and after the first declaration of a state of emergency. Between March and April 2020, the monthly dental expenses per patient (MDEPP) increased by approximately JPY 950 (JPY) (p < 0.001) in patients aged ≤64 years and ≥65 years. Dental expenses per treatment (DEPT) increased by approximately JPY 300–400 (p < 0.001) in both age groups. After April 2020, the slope of the regression line for DEPT significantly increased in those aged ≤64 years (p < 0.001) and in those ≥65 years (p = 0.024). The number of treatments per month (NTPM) increased after the declaration of a state of emergency. However, the decreasing trend in the regression line for NTPM was stronger in those aged ≤64 years (p < 0.001). The MDEPP, DEPT, and NTPM showed an increasing trend during the first state of emergency compared to those observed in the previous year. The proportion of patients with relatively severe disease may have increased because patients with mild disease refrained from undergoing dental examinations. These results suggest changes in the type of dental treatment during the COVID-19 pandemic. Full article

The COVID-19 pandemic disrupted dental education significantly, forcing adaptations in both didactic and clinical curricula. This study evaluates the impact of COVID-19 on dental students’ mental health and perceptions of the SARS-CoV-2 vaccine. An anonymous online survey was administered to dental students at Roseman University of Health Sciences, focusing on health experiences and vaccination perceptions. Results showed 56.8% of students were concerned about their emotional health, 82.1% felt stressed, and 60.6% felt depressed. About 81.9% received the vaccine, with 75.5% believing it effective, though only 55.3% supported mandatory vaccination. The pandemic negatively impacted students’ emotional health, indicating a need for institutional mental health support. This study was conducted during the COVID-19 pandemic, and findings relate specifically to that period. Further research can focus on investigation of reasonings behind the sentiments. Full article

The COVID-19 pandemic has spread worldwide for over two years. It was considered a significant threat to global health due to its transmissibility and high pathogenicity. The standard test for COVID-19, namely, reverse transcription polymerase chain reaction (RT–PCR), is somehow inaccurate and might have a high false-negative rate (FNR). As a result, an infected person with a negative test result may unknowingly continue to spread the virus, especially if they are infected with an undiscovered COVID-19 strain. Thus, a more accurate diagnostic technique is required. In this study, we propose 3Cs, which is a capsule neural network (CapsNet) used to classify computed tomography (CT) images as novel coronavirus pneumonia (NCP), common pneumonia (CP), or normal lungs. Using 6123 CT images of healthy patients’ lungs and those of patients with CP and NCP, the 3Cs method achieved an accuracy of around 98% and an FNR of about 2%, demonstrating CapNet’s ability to extract features from CT images that distinguish between healthy and infected lungs. This research confirmed that using CapsNet to detect COVID-19 from CT images results in a lower FNR compared to RT–PCR. Thus, it can be used in conjunction with RT–PCR to diagnose COVID-19 regardless of the variant. Full article

The COVID-19 pandemic has revealed a diverse spectrum of clinical manifestations in the pediatric population, including the rare but notable presentation of unilateral parotitis. This comprehensive review explores the complexities surrounding SARS-CoV-2-associated unilateral parotitis in children. It addresses the initial clinical presentation, diagnostic challenges, treatment strategies, and the wider epidemiological impacts of this unusual symptom. The review synthesizes the available literature, providing insights into the pathophysiological mechanisms underlying this atypical manifestation and its implications for pediatric healthcare during the pandemic. Through the rigorous analysis of reported cases, this study underscores the need for increased awareness and a broad differential diagnosis among clinicians. It also emphasizes the importance of continued research to delineate the full clinical spectrum of COVID-19 in children. Full article