COVID, Volume 5, Issue 9 (September 2025) – 15 articles

Cardiovascular diseases (CVDs) are among the most common comorbidities in COVID-19 patients. This multicenter cross-sectional study assessed knowledge, risk perception, precautionary measures, and psychological burden related to COVID-19 among Lebanese individuals with and without CVD during the pandemic’s first wave. A total of 485 CVD patients and 1033 control group (CG) participants completed standardized questionnaires, including the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), and Coronavirus Anxiety Scale. Compared to CG, CVD patients demonstrated significantly lower COVID-19-related knowledge (86.4% vs. 90.0%, p < 0.001) and adherence to preventive measures (81.5% vs. 85.7%, p < 0.001). After stratification, limited knowledge was more common among CVD patients (45.7% vs. 31.8%), as was limited precautionary behavior (70.3% vs. 54.2%). Risk perception was suboptimal in both groups, with no significant difference (41.3% vs. 38.6%, p = 0.072). Anxiety (GAD-7 ≥ 10) and depression (PHQ-9 ≥ 10) were more prevalent among CVD patients (13.4% and 11.3%) than CG participants (9.5% and 16.5%). Survey outcomes were influenced by educational, socioeconomic, and psychosocial factors. These findings highlight the need to target CVD patients in public health campaigns to enhance preparedness and mental health support during pandemics. Full article

The COVID-19 pandemic increased demand for intensive care unit (ICU) beds, requiring reliable disease severity scoring tools to optimise patient management and resource allocation. This retrospective study investigated the accuracy of the Sequential Organ Failure Assessment (SOFA) score in predicting mortality among critically ill COVID-19 patients. Data from 357 patients aged 18 years and above admitted to the ICU with COVID-19 category 5a and above, requiring ventilatory support throughout 2021, were analysed. The SOFA scores were calculated on days 1, 3 and 5 of ICU admission. The highest score and trends were noted; whether scores increased, were maintained or decreased was also determined. Patient outcomes were classified as survivors and non-survivors. There were significant differences in SOFA score trends between survivors and non-survivors. The high sensitivity (83.95%) and positive predictive value (PPV) (86.08%) in those with increased SOFA score trends showed that a SOFA score of ≥9 strongly predicted mortality, albeit with moderate specificity (65.63%). High sensitivity (81.85%) with low PPV (49.45%) was seen in those with decreased SOFA score trends. A high negative predictive value (87.50%) was observed for survivors. The SOFA score trend is effective in prognosticating survival in critically ill patients with COVID-19 infection, making it useful for critical care resource management. Full article

The COVID-19 pandemic has left millions worldwide with persistent cognitive difficulties, making long-term studies essential to understand their trajectory and inform rehabilitation strategies. This research is presented within the context of Long COVID, emphasizing that cognitive symptoms (including deficits in attention, memory, and executive functions) are reported even in non-hospitalized individuals, yet longitudinal evidence beyond two years remains scarce. An observational, cross-sectional, and retrospective design was applied to a sample of 297 adults with their cognition assessed, divided into mild, moderate, and severe COVID-19 groups, and evaluated using standardized cognitive tests. Findings showed that cognitive performance declined with increasing severity of COVID-19 symptoms, particularly in divided attention, working memory, executive control, verbal fluency, recognition memory, and general intelligence. Age consistently predicted lower scores across cognitive domains, especially in moderate and severe groups, whereas education level did not exert a significant protective effect. The study shows that cognitive deficits can persist at least three years after infection, affecting older adults and those with the more severe symptoms. These results highlight the need for long-term neuropsychological monitoring and individualized rehabilitation strategies to mitigate impacts on autonomy and quality of life. Full article

Background/Objectives: The impact of COVID-19 on male reproductive health remains unclear, with existing studies reporting conflicting results. This study aimed to evaluate longitudinal changes in sperm parameters, functional tests, and key markers related to the inflammasome complex in men diagnosed with COVID-19. Methods: In this experimental study, semen and blood samples were collected from 34 men at one- and three-months following COVID-19 diagnosis. Assessments included sperm parameters, chromatin damage, protamine deficiency, residual histones, and key inflammasome pathway markers (NLRP3, ASC, and caspase-1) in sperm samples. Additionally, blood levels of LH, testosterone, interleukin-6, and TNF-ɑ were measured. Results: While semen volume, sperm count, concentration, total motility, and DNA damage showed no significant changes, notable improvements were observed in sperm vitality, rapid motility, chromatin integrity, protamine content, and residual histones at three months compared to one-month post-diagnosis. Serum levels of LH, testosterone, and interleukin-6 remained stable, whereas TNF-ɑ levels significantly decreased after three months. Western blot analysis revealed a significant increase in NLRP3 protein expression after three months, while ASC and caspase-1 levels showed no significant changes. Conclusions: These results suggest a gradual recovery in sperm function over time after COVID-19 infection, highlighting possible implications for male reproductive health. Further studies with larger populations are necessary to better understand the underlying mechanisms and long-term effects of COVID-19 on male fertility. Full article

Cervical cancer is a leading cause of morbidity and mortality among women, particularly in low- and middle-income countries. Early detection through routine Pap smear screening is essential to prevent disease progression. The COVID-19 pandemic severely disrupted healthcare services worldwide, including cancer screening programs. This study aimed to evaluate the impact of the COVID-19 pandemic on cervical cancer screening in Brazil. A nationwide retrospective population-based study was conducted using data from the Cancer Information System (SISCAN) of Brazil’s public health system (SUS). Data from 2018–2019 (pre-pandemic) were compared to 2020–2021 (pandemic period) regarding the number of Pap smear tests performed, regional distribution, and diagnostic outcomes. Furthermore, data from 2022–2023 were incorporated to evaluate the volume of cytopathological exams performed in the post-pandemic context. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and repeated measures ANOVA with Bonferroni correction. A significant reduction in Pap smear testing was observed nationwide during the pandemic (p < 0.01), with variations across regions. Despite fewer screenings, there was an increase in unsatisfactory exams and a rise in adenocarcinoma and atypical findings in some regions. In contrast, the post-pandemic period showed a significant recovery in the number of exams, reaching volumes comparable to those observed before the pandemic (p < 0.05). The COVID-19 pandemic substantially reduced cervical cancer screening coverage in Brazil, highlighting structural vulnerabilities in the healthcare system. Strengthening organized screening programs is essential to mitigate the long-term impact of these disruptions. Full article

The COVID-19 pandemic created unprecedented conditions for examining how vaccination willingness evolves during prolonged health crises. This longitudinal mixed-methods study examines temporal dynamics in COVID-19 vaccination willingness across three phases of Germany’s vaccination campaign (N = 1063 survey respondents; n = 40 interview participants). Using mixed-effects models and thematic analysis, we tested whether institutional trust and personal risk perception predict vaccination willingness and how their relative importance changes over time. Results reveal that trust in scientific institutions emerges as the strongest predictor, outperforming political trust and becoming more influential over time, while risk perceptions become less predictive with time. Qualitative analysis identified a multitude of different argumentative themes for and against COVID-19 vaccination (as well as conditional acceptance), with 30% of participants expressing both. The themes complement the quantitative analysis by demonstrating a shift from analytical, risk-focused decision-making to heuristic, trust-based processing as vaccination campaigns progress, with important implications for adaptive public health communication strategies. Full article

The COVID-19 pandemic caused by SARS-CoV-2 has significantly impacted public health worldwide. This study aimed to assess the clinical and diagnostic features of COVID-19 cases in the Tlemcen region, Algeria, and analyze epidemiological trends from January to December 2021. This retrospective study included 68,745 confirmed snapshot active COVID-19 cases from the Public Local Health Care Establishment (EPSP)—University Hospital of Tlemcen. Patients underwent PCR testing and chest CT imaging for clinical evaluation. Data on symptoms, PCR cycle threshold (Ct) values, and CT imaging findings were collected, and statistical analysis was performed to examine the patient’s viral load and lung involvement data. Among 488 confirmed cases, common symptoms included fever, cough, and shortness of breath. PCR Ct values ranged from 15 to 35, and CT imaging revealed widespread lung involvement, with ground-glass opacities being the predominant feature. Epidemiological trends showed a consistent increase in cumulative cases, highlighting sustained transmission throughout the study period. Over the study period, epidemiological surveillance recorded a progressive rise in daily cases, peaking in July with 72 cases, followed by a gradual decline toward the end of the year. The findings underscore the utility of PCR Ct values and CT imaging in evaluating disease severity and monitoring regional case progression. The upward trend in cumulative cases emphasizes the need for ongoing public health measures and diagnostic strategies to manage future outbreaks effectively. Full article

Background: Elective surgery soon after SARS-CoV-2 infection is linked to high morbidity, but the risk > 7 weeks post-infection is uncertain. Methods: A PROSPERO-registered systematic review (CRD42023416842) following PRISMA 2020 searched PubMed, Web of Science, WHO COVID Database, Wiley, Google Scholar, and Scopus (Jane 2020–July 2025) for studies reporting postoperative outcomes in patients with confirmed COVID-19 ≥ 7 weeks before elective surgery. Primary endpoints were cardiopulmonary, neurological, renal and thrombotic complications, ICU/hospital stay and 30-day mortality. Results: Thirteen observational studies (38,055 patients) met inclusion criteria. In patients operated ≥7 weeks after mild or asymptomatic infection, overall mortality rate was 2.27% (607/26,688), with no significant excess versus uninfected controls. Pneumonia (1.66%), pulmonary embolism (1.47%), arrhythmias (2.57%) and myocardial injury (1.06%)—did not exceed baseline surgical rates. Thrombosis occurred in 2.8% but lacked a clear association with prior infection. Conversely, individuals with previous moderate-to-severe disease or recent COVID-19-related hospitalization showed higher complication rates, especially in complex procedures such as coronary bypass. Conclusions: Evidence to date indicates that COVID-19 history beyond seven weeks does not independently raise perioperative morbidity or mortality for most elective procedures. Full article

Wastewater-based epidemiology (WBE) is increasingly recognized as a valuable tool for monitoring disease cycles, including pandemics like COVID-19. Unlike pandemics, epidemics exhibit distinct dynamics, spread patterns, multiple origin points, and varying levels of population immunity. This study evaluates the applicability of WBE for epidemic monitoring and emergency preparedness by analyzing SARS-CoV-2 presence in Jaipur’s wastewater over one year post-second pandemic wave, covering a minor surge (third) and a mild resurgence (fourth) of COVID-19. A total of 1050 samples from different city localities were analyzed using a combination of two concentration methods (the direct method and the Polyethylene Glycol (PEG) method) and two detection kits (qualitative and quantitative). WBE effectively detected both minor and major epidemic outbreak cycles of SARS-CoV-2. A total of 62.91% samples out of all untreated samples tested, were found to be positive with viral genome; however, the positivity rate of any particular day did not exceed 25% even during the peaks. Notably, short-distance transportation under ambient conditions had no significant impact (p > 0.05) on detection, and the combination of the direct method with quantitative kits provided the highest sensitivity. Based on these findings, a cost-effective bi-phase surveillance model is proposed for year-round epidemic monitoring. This model suggests routine use of the faster, cheaper direct method, switching to the PEG concentration method during rising viral loads for enhanced resolution. Such an approach ensures sustainable, resource-efficient surveillance, particularly benefiting low- and middle-income countries facing financial constraints. Full article

This study examines the use of alternative financial services in the context of COVID-19-induced economic displacement. We utilize data from the 2020 Collaborative Multiracial Post-Election Survey and the ABC-X model of family stress and coping to examine how economic displacement, prior AFS use, and sociodemographic factors collectively promote AFS utilization. This study examines four types of financial coping strategies: credit cards, payday loans, public benefits, and borrowing from family and friends. Of these, payday loan use represents the primary indicator of AFS reliance. Our findings indicate that borrowing from friends and family is a significant predictor of payday loan usage. Furthermore, prior use of AFS, such as payday loans, check-cashing services, and pawnshops, strongly predict future AFS use. This study also finds a negative relationship between ethno-racial identity and AFS use which contradicts much of the existing literature. We find that lower levels of education and living in large urban areas are predictors of AFS use. This study highlights how the pandemic exacerbated financial vulnerabilities and validates the need for education and advocacy to prepare the most vulnerable to break cycles of AFS use. Full article

Although acute kidney injury (AKI) is common among patients with coronavirus disease 2019 (COVID-19), there are only limited data on its occurrence at intensive care unit (ICU) admission. Assessing the factors associated with AKI is essential for early diagnosis and intervention. This study aims to compare the clinical and laboratory characteristics and survival outcomes of COVİD-19 patients with and without AKI at ICU admission and determine the factors associated with AKI. In this study, patients with SARS-CoV-2 infection were categorized based on the presence (AKI group) or absence (non-AKI group) of AKI. Clinical and laboratory data and outcomes were analyzed retrospectively. Of the 712 patients included in this study, 198 were assigned to the AKI group and 514 were assigned to the non-AKI group. Patients with AKI had more comorbidities and higher disease severity; higher rates of invasive mechanical ventilation, vasopressor therapy, and mortality; and longer hospital stays (p < 0.05). Our multivariate analysis identified advanced age, a high Acute Physiology and Chronic Health Evaluation II score, a high neutrophil-to-lymphocyte ratio, a low albumin level, and the presence of comorbidities as independent factors associated with AKI. In patients with COVID-19, AKI observed at ICU admission is associated with advanced age and increased disease severity. The early diagnosis and monitoring of patients may improve clinical outcomes. Full article

The current study aims to examine the impact of non-work responsibilities (NWRs) due to work from home (WfH) conditions on the work–life imbalance (WLI) and emotional exhaustion (EE) experienced by pregnant working women during the pandemic (COVID-19) in Indian settings. Due to lack of empirical evidence on the increasing rate of mental health issues during the prepartum period amid the pandemic, the study attempted to explore the effect of NWRs, prepartum burnout (PB) on the WLI and EE during WfH. The research study was carried out in urban cities of eastern coastal India and other major eastern cities by collecting data from 386 working pregnant women from January to March 2023. For assessing the reliability and validity of the measurement model, a Confirmatory Factor Analysis (CFA) using AMOS 23 was performed, and SPSS 26 using Process macro was used for examining the direct, mediation, and moderated mediation effects. Findings depicted that NWRs and PB are positively significant with EE. Additionally, WLI mediates the relationship between NWRs → EE and PB → EE. Moderated mediation was also examined and reported the contradictory results, with COVID-19 rumination (CR) as the moderator. To the best of our knowledge, this study is the first to explore the combined effects of organizational psychology (WLI, WfH) and mental health (PB, EE) variables on pregnant working professionals in the Indian context. The study has the potential to overcome the challenges faced by prepartum working professionals in the forthcoming pandemic and challenging times, if any, keeping in mind their robustness in overpowering severe public health emergency events. Full article

Coronavirus disease 2019 (COVID-19) emerged in late 2019 and was declared a pandemic from March 2020 to May 2023, profoundly affecting public health systems, economies, and daily life worldwide. University students were among the most impacted groups, facing abrupt transitions to remote learning, social isolation, and increased psychological distress due to academic and personal uncertainties. During the pandemic, few studies have been conducted with this population and so far, none have evaluated factors associated with COVID-19 infection in university students, so this study aimed to evaluate variables associated with COVID-19 infection among university students in southern Brazil. Data were collected from July to November 2020 through an online questionnaire addressing lifestyle and health, with participation from 1533 students. Among the variables analyzed, statistically significant associations with COVID-19 infection were identified for age, occupation, use of continuous medication, compliance with social distancing, and self-medication practices. Younger students (18–29 years) and those dedicated solely to studying exhibited higher infection rates. Additionally, participants who reported using continuous medication, not adhering to social distancing measures, or engaging in self-medication were significantly more likely to have contracted COVID-19. These results help outline risk profiles within the university student population and contribute to improved preparedness for future disease outbreaks. Furthermore, they underscore attitudes and behaviors that may increase vulnerability to infectious diseases, highlighting the importance of targeted health promotion and prevention strategies in this demographic. Full article

A key requirement in containing contagious diseases, like the COVID-19 pandemic, is the ability to efficiently carry out mass diagnosis over large populations, especially when testing resources are limited and rapid identification is essential for outbreak control. Some of the leading testing procedures, such as those utilizing qualitative polymerase chain reaction, involve using dedicated machinery which can simultaneously process a limited amount of samples. A candidate method to increase the test throughput is to examine pooled samples comprised of a mixture of samples from different patients. In this work, we study pooling-based tests which operate in a one-shot fashion, while providing an indication not solely on the presence of infection, but also on its level, without additional pool-tests, as often required in COVID-19 testing. As these requirements limit the application of traditional group-testing (GT) methods, we propose a multi-level GT scheme, which builds upon GT principles to enable accurate recovery using much fewer tests than patients, while operating in a one-shot manner and providing multi-level indications. We provide a theoretical analysis of the proposed scheme and characterize conditions under which the algorithm operates reliably and at affordable computational complexity. Our numerical results demonstrate that multi-level GT accurately and efficiently detects infection levels, while achieving improved performance and less pooled tests over previously proposed oneshot COVID-19 pooled-testing methods. Our simulations show that the efficient method proposed in this work can correctly identify the infected items and their infection levels with high probability at the known upper bound (for a maximum likelihood decoder in GT) on the number of tests. We also show that the method works well in practice when the number of infected items is not assumed to be known in advance. Full article

This study highlights how socio-demographic, information, and government factors play different roles in people’s health during COVID-19 between Asian countries and non-Asian countries by employing the Hierarchical Linear Regression. This study finds that government factors play a more significant role in shaping wellness and happiness in Asian countries, whereas they have a stronger impact on health status in non-Asian countries. Second, information factors—such as knowledge about vaccines, medical professionals, and reliable sources—have a more substantial effect on health status in Asian countries, while they are more strongly associated with wellness and happiness in non-Asian contexts. Third, socio-demographic variables exert a greater influence on overall health outcomes in non-Asian countries compared to Asian countries. In particular, gender, occupation, socioeconomic placement, height, and weight consistently play a significant role across all health dimensions in non-Asian countries, whereas their impact varies across different health domains in Asian settings. Full article