COVID

Since COVID-19, reliance on digital technology has surged, and digital literacy has gained attention as a key factor in explaining changes in how people use the Internet. However, most existing studies have focused on the general public, and there has been insufficient research on how digital literacy relates to changes in Internet usage among people with disabilities. This study examined the effect of digital literacy among people with physical disabilities on changes in Internet use on personal computers (PC) and smart devices during the COVID-19 pandemic using data extracted from the 2020 Digital Divide Survey conducted by the National Information Society Agency. The survey was conducted between September and December 2020. A total of 75,000 individuals participated, of which 2200 were disabled. Data was extracted from participants who used the Internet, and the final analysis data included the response results of 1239 individuals. The findings suggest competence is unrelated to changes in Internet use in PCs and smart environments during COVID-19. For example, use/behavior, search, email, content, life services, and economic activities are related to Internet use changes on PCs and remain static with smart devices. Social media services (SNS), networking, and social participation are negatively related to changes in Internet use on PCs and smart devices. This study extends the discourse on the role of digital literacy among people with disabilities by empirically elucidating the relationship between digital literacy and changes in Internet use among people with physical disabilities during the pandemic, drawing on a nationally representative sample. The results of this study suggest that a digital literacy education program must be developed for people with physical disabilities to lead the necessary digital life in crises such as COVID-19. Full article

Severe coronavirus disease 2019 (COVID-19) is characterized by acute immune dysregulation, with monocytes playing a central role in driving inflammation and disease severity. However, the transcriptional and post-transcriptional regulatory mechanisms underlying monocyte dysfunction in severe COVID-19 remain unexplored. In the study, an integrative analysis of paired bulk RNA-seq and miRNA-seq datasets was performed together with independent single-cell RNA-seq (scRNA-seq) data from convalescent individuals with a history of ICU or non-ICU COVID-19. Pooled cell proportions descriptively indicated a higher proportion of classical monocytes and lower proportions of non-classical monocytes, B cells and dendritic cells in individuals with a history of ICU disease; however, none of these differences was statistically significant in patient-level analyses after multiple-testing correction. Using the miRSCAPE framework, miRNA expression was inferred at single-cell resolution and identified distinct cluster-specific inferred miRNA expression patterns. Differential expression analysis of classical monocyte populations identified 284 nominally significant differentially expressed genes between convalescent ICU and non-ICU samples. Integration of miRNA-mRNA correlation analysis with experimentally validated interactions and independent assessment highlighted a focused regulatory network centered on ZMAT3, RHOB and HLA-DQA1. Host–pathogen interaction analysis identified database-supported SARS-CoV-2-host interactions involving ORF3a-RHOB and nucleoprotein-RHPN2, with additional host–host interactions connecting RHPN2, HLA-C and HLA-DQA1. Collectively, these findings provide a computational framework for investigating inferred miRNA associations of monocyte inflammatory pathways associated with prior COVID-19 severity and highlight regulatory interactions that warrant further experimental validation. Full article

Background/Objectives: Post-COVID syndrome (PCS) remains a clinically heterogeneous condition. In patients with chronic diseases, real-world evidence is needed to describe its frequency and to identify clinical factors associated with its current presence. This study assessed the prevalence of PCS and factors associated with current PCS status among patients with chronic diseases. Methods: This observational cross-sectional study included a consecutively enrolled source clinical sample of 850 adults receiving inpatient or outpatient care in Almaty and the Almaty Region between June and December 2025. The primary analytic cohort comprised participants with documented prior COVID-19 (n = 250). PCS was assessed at study enrollment according to the national clinical protocol as current symptoms persisting for more than 12 weeks and not explained by an alternative diagnosis. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). COVID-19 vaccination was excluded from the primary model and evaluated only in a sensitivity analysis because vaccination timing relative to infection was unavailable. The exploratory association-based probability model was evaluated using the AUC with 95% CI, Brier score, calibration assessment, bootstrap internal validation with 1000 resamples, assessment of age nonlinearity, and decision curve analysis. Results: PCS was identified in 147 of 250 participants with prior COVID-19 (58.8%). In the revised primary multivariable model, age (OR = 1.24 per 10-year increase; 95% CI: 1.01–1.54; p = 0.040) and endocrine diseases (OR = 3.36; 95% CI: 1.69–6.98; p < 0.001) remained associated with current PCS status. The association with endocrine diseases persisted after adjustment for body mass index. The apparent AUC was 0.687 (95% CI: 0.620–0.753), and the Brier score was 0.218. Bootstrap internal validation yielded an optimism-corrected AUC of 0.655, a calibration intercept of 0.061, and a calibration slope of 0.816. Conclusions: PCS was frequent among patients with chronic diseases who had prior COVID-19. Older age and endocrine pathology were the most consistent factors associated with current PCS status. All model-performance estimates were obtained within the development sample; the model should not be used for individual prediction or follow-up planning without prospective external validation. Full article

The COVID-19 pandemic caused major disruptions to agricultural value chains in the Global South, revealing vulnerabilities in food production, processing and distribution. Global estimates reveal that the COVID-19 pandemic did, in fact, worsen food insecurity in the Global South. This paper, through a systematic literature review, clarifies the relationship between agricultural value chains and the four dimensions of food security and proposes policy paths to enhance the resilience of agricultural value chains in the Global South. The literature reveals that resilience of agricultural value chains is not an intrinsic trait, but a dynamic result of ecosystem governance. It is essential, therefore, that policy interventions move beyond simple input subsidies and toward the integration of digital financial tools and formalized relational governance to link farmers to formal markets. Full article

Working during an outbreak poses additional challenges for staff working in long-term care facilities (LTCFs). The existing literature explores the experiences of LTCF staff during the COVID-19 pandemic, but there is a paucity of research focusing on the specific challenges of working during COVID-19 outbreaks in rural and northern communities. Secondary analysis was conducted on interview transcripts from sixteen participants with experience working during COVID-19 outbreaks in northern LTCFs. Participants engaged in in-depth semi-structured interviews and shared their experiences working during COVID-19 outbreaks in the COVID-19 pandemic. Seven themes emerged through thematic analysis, including: (1) personal fear and moral distress, (2) coping with resident death due to COVID-19, (3) relationship dynamics, (4) changing workload expectations during staffing shortages, (5) resource constraints and organizational support gaps, (6) resources and support, and (7) impact of vaccinations. Findings emphasize the increased complexity of working during a COVID-19 outbreak in rural and northern communities and describe factors that shaped both the positives and negatives of the experience for staff. These findings show that rural and northern LTCFs faced additional challenges during COVID-19 outbreaks due to pre-existing resource and staffing shortages. However, we also highlight the unique strength of these communities in how they coped and supported each other through COVID-19 outbreaks. This study provides practical insights to inform improved outbreak management, including the need for region-specific guidance and support, clear communication from management, reliable access to personal protective equipment, consistent staffing, and support for grief and burnout, all while highlighting the voices of those who worked through these outbreaks. Full article

Background: Local vaccine manufacturing is being pursued across Africa to improve pandemic preparedness and reduce reliance on imports. In Nigeria, where COVID-19 vaccines were largely imported, willingness to accept locally produced vaccines is important for sustainable domestic production. The objective of this study was to estimate willingness to accept a locally manufactured COVID-19 vaccine among adults in Lagos, Nigeria, and to identify demographic predictors. Methods: We conducted a cross-sectional survey of adults in Lagos State from 7 September to 16 September 2024, using a questionnaire administered in four open-air markets. The primary outcome was willingness to accept a COVID-19 vaccine manufactured in Nigeria (yes/no). We summarized respondent characteristics, tested bivariate associations using chi-square tests, and estimated adjusted odds ratios (AORs) using multivariable logistic regression. Model calibration and discrimination were assessed using Hosmer–Lemeshow testing and the area under the ROC curve (AUC). Results: Of 388 consenting respondents, 335 provided complete data (86.3%). Respondents were predominantly female (60.6%); the largest age groups were 25–34 (30.2%) and 35–44 (28.4%) years. Overall, 75.8% reported willingness to accept a Nigerian-made COVID-19 vaccine. Willingness differed by age group (p = 0.0028; trend p = 0.0002) and religion (p = 0.0403). In adjusted models, respondents aged 45–54 years (aOR 6.54; 95% CI: 1.73–24.79) and 55–64 years (aOR 4.97; 95% CI: 1.05–23.55) had higher odds of acceptance than those aged 18–24 years. Christian affiliation was associated with lower odds than Muslim affiliation (aOR 0.41; 95% CI: 0.20–0.83). Discrimination was acceptable (AUC 0.75; 95% CI: 0.69–0.80). Conclusions: Most respondents were willing to accept a Nigerian-made COVID-19 vaccine, suggesting demand-side readiness. Confidence-building strategies tailored to younger adults and implemented with faith-based and community institutions may support uptake of locally produced vaccines. Full article

The COVID-19 pandemic resulted in historically high levels of psychological distress. Significant age differences in distress were consistently observed, and they present an opportunity to identify the mechanisms driving the prosocial decision-making underlying pandemic mitigation behaviors. As predicted by the cascade model of individual and age differences in prosocial motivation, re-analyses of the data from two previous surveys revealed the positive role of prosocial motivation in pandemic decisions as well as the negative roles played by neuroticism, anxiety, and depression. Social distancing was altruistically motivated, as evidenced by its positive associations with both altruism and sympathy measures. Moreover, the increases in distancing with age and concern for close others suggests that distancing was not primarily driven by concerns regarding the personal consequences of infection. Multiple age-related positivity effects were observed in which concerns and risk assessments decreased with age. Concern for others decreased with age less than concerns for oneself, suggesting a possible basis for age-related increases in altruism. Taken together, these findings suggest theoretical linkages between the cascade model and socioemotional selectivity theory, linkages that may have implications for prosocial public health messaging. Full article

Introduction: Community engagement offers an approach to improve our understanding of vaccine hesitancy, yet some worry that public engagement centered around controversial and politicized topics such as COVID-19 vaccines carries a risk of increasing concerns. Methods: Respondents who reported hesitance to vaccinate against COVID-19 in a December 2020 national panel survey were recruited to participate in three interactive and respectful virtual community engagement meetings. A second survey in September 2021 resampled respondents to ascertain changes over time. Of the 291 respondents to both survey waves who had been willing to participate in community meetings, 94 (32%) participated. Multivariate linear and logistic regressions were used to assess the potential impact of meeting participation on outcomes of interest. Results: At follow-up, participants had nearly double the odds of vaccinating against COVID-19 (adjusted Odds Ratio: 1.88; 95% Confidence Interval: 1.06–3.34), about one-third the odds of contracting COVID-19 disease (aOR: 0.37; 95% CI: 0.14–0.96), and increased trust in the Centers for Disease Control and Prevention (CDC) (adjusted Regression Coefficient: 4.16; 95% CI: 0.37–7.94), compared to non-participants. Most participants found the meetings unbiased (89%) and trustworthy (90%). Conclusions: The design of our community meetings to focus on learning from and supporting the decision-maker (versus only promoting “shots in arms”) improved health outcomes and increased trust. Similar meetings could improve how public health engages communities. Full article

Cancer survivors face an elevated risk of severe COVID-19 outcomes and were prioritized for vaccination, yet reported rates of vaccination refusal in this population vary widely. The objective of this scoping review was to map the available evidence on COVID-19 vaccination refusal among adult cancer survivors in the United States, to characterize the reported barriers and enablers, and to examine how differences in measurement account for variation in the reported estimates. PubMed, EBSCOhost, CINAHL, medRxiv, and Google Scholar were searched for studies published between 1 December 2020 and 30 April 2026 reporting primary data on COVID-19 vaccination refusal among U.S. adults with a current or previous cancer diagnosis. Findings were charted and summarized descriptively. Six sources comprising 3344 participants met the eligibility criteria. Reported refusal ranged from 7.3% to 39.0%, a more than fivefold difference, with a median of 14.7%. This variation corresponded closely to what each source measured: declination of an offered vaccine, likelihood of acceptance on a Likert scale, hesitancy assessed before vaccines were widely available, or observed non-receipt of any dose. Barriers included concerns about vaccine safety, efficacy, and interaction with cancer treatment, mistrust of science and government, and low perceived need; clinician recommendation was the most consistent enabler. Estimates of vaccination refusal in this population are not directly comparable and should be interpreted alongside the construct measured. Full article

MicroRNAs (miRNAs) are key post-transcriptional regulators of gene expression and play a fundamental role in host response to viral infections. SARS-CoV-2 has been shown to dysregulate host miRNA expression, potentially as a mechanism to modulate cellular pathways for its own replication or to evade immune responses. However, evidence from the literature related to the specific miRNA landscape in SARS-CoV-2 infection is conflicting and unclear. We employed an integrative multi-model approach using human nasal lung epithelial cell lines and pulmonary organoids to map miRNA expression dynamics after SARS-CoV-2 infection. Data obtained from the CALU-3 miRNAome were successively validated in other two cellular models (hAEC and hLORG), and from this comparative analysis, two miRNAs, miR-141-3p and miR-33a-5p, were found to be significantly dysregulated. These miRNAs are involved in critical pathways, including cytokine-mediated signalling, apoptotic processes and epithelial cell junction integrity. High-throughput miRNA profiling was followed by functional enrichment analysis of their predicted targets to delineate affected biological pathways. By highlighting candidate miRNAs and regulatory pathways that may contribute to disease pathogenesis, we identified robust, infection-associated hallmarks across cell models, establishing a foundation for future therapeutic strategies for COVID-19 based on the development of miRNA-guided approaches. Full article

Background and Objectives: In-hospital cardiac arrest (IHCA) in critically ill patients with COVID-19 is among the most severe clinical outcomes, associated with high mortality and a significant risk to healthcare workers during cardiopulmonary resuscitation (CPR). The aim of this study was to evaluate the incidence, characteristics, associated factors, and outcomes of IHCA among COVID-19 patients treated in the intensive care unit (ICU), with particular emphasis on resuscitation outcomes and survival. Materials and Methods: A retrospective cohort study was conducted including critically ill patients with confirmed SARS-CoV-2 infection treated in the ICU of the Clinical-Hospital Center (KBC) in Kosovska Mitrovica between March 2020 and December 2022. Patients were categorized into two groups: (1) CA group—patients who experienced CA in the ICU, and (2) non-CA group—patients who did not experience CA during ICU treatment. Results: A total of 222 patients were analyzed, of whom 114 (51.4%) experienced IHCA. Patients with IHCA were significantly older, more frequently obese, and had a higher burden of comorbidities. They also exhibited more pronounced hematological and inflammatory abnormalities, including lower erythrocyte and hemoglobin levels, thrombocytopenia, and elevated leukocyte counts, fibrinogen, C-reactive protein, and procalcitonin levels. In addition, higher lactate and D-dimer concentrations were observed, along with a more frequent occurrence of hyperkalemia and hypernatremia. The predominant cause of IHCA was respiratory failure, most commonly associated with severe hypoxemia (59.6%), while non-shockable initial rhythms (asystole and pulseless electrical activity (PEA)) were most common (76.3%). Among patients with IHCA, return of spontaneous circulation (ROSC) was achieved in 11 patients (9.6%), and 3 patients (2.6%) survived to hospital discharge. Conclusions: Despite rapid response and CPR in the ICU setting, outcomes remained poor. More favorable outcomes were observed mainly in cases with potentially reversible etiologies (such as myocardial infarction and pulmonary embolism (PE)), in contrast to hypoxia-mediated CA. Full article

COVID-19, caused by the SARS-CoV-2 coronavirus, emerged as a global pandemic in 2020, with profound impacts on public health and a substantial burden on intensive care units (ICUs). Because critically ill patients are at increased risk of rapid clinical deterioration and death, there is a need for reliable early prognostic biomarkers to support risk stratification and optimize clinical management. Therefore, this study investigated whether clinical and laboratory parameters obtained at hospital admission could serve as prognostic biomarkers for endotracheal intubation and mortality in critically ill patients with COVID-19 admitted to ICUs. A retrospective analytical study was conducted using the medical records of 107 critically ill patients with confirmed COVID-19 admitted to ICUs. Patients were classified according to clinical outcome as survivors (n = 22) or non-survivors (n = 85). Clinical characteristics and laboratory biomarkers obtained at hospital admission were analyzed. D-dimer, lactate dehydrogenase (LDH), red cell distribution width (RDW), the AST/ALT ratio, and age were independently associated with mortality. In addition, D-dimer and LDH demonstrated moderate discriminatory performance for predicting the need for endotracheal intubation. These findings suggest that routinely available clinical and laboratory parameters obtained at hospital admission may serve as complementary prognostic biomarkers to support early risk stratification and clinical decision-making in critically ill patients with COVID-19. Nevertheless, prospective multicenter studies are warranted to externally validate these findings and further establish their clinical applicability. Full article

The aim of the study was to analyse the epidemiological characteristics of confirmed COVID-19 cases in the Tumbes region between March 2020 and December 2022. Method: An ecological design with a descriptive approach was used for the study population, which consisted of 51,421 confirmed cases of COVID-19 residing in the provinces of Contralmirante Villar, Tumbes, and Zarumilla in the department of Tumbes. Confirmed cases of COVID-19 reported in SISOVID by the Ministry of Health and the registry of confirmed cases of COVID-19 in all age groups were recorded. The sociodemographic data collected was supplemented with information available on the web platform of the National Institute of Statistics and Informatics (INEI). The data were organized into databases and analyzed using software such RStudio (versión 2024.12.1), applying epidemiological indicators (incidence, prevalence, mortality, and lethality). The epidemiological data were organized and analyzed in a database prepared in Microsoft Excel to consolidate the information through data filtering and organization. Results: Among the main findings, a decrease in incidence was observed between 2021 (7840/100,000 inhabitants) and 2022 (5721/100,000 inhabitants), although the cumulative case rate increased from 15% to 20%. The mortality rate fell significantly from 2.57 per 1000 inhabitants in 2021 to 0.33 in 2022. The highest fatality rates were concentrated among people over 60 years of age with comorbidities, especially men. Conclusion: The pandemic was unevenly distributed, affecting adults between 30 and 59 years of age, populations with pre- existing conditions, and densely populated urban areas the most. The geographic distribution of cases helped identify areas warranting priority for improving the health response. It is recommended to strengthen epidemiological surveillance, improve access to health services in densely populated areas, and prioritise care for vulnerable groups such as older adults and indigenous peoples. Full article

The COVID-19 pandemic presented a unique opportunity for researchers to use pragmatic methods to obtain information about the virus and promptly disseminate the findings for healthcare providers to utilize them. One such approach to studying patients who presented with COVID-19 and ST-Elevation Myocardial Infarction (STEMI) was the development of the North American COVID-19 STEMI (NACMI) registry. By leveraging social media and communication platforms such as WhatsApp, cardiologists across North America initiated the development of the NACMI registry within 14 days—an accomplishment which was unfathomable pre-pandemic. This was followed by ethics approval through a centralized Institutional Review Board, which led to patient consent being waived, and the use of a single coordinating center (Minneapolis Heart Institute Foundation) responsible for sites, database, and analysis. The NACMI findings were published rapidly across various media, including high-profile cardiovascular journals. Early results demonstrated an elevated mortality rate, disproportionality based on race, and angiographic differences showing unique mechanistic differences in the etiology of STEMI due to COVID-19. Additionally, NACMI provided early evidence that vaccination for COVID-19 reduced the risk of mortality in those with COVID-19 and STEMI. NACMI provided a framework for informing cardiologists early on regarding the optimal treatment of STEMI in patients with COVID-19. The lessons learned may be valuable for developing policy in future pandemics to treat patients using real-world application and routinely collected variables. Full article

Care transition comprises integrated actions that ensure individualized, multidimensional care and became especially relevant after COVID-19 due to complications, readmissions, and fragmented healthcare delivery. The aim this study was to assess care transition care quality for post-COVID-19 patients using the Care Transition Measure (CTM-15) and its association with sociodemographic and clinical variables. This cross-sectional quantitative study included 176 post-COVID-19 patients or caregivers from a Brazilian public hospital (2020–2021). Data were collected by telephone within 30 days after discharge using a sociodemographic/clinical questionnaire and the CTM-15. The results demonstrated that care transition quality was rated as satisfactory. The highest scores were observed in health management preparation and the lowest in understanding medications. Better evaluations were associated with younger age, higher income, influenza diagnosis, and non-smoking status, whereas diabetes and chronic obstructive pulmonary disease negatively influenced care plan scores. In conclusion, care transition quality was satisfactory and influenced by sociodemographic and clinical factors, highlighting the importance of individualized discharge planning. Full article

The COVID-19 pandemic affected maternal mental health in the UK, increasing postpartum emotional distress. This scoping review identified forms of postpartum emotional distress (PPED) examined during the pandemic, the methodologies and assessment tools used, analytical approaches, reported limitations, future research directions, and overall findings. This review followed Arksey and O’Malley’s framework and the Joanna Briggs Institute scoping review guidelines. A comprehensive, keyword-based search strategy was applied across electronic databases, initially on 28 January 2023, and updated on 20 July 2023, and 3 September 2025. Strict inclusion criteria were used, and data from eligible studies were charted and synthesised. This review of 35 UK studies on postpartum emotional distress (PPED) during COVID-19 found a dominant focus on depression and anxiety, with other PPED forms largely neglected. Quantitative designs overwhelmingly outnumbered qualitative and mixed-method approaches. Common limitations included low sample diversity, reliance on online self-report surveys, cross-sectional designs, convenience sampling, and social-media-based recruitment. This review is the first to map research approaches used to explore postpartum emotional distress (PPED) during COVID-19 in the UK. The limitations and future research directions identified in this review highlight an urgent need for more diverse sampling, longitudinal study designs, qualitative research exploring women’s lived experience narratives of different forms of postpartum emotional distress, greater consideration of biopsychosocial factors, and evidence-based interventions. Full article

Background: Brazilian psychologists faced heightened occupational and emotional demands during the COVID-19 peak, yet evidence on longer-term changes in distress and self-care is limited. This repeated cross-sectional study compared psychological distress and multidimensional self-care among Brazilian psychologists at the pandemic peak (T1: April 2021; n = 578) and three years later (T2: April 2024; n = 524). Methods: Distress (DASS-21) and self-care indicators (perceived self-care, working hours, work–life balance, psychotherapy/psychiatric care) were assessed. Blockwise OLS and logistic models (M0–M3) estimated time differences; dose–response and moderation analyses used adjusted marginal means with FDR correction. Results: Anxiety and stress were lower at T2 (M3: anxiety β = −1.53; stress β = −2.08; p < 0.001), whereas depression showed no statistically significant change in fully adjusted models (β = −0.37, p = 0.456), with only a modest downward tendency evident in unadjusted and nonparametric comparisons. Clinically elevated (Moderate+) anxiety decreased robustly (OR = 0.56), while the reduction in Moderate+stress was attenuated after full adjustment (OR = 0.71, p = 0.049) and did not remain significant after FDR correction. Perceived self-care showed a dose–response association with lower distress, and stress declined most among telehealth and hybrid practitioners. Conclusions: Three years post-peak, anxiety and stress were lower, whereas depression showed no clear change in fully adjusted models, indicating heterogeneous recovery. Self-care and work conditions were key associated factors, underscoring the need for sustained workforce well-being strategies. Because the design was repeated cross-sectional, these findings reflect sample-level trends rather than within-person change. Full article

The first case of Coronavirus Disease 2019 (COVID-19) in Tunisia was reported on 2 March 2020. This study aimed to describe the epidemiological evolution of the COVID-19 pandemic in Tunisia from March 2020 to December 2022 and to assess changes in key transmission indicators across the different phases and epidemic waves. We conducted a nationwide longitudinal descriptive study based on prospectively collected surveillance data including all laboratory-confirmed COVID-19 cases reported through the national surveillance system between March 2020 and December 2022. Descriptive analyses were performed to estimate screening rates, test positivity rates, cumulative incidence rates, and the time-varying effective reproduction number (Rt). During the three-year study period, Tunisia reported a cumulative incidence of 9562.05 cases per 100,000 inhabitants. The mean daily screening rate was 38.23 tests per 100,000 inhabitants, while the average positivity rate reached 16.03%. The mean effective reproduction number was estimated at 1.14 (95% CI: 1.11–1.17). The epidemic evolved through two distinct transmission phases. The first phase, extending from 2 March to 17 August 2020, was characterized by limited community transmission mainly associated with imported cases. The second phase was marked by sustained autochthonous community transmission and comprised five epidemic waves. Between March and May 2021, genomic surveillance identified the predominance of the Alpha Variant of Concern (VOC). The fourth wave was dominated by the Delta VOC until December 2021, whereas the fifth wave, occurring in 2022, was associated with the Omicron VOC. Continuous monitoring of transmission indicators through the national surveillance system provided timely evidence to support risk assessment, guide public health decision-making, and adapt prevention and control measures throughout the different phases of the pandemic in Tunisia. Full article