COVID

The health crisis caused by COVID-19 led to a series of restrictive measures worldwide. Amongst them, a period of lockdown that resulted in a decrease in social contact, which had a series of effects at the emotional, educational, and social levels, the greatest concern being the mental health effects in minors. The aim of this study is to analyse mental health disorders affecting Primary Education students before and during the pandemic, at emotional, social and behavioural levels. A total of 1045 students from different educational centres, in 5th and 6th year of Primary Education, of both sexes and aged between 10 and 12 years old, took part in the study. The instrument used was the “Strengths and Difficulties Questionnaire, SDQ”, which measures mental health disorders in minors. The results indicate that during the pandemic there was an increase in emotional problems among minors, alongside a decrease in hyperactivity, conduct problems, and peer-related problems. Social distancing during the pandemic may have acted as a key mediating variable in the observed outcomes. It is concluded that these results are important in preventing psychological effects on the mental health of minors in crisis situations. Full article

The COVID-19 pandemic altered individuals’ worldviews. This study examined how cultural values shaped the ways students navigated stress and adapted after the COVID-19 pandemic. Drawing on Conservation of Resources (COR) Theory and cultural psychology frameworks of individualism and collectivism, we hypothesized that university students in two culturally distinct contexts—China and Canada—would demonstrate resilience differently. Chinese students would display collectivistic coping strategies (e.g., social responsibility and perspective-taking), while Canadian students would show resilience through individualistic strategies (e.g., personal reflection and self-efficacy). A total of 814 students completed a mixed-methods survey assessing resilience, cognitive reflection, and post-pandemic adaptations. Quantitative data were analyzed using factor analysis and stepwise regression to identify predictors. Qualitative responses were thematically analyzed for context. Results revealed cultural differences in resilience and adaptation, with social responsibility, healthy habits, and third-person perspective-taking predicting the responses of Chinese students, whereas internal emotional processing and personal moral reflection predicting it for Canadian students. This study enhances cross-cultural understanding of resilience and adaptation after collective trauma. Full article

The COVID-19 pandemic exposed the fragility of global health systems, as physicians faced extremely challenging conditions including excessive workloads, infection risk, and high patient mortality. We conducted a cross-sectional survey that aimed to assess the post-pandemic prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) in a sample of Greek physicians who worked on the frontline during the SARS-CoV-2 (COVID-19) pandemic. An online survey was conducted between 1 March and 31 July 2023, in which 200 Greek physicians were invited via e-mail to voluntarily answer a confidential online questionnaire, and 58 of them responded. The survey included two clinically validated tools: the Patient Health Questionnaire-4 (PHQ-4) and the Impact of Event Scale—Revised (IES-R). Univariate correlations of 26 exposure variables with anxiety, depression, combined anxiety/depression, and PTSD were performed. In total, 58 eligible physicians (46.6% female) participated in this study. The rates of anxiety, depression, combined anxiety/depression, and PTSD were 27.5% (95% CI: 16.7–40.9), 31.0% (19.5–44.5), 22.4% (12.5–35.3), and 24.1% (13.9–37.2), respectively. Notably none of the physicians working in a laboratory developed any mental health symptoms. The following factors were found to be associated with the development of higher mental health symptoms: age ≤ 30, employment in healthcare ≤ 10 years, working in COVID-19 wards, working in intensive care units or COVID-19 wards, a history of mental health symptoms, a history of physical conditions, shortages of materials and equipment for diagnosing or treating patients, development of a disease other than COVID-19, and the development of a new mental health condition during the pandemic (p < 0.05 for all associations). Our findings highlight the need to better prepare physicians with adequate materials, infrastructure, and psychological support such that, in a potential future health crisis, they will not be at such high risk of mental health problems. Full article

Background: Fear of COVID-19 has been associated with adverse mental and physical health outcomes, yet evidence from The Netherlands is limited. This study investigated associations between fear of COVID-19, mood, quality of life, immune fitness, and related health variables during the first Dutch national lockdown and identified key predictors of fear. Methods: In June–July 2020, n = 1020 Dutch adults completed an online survey assessing demographics, personality, mental resilience, pain sensitivity, pain catastrophizing, alcohol use, immune fitness, and mood. Retrospective ratings were provided for the pre-pandemic period (January–March 2020) and the first lockdown (March–May 2020). Fear of COVID-19 was measured using a modified Fear of COVID-19 Scale. Results: Overall, 13.2% of participants reported significant fear of COVID-19, which was associated with poorer mood, reduced quality of life, lower immune fitness, more severe COVID-19 symptoms, greater pain sensitivity, and higher levels of pain catastrophizing. Regression analysis explained 19.6% of the variance, with pre-pandemic anxiety (8.7%) and poorer immune fitness (3.4%) as the strongest predictors of fear of COVID-19, followed by lower psychoticism, lower mental resilience, older age, greater helplessness, and greater extraversion. Discussion: These findings suggest that a minority experienced high levels of fear of COVID-19 with substantial consequences, including negative effects on mood, immune fitness, and quality of life. The strong association with pre-existing anxiety and immune fitness highlights the need for early identification and targeted interventions for vulnerable groups to reduce psychological and physical health impacts in future public health crises. Full article

The COVID-19 pandemic has had a diverse impact worldwide, affecting all strata of society. This article examines the relationship between health system adaptation and socioeconomic inequality in countries and the WHO Eastern Mediterranean Region (WHO-EMR), and we suggest that the dynamics among government response, health system preparedness, and epidemic spread are calibrated by the present socioeconomic inequality. With the use of a panel dataset spanning February 2020 to March 2021 and both linear (PARDL) and nonlinear (PNARDL) estimation techniques, we find that more socioeconomically vulnerable regions were disproportionately hit by the efforts of the pandemic, even in the presence of containment measures. From our findings, we find that health system capacity measures, such as hospital bed density and primary healthcare expenditure, are positively related to long-term economic resilience, while antimicrobial drug resistance is strongly negatively related to it. The study emphasizes the need for selective policy interventions to protect the most disadvantaged groups, a finding of relevance for other high-inequality low- and middle-income countries. Full article

Global estimates show a 17.9% prevalence of neuropsychiatric disorders in individuals recently hospitalized with COVID-19. Cognitive behavioral therapy (CBT) has been proposed as a nonpharmacological strategy to mitigate these effects. This study examined the potential effects of CBT on anxiety, depression, post-traumatic stress disorder (PTSD), and quality of life (QoL) in post-COVID-19 patients. This prospective, nonrandomized, single-center clinical trial involved 15 patients (mean age 53.4 years) who underwent weekly CBT sessions for six weeks. Between-group differences in anxiety and depression scores were non-significant (p > 0.05); however, significant intragroup improvements were observed in anxiety (p = 0.01), depression (p = 0.01), and PTSD (p = 0.01) after the intervention. Thus, CBT was associated with reduced anxiety, depression, and PTSD as well as improved quality of life in post-COVID-19 patients. Improvements in QoL were noted mainly in the domains of functional capacity, vitality, emotional aspects, and mental health. While these findings suggest that CBT may be beneficial for post-COVID-19 patients, the small sample size, absence of a control group, and short follow-up period limit the strength of our conclusions. Therefore, the results should be considered preliminary, and further randomized controlled trials with larger sample sizes are warranted. Full article

The recent resurgence of COVID-19 in a Hepatitis B virus some endemic countries could lead to adverse outcomes. In this article, we formulate and analyse a mathematical model to explains the co-infection dynamics of Hepatitis B virus and COVID-19. Our aim is to investigate the effect of Hepatitis B virus prevention, COVID-19 prevention, COVID-19 vaccination, and environmental factors on transmission dynamics, and formulate conditions for extinction and persistence of the diseases. First, we derive the basic reproduction number for HBV only, COVID-19 only, and co-infection stochastic models using the next-generation matrix method. Next, we establish the conditions for stability in the stochastic sense for HBV only, COVID-19 only sub-models, and the co-infection model using suitable Lyapunov functions. Furthermore, we devote our attention to finding sufficient conditions for extinction and persistence. Finally, motivated by Ghana data, we applied the Euler–Murayama scheme to illustrate the dynamics of the co-infection, COVID-19, HBV, and the effect of some parameters on disease transmission dynamics by means of numerical simulations. Full article

Health professionals’ safety is directly linked to organizational culture, and during the COVID-19 pandemic, weaknesses at organizational, emotional, professional, and structural levels became evident. This study aimed to assess health professionals’ perceptions of their safety in facing the COVID-19 pandemic. A cross-sectional, descriptive, and analytical study was conducted with professionals from the public health network of a Brazilian municipality who had taken medical leave due to COVID-19. Data were collected between October and December 2022 using the validated Questionnaire on Health Professional Safety in the COVID-19 Pandemic (QSP COVID-19), which consists of 30 items distributed across four domains: organizational, emotional, professional, and structural. A cut-off score ≥75 was considered a positive perception. Associations were tested using the chi-square test followed by the Bonferroni post hoc test, and multivariate logistic regression was applied to identify associated factors. Significance level: 5%. A total of 235 professionals participated, mostly women (81.7%), working in primary health care (68.1%), and employed under statutory contracts (74.5%). Only 50.6% reported an overall positive perception of safety. The emotional domain showed the highest score (85.5%), followed by the professional domain (74.0%). Organizational (50.6%) and structural (33.6%) domains had the lowest scores, reflecting shortcomings in infrastructure, human resources, and material supplies. In the multivariate analysis, temporary contracts, a 20 h workweek, and specific training were protective factors, whereas belonging to a risk group and being female increased the likelihood of negative perception in the structural dimension. Health professionals’ safety is supported by continuous education, emotional support, adequate infrastructure, professional recognition, participatory leadership, and strengthening of the safety culture. Full article

SARS-CoV-2 persists worldwide, driving the demand for effective antivirals that inhibit replication and limit the emergence of resistant variants. Lycorine, a non-nucleoside inhibitor of SARS-CoV-2 RNA-dependent RNA polymerase, exhibits antiviral activity without direct mutagenic effects. Here, we examine the occurrence of single-nucleotide variants (SNVs) and insertions/deletions (indels) in SARS-CoV-2 B.1.499 strain during serial passages in Vero cells, comparing lycorine-treated cultures (2.5 and 5 µg/mL) with untreated controls. Whole-genome sequencing was used to assess mutation patterns and frequencies. Lycorine-treated passages displayed greater variant diversity than controls, with fixed mutations mainly affecting non-structural proteins (Nsp3-F1375A, Nsp5-L50F, and Nsp14-G265D) and the envelope protein (E-S6L). A 15-nucleotide deletion in the spike gene (QTQTN motif) occurred in both groups but became fixed only in untreated passages, suggesting negative selection under lycorine pressure. Notably, the L50F mutation in Nsp5, previously linked to nirmatrelvir resistance, was found exclusively in lycorine-treated passages. Additionally, a 1-nucleotide deletion in the accessory gene ORF8, detected only under lycorine treatment, resulted in a frameshift mutation that added four amino acids, potentially altering the protein’s function. Overall, lycorine induces a distinct mutation profile, favoring replication-related variants while suppressing deleterious deletions. These findings suggest potential mechanisms of cross-resistance and highlight the importance of monitoring resistance during clinical use. Full article

Men who have sex with men (MSM) are part of the key populations (KPs) that are susceptible to Human Immunodeficiency Virus (HIV) acquisition, transmission, and disruptions to access HIV services. This study aimed to explore and describe the HIV interventions implemented among MSM during the COVID-19 lockdown in the Capricorn District of Limpopo Province in South Africa. This study followed an exploratory qualitative study design with a purposive sample of 16 men who identified as MSM. Data were collected through in-depth interviews which were tape-recorded, transcribed verbatim, and captured on Atlas.ti. Patterns from the created codes were formulated into themes/sub-themes guided by the Consolidated Framework for Implementation Research (CFIR). The MSM had a mean age of 27.9 years. Various constructs and domains of the CFIR showed that during the COVID-19 lockdown, MSM encountered a disruption of HIV services. The response time was elongated, thus increasing the complexity of interventions. Interventions were implemented to ensure continuity of services. These included tailoring the programme through a door-to-door strategy and offering resources to healthcare facilities to enable MSM to access antiretroviral therapy (ART) and related services. The relative advantage of the programme is that it prioritises MSM. Future research should look into COVID-19’s impact on a bigger scale. Full article

Rheumatic diseases affect the musculoskeletal system and may also compromise internal organs. The immunosuppressive treatments commonly used in these conditions can weaken the immune system, raising concerns about the efficacy of immunizations, particularly against SARS-CoV-2. This observational and analytical study evaluated the humoral immune response in patients with rheumatic diseases who were vaccinated with a fourth dose of the SARS-CoV-2 vaccine in comparison with a control group and the effect prior COVID-19 infection. The results showed that individuals with a history of COVID-19 infection developed significantly higher levels of neutralizing antibody titers, indicating a stronger immune response. Moreover, the response on the Wuhan strain elicited a more robust humoral response than the Omicron strain in both immunocompromised patients and healthy controls. These findings highlight the impact of previous viral exposure on the effectiveness of immunization in rheumatology patients. Full article

This study adopted a survey instrument based on a consistent conceptual framework to investigate racial and ethnic disparities in COVID-19 exposure, susceptibility, and treatment among Pennsylvania residents. A cross-sectional design was implemented through primary data collection using a non-probability web panel. Quota sampling ensured statewide representativeness by region and combined age/gender categories, yielding a final sample of 1043 residents across 64 counties who completed the survey between February and April 2021. Propensity score matching was utilized to estimate average effects of race/ethnicity on COVID-19-related outcomes. Results indicated that racial/ethnic minority respondents were more likely than non-Hispanic White respondents to live in apartments or group quarters. Non-Hispanic Blacks and Asians were disproportionately urban residents, while non-Hispanic Blacks faced increased COVID-19 exposure risks due to reliance on public transportation. Additionally, Non-Hispanic Others experienced higher exposure risks from insufficient sick leave and caregiving responsibilities. The study found limited evidence for disparities in susceptibility and treatment. These findings highlight how disparities in COVID-19 exposure conditions likely contribute significantly to the differing COVID-19 outcomes observed between racial/ethnic minorities and non-Hispanic Whites in Pennsylvania. Full article

Long COVID, characterized by persistent symptoms following COVID-19 infection, poses significant challenges to individuals’ well-being. This study explores the multifaceted nature of long COVID, encompassing neurological and psychological manifestations. Neurological symptoms, including difficulty thinking clearly (brain fog) and concentrating, are prominent features of long COVID, drawing increasing attention due to their potential long-term adverse impact on the patient’s daily functioning and quality of life. Furthermore, anxiety emerges as a prevalent psychological concern among individuals with long COVID, exacerbating the uncertainty and distress associated with the ongoing symptoms of the virus. Despite growing recognition of the interplay between long COVID, neurological symptoms, and anxiety, there remains a notable gap in the literature regarding the specific relationship between these domains. This study addresses this gap by investigating how the presence of long COVID symptoms relates to the manifestation of neurological symptoms, with anxiety as a potential mediator. Utilizing data from the COVID-19 Health and Mental Health Survey, this research provides insights into the complex interplay between long COVID, neurological symptoms, and anxiety. This research provides a deeper understanding of the long-term implications of this virus and informs assessment and intervention for these patients. Full article

To analyze the relationship between lactoferrin and COVID-19, a systematic review and meta-analysis of works published between 2020 and 2025 was carried out. The search strategy consisted of compiling research and review articles with the keywords COVID-19 and lactoferrin, COVID-19 and lactoferrin, SARS-COV-2 and lactoferrin, and SARS-COV-2 and lactoferrin in the databases of the search engines Elsevier, PubMed, and Google Scholar. In addition, these were classified depending on the type of study (e.g., in vivo, in vitro, both, or neither). PRISMA was used to perform a systematic review and meta-analysis. A total of 1531 articles were found, of which any duplicates were discarded, leaving 1234. A second database was created for strictly research and in vivo type articles, obtaining only 69 articles. Lactoferrin demonstrated a significant effect in reducing fatigue among COVID-19 patients, contributing to improved recovery and functional status—particularly in individuals with post-acute COVID-19 syndrome. However, its impact on other symptoms did not reach statistical significance. Full article

We set out to determine the impact of delirium and COVID-19 on length of stay and mortality. For this study, we conducted a retrospective cohort study of patients aged >65 years admitted to the Owensboro Health Regional Hospital between August 2021 and December 2023. Delirium was determined based on a score of ≥2 on the Nurse Delirium Screening Scale (NuDESC) recorded on all admitted patients three times a day during nursing shift change. Multivariate logistic regression models were used to evaluate the association between delirium, COVID-19, or both on 30-day, 60-day, 90-day, 180-day, 360-day mortality, adjusting for age, sex, race, smoking status, diabetes, hypertension, dementia, COPD, obesity, heart failure, and heart disease. A total of 4872 hospitalized patients were included in the study. Of these, 698 (14.3%) were identified as having delirium and 4174 (85.7%) as without delirium. Patients with delirium were slightly older than those without (79.5 ± 8.6 years old vs. 77.0 ± 7.9). After adjusting for comorbidities, delirium was associated with an increase of 3.3 hospitalization days (8.6 ± 9.6 days vs. 5.3 ± 5.6 p < 0.01). Delirium was associated with higher 30-day, 60-day, 90-day, 180-day, and 360-day mortality rates. COVID-19-positive patients with delirium had 717% higher odds of 30-day mortality compared to the COVID-19-negative patients without delirium (aOR 8.17 95% CL 4.60–14.3). Full article

The emergence or mutation of aggressive viruses represents a latent threat to human health that could lead to new pandemics, so it is important to constantly monitor and analyze the behavior of the diseases they can cause. In this sense, the purpose of this work was to generate models to predict the behavior of recoveries and deaths from COVID-19 in Mexico in the post-pandemic era, applying machine learning techniques to data related to this disease, published by the Mexican government. Models based on artificial neural networks, logistic regression, and classification algorithms were generated and validated, yielding high rates of correct classification, accuracy, and recall, so that they could be used to make predictions about future cases of patients infected with the SARS-CoV-2 virus. Full article

Background: The COVID-19 pandemic significantly impacted adolescent development, increasing behavioral problems and emotional distress. This study aimed to examine the impact of sensation seeking, empathy, and COVID-19-related stressors on deviant behavior in adolescents. Methods: A cross-sectional study was conducted with 638 Italian adolescents and young adults (M = 18.8 years, SD = 3.51) recruited from schools, universities, and the general population in Tuscany and Emilia-Romagna. Participants completed validated measures assessing sensation seeking, empathy, COVID-19-related stress, and deviant behaviors. Multiple regression analyses examined predictors of deviant behavior, while mediation analyses tested whether empathy mediated the relationship between sensation seeking and deviant behavior. Results: Correlation analyses show a positive association between sensation seeking and deviant behavior and a weaker positive association with COVID-19 isolation. Conversely, affective empathy demonstrated negative correlations with both deviant behavior and sensation seeking. COVID-19 stress demonstrated differentiated effects: social isolation increased deviance, whereas fear of contagion was protective. Mediation analysis revealed that affective empathy partially mediated the relationship between sensation seeking and deviance. Conclusions: This study demonstrates that sensation seeking is a primary risk factor for deviant behavior in adolescents and young adults, while affective empathy acts as a protective mechanism that partially mediates this relationship. Furthermore, COVID-19-related stressors have shown complex effects, with social isolation amplifying the risk of deviance, while fear of contagion promotes more inhibited behavior. These findings underscore the importance of considering both stable personality traits and situational stressors when seeking to understand the pathways leading to adolescent behavioral problems during periods of social crisis. Full article

Severe acute respiratory syndrome (SARS), caused by the COVID-19 virus, continues to pose a significant public health challenge in Brazil, particularly in 2024, with high mortality rates among vulnerable groups. This study aimed to describe the sociodemographic, clinical and vaccination profiles of SARS cases due to COVID-19 in Brazil in 2024, as well as analysing factors associated with clinical outcomes such as death, admission to the intensive care unit (ICU) and the need for ventilatory support. A total of 30,529 reported cases were analysed. On average, the interval between the last vaccine dose and symptom onset was 30.31 months (SD = 6.77), while the interval between symptom onset and clinical outcome was 13.26 days (SD = 16.55), revealing significant variability. The results showed higher mortality rates among men (23.7%) than women (19.1%) (p < 0.0001). Mortality increased progressively with age, reaching 24.4% in individuals aged 60 years or older, whereas rates were below 2% in children under 10 years of age. The highest proportions of deaths were observed regionally in the Northeast (26.8%) and North (22.6%), in contrast to the Midwest (17.7%) (p < 0.0001). Men were also more likely to require ICU admission (38.1% vs. 33.6%) and ventilation (62.9% vs. 60.5%). A time interval of over 24 months since the last vaccine dose was associated with higher mortality (21.9% vs. 20.6%; p = 0.0005). These results highlight the importance of ongoing surveillance and updating the vaccination schedule, particularly for more vulnerable populations. Full article

The COVID-19 pandemic has placed a considerable psychological burden on healthcare workers, potentially leading to increased burnout and anxiety. This study aimed to evaluate burnout and anxiety levels among healthcare workers compared to non-healthcare professionals during the pandemic. We initially recruited 438 adults; 351 (217 HCWs and 134 non-HCWs) provided complete responses across all three survey waves and were analyzed. Burnout was assessed using the Maslach Burnout Inventory, and anxiety with the State–Trait Anxiety Inventory. Data were collected through an online self-administered survey at three different time points during the pandemic, and analyzed with non-parametric tests and effect sizes. Healthcare workers exhibited significantly higher levels of emotional exhaustion, depersonalization, overall burnout, and anxiety compared to non-healthcare workers across all three periods (p < 0.05). Of 438 consented individuals, 351 (80.1%) completed all waves, allowing within-population longitudinal comparisons. Within the healthcare worker group, women, individuals living alone, those working night shifts, and those considering a career change had notably higher burnout and anxiety scores. No significant differences were observed in personal accomplishment scores. Healthcare workers experienced greater psychological distress than non-healthcare workers during the COVID-19 pandemic. Identifying vulnerable subgroups and implementing supportive strategies are essential to protect the mental health and well-being of healthcare professionals during pandemics and similar crises. Full article