Special Issue "Novel Coronavirus (SARS-CoV-2) Outbreak: Epidemiology, Research and Implications for Public Health"

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: 30 June 2021.

Special Issue Editors

Dr. Emanuele Amodio
Website
Guest Editor
Università degli Studi di Palermo, Palermo, Italy
Interests: Biostatistics; Clinical epidemiology and public health; Air, surfaces and personnel microbial monitoring in high risk environments (surgery rooms and intensive care units); Epidemiology and prevention of infectious diseases
Dr. Palmira Immordino

Co-Guest Editor
Section of Hygiene, Department of Health Promotion Sciences, Maternal and Infantile Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy
Interests: Public health; Infectious Diseases; Tropical Medicine, Refugees and Migrants Health, Vaccine-preventable diseases; Health diplomacy; Health policies

Special Issue Information

Dear Colleagues,

At the end of December 2019, Chinese authorities reported the spread of a novel coronavirus (named 2019-nCoV before, newly defined as SARS-CoV-2) responsible for cases of acute respiratory syndrome in the Wuhan municipality. In a few weeks, the spread of this new strain of coronavirus rapidly evolved, affecting other parts of China and determining cases outside the country. Further global diffusion can be not excluded, and it is expected that international exportation of cases may occur worldwide. To reduce the risk of a possible epidemic, the World Health Organization has declared the current outbreak a global public health emergency and invites all countries to be prepared for containment, including through active surveillance and case management.

Unfortunately, to date there is still a limited knowledge about the characteristics of the virus, how it spreads between people, how severe are the resulting infections, and how to treat them. To answer these questions, the scientific international community is committed to rapidly covering these gaps and sharing emerging information on this topic. In particular, healthcare professionals are called to put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and prevent and reduce the spread of the infection.

According to the previously reported considerations, in this Special Issue we particularly welcome articles and commentaries providing new insights into general epidemiology of this novel virus, disease prevention and control strategies, risk management and communication, evaluation of the impact of public health interventions, and innovative researches for developing necessary pharmaceutical and non-pharmaceutical treatments.

Dr. Emanuele Amodio
Dr. Palmira Immordino
Guest Editors

Manuscript Submission Information

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Keywords

  • Novel coronavirus
  • Epidemiology
  • Public health
  • Disease prevention
  • Control strategies
  • Risk management and communication
  • Innovative researches

Published Papers (21 papers)

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Editorial

Jump to: Research, Review, Other

Open AccessEditorial
Outbreak of Novel Coronavirus (SARS-CoV-2): First Evidences From International Scientific Literature and Pending Questions
Healthcare 2020, 8(1), 51; https://doi.org/10.3390/healthcare8010051 - 27 Feb 2020
Cited by 12 | Viewed by 6860
Abstract
On 31 December, 2019, a cluster of 27 pneumonia cases of unknown etiology was reported by Chinese health authorities in Wuhan City (China) [...] Full article
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Research

Jump to: Editorial, Review, Other

Open AccessArticle
Mortality, Severity, and Hospital Admission among COVID-19 Patients with ACEI/ARB Use: A Meta-Analysis Stratifying Countries Based on Response to the First Wave of the Pandemic
Healthcare 2021, 9(2), 127; https://doi.org/10.3390/healthcare9020127 - 28 Jan 2021
Viewed by 400
Abstract
Background: The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is controversial for treating COVID-19 patients. We aimed to estimate pooled risks of mortality, disease severity, and hospitalization associated with ACEI/ARB use and stratify them by country and country clusters. [...] Read more.
Background: The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is controversial for treating COVID-19 patients. We aimed to estimate pooled risks of mortality, disease severity, and hospitalization associated with ACEI/ARB use and stratify them by country and country clusters. Methods: We conducted a search in various databases through 4 July 2020 and then applied random-effects models to estimate pooled risks (ORp) across stratifications by country cluster. Clusters were chosen to reflect outbreak times (China followed by Korea/Italy, others subsequently) and mobility restrictions (China and Denmark/France/Spain with stricter lockdowns than the UK/US). Results: Overall analysis showed no increase in mortality; however, a statistical increase in mortality was seen in the US/UK cluster with ORp = 1.28 [95% CI = 1.04; 1.56] and a decrease in China with ORp = 0.65 [95% CI = 0.43; 0.96] and France with OR = 0.31 [95% CI = 0.14; 0.69]. Severity and hospitalization were not statistically significant in the analysis; however, several associations were seen in specific countries but not in country clusters. Conclusion: The country-cluster meta-analysis provided a reasonable explanation for COVID-19 mortality among ACEI/ARB users. The analysis did not explain differences in severity and suggested the involvement of other factors. Hospitalization findings among ACEI/ARB users may be considered informative as they may have been subjected to clinical decisions and hospital-bed availability. Full article
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Open AccessArticle
Retrospect: The Outbreak Evaluation of COVID-19 in Wuhan District of China
Healthcare 2021, 9(1), 61; https://doi.org/10.3390/healthcare9010061 - 08 Jan 2021
Cited by 1 | Viewed by 432
Abstract
There were 27 novel coronavirus pneumonia cases found in Wuhan, China in December 2019, named as 2019-nCoV temporarily and COVID-19 formally by the World Health Organization (WHO) on the 11 February 2020. In December 2019 and January 2020, COVID-19 has spread on a [...] Read more.
There were 27 novel coronavirus pneumonia cases found in Wuhan, China in December 2019, named as 2019-nCoV temporarily and COVID-19 formally by the World Health Organization (WHO) on the 11 February 2020. In December 2019 and January 2020, COVID-19 has spread on a large scale among the population, which brought terrible disaster to the life and property of the Chinese people. In this paper, we analyze the features and pattern of the virus transmission. Considering the influence of indirect transmission, a conscious-based Susceptible-Exposed-Infective-Recovered (SEIR) (C-SEIR) model is proposed, and the difference equation is used to establish the model. We simulated the C-SEIR model and key important parameters. The results show that (1) increasing people’s awareness of the virus can effectively reduce the spread of the virus; (2) as the capability and possibility of indirect infection increases, the proportion of people being infected will also increase; (3) the increased cure rate can effectively reduce the number of infected people. Then, the virus transmission can be modelled and used for the inflexion and extinction period of pandemic development so as to provide theoretical support for the Chinese government in the decision-making of pandemic prevention and recovery of economic production. Further, this study has demonstrated the effectiveness of the prevention measures taken by the Chinese government such as multi-level administrative district isolation and public health awareness. Full article
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Open AccessArticle
Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients
Healthcare 2021, 9(1), 47; https://doi.org/10.3390/healthcare9010047 - 05 Jan 2021
Viewed by 470
Abstract
Hemodialysis (HD) patients are highly susceptible to COVID-19 infection. However, comprehensive assessments of current evidence regarding COVID-19 in HD patients remain incomplete. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in HD patients until September [...] Read more.
Hemodialysis (HD) patients are highly susceptible to COVID-19 infection. However, comprehensive assessments of current evidence regarding COVID-19 in HD patients remain incomplete. We systematically searched PUBMED and EMBASE for articles published on incidence or mortality of COVID-19 infection in HD patients until September 2020. Two independent researchers extracted data and study-level risk of bias across studies. We conducted meta-analysis of proportions for incidence and mortality rate. Study heterogeneity and publication bias were assessed. A total of 29 articles with 3261 confirmed COVID-19 cases from a pool of 396,062 HD patients were identified. Incidence of COVID-19 in these HD patients was 7.7% (95% CI: 5.0–10.9%; study heterogeneity: I2 = 99.7%, p < 0.001; risk of publication bias, Egger’s test, p < 0.001). Overall mortality rate was 22.4% (95% CI: 17.9–27.1%; study heterogeneity: I2 = 87.1%, p < 0.001; risk of publication bias, Egger’s test: p = 0.197) in HD patients with COVID-19. Reported estimates were higher in non-Asian than Asian countries. Quality of study may affect the reported incidence but not the mortality among studies. Both incidence and mortality of COVID-19 infection were higher in HD patients. Available data may underestimate the real incidence of infection. International collaboration and standardized reporting of epidemiological data should be needed for further studies. Full article
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Open AccessArticle
Toward COVID-19 Information: Infodemic or Fear of Missing Out?
Healthcare 2020, 8(4), 550; https://doi.org/10.3390/healthcare8040550 - 10 Dec 2020
Cited by 2 | Viewed by 557
Abstract
Coronavirus disease 2019 (COVID-19) has caused a global pandemic and exerted a profound physiological and mental impact on the public. Due to anxiety from being bombarded by information from the news and social media, people may constantly read and repost, with a fear [...] Read more.
Coronavirus disease 2019 (COVID-19) has caused a global pandemic and exerted a profound physiological and mental impact on the public. Due to anxiety from being bombarded by information from the news and social media, people may constantly read and repost, with a fear of missing out (FOMO), information about COVID-19 on social media. So far, there has been little research on COVID-19 FOMO. We therefore compiled the COVID-19 information fear of missing out scale (CIFS) and administered it to 1178 adults in Taiwan to identify the possible factors influencing CIFS scores. We demonstrated that the CIFS had good reliability, factor validity, and criterion validity. With regard to demographic variables, we found that gender, marital status, travel time to the nearest hospital, and educational background influenced CIFS scores. In contrast, the participant age and whether he or she lived in an urban area did not affect the CIFS scores. With regard to social media usage, social media usage time (r = 0.025) and the numbers of COVID-19-related posts read on social media (r = 0.117) or instant messaging (r = 0.169) were not highly correlated with CIFS scores. Rather, CIFS scores were found to be significantly correlated to the frequency of reposting COVID-19-related information on social media (r = 0.497) and on instant messaging (r = 0.447). These results indicate that CIFS scores are closely associated not with passive browsing on social media but with the frequency at which an individual actively reposts information. In other words, what creates CIF is not an overabundance of information (i.e., an infodemic) but the active reposting and interpretation of information. Individual autonomy for interpretation of the received information and self-determination about reposting are key factors for COVID-19 information FOMO. When facing the COVID-19-related news on social media, it is the active information-related FOMO, not the passive infodemic, that influences our social media usage. Full article
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Open AccessArticle
Lessons Learned from Japan’s Response to the First Wave of COVID-19: A Content Analysis
Healthcare 2020, 8(4), 426; https://doi.org/10.3390/healthcare8040426 - 23 Oct 2020
Cited by 4 | Viewed by 1355
Abstract
While the epidemiological impact of the coronavirus disease 2019 (COVID-19) pandemic has been relatively moderate in East-Asian countries, the pandemic has significantly impacted on citizens’ lives and livelihoods, and Japan is no exception. In the early phase of the COVID-19 pandemic, Japan managed [...] Read more.
While the epidemiological impact of the coronavirus disease 2019 (COVID-19) pandemic has been relatively moderate in East-Asian countries, the pandemic has significantly impacted on citizens’ lives and livelihoods, and Japan is no exception. In the early phase of the COVID-19 pandemic, Japan managed unprecedented quarantines and realized the difficulty of controlling COVID-19, finally recording a relatively high number of deaths per million in the Western Pacific region. However, scant research has highlighted the distinctive features of Japan’s reaction and the challenges encountered. To clarify these points and examine Japan’s first response to COVID-19, we performed a content analysis. Minutes of expert meetings were analyzed from multiple viewpoints, including epidemiology, health systems, border control, and health communication. The obscure evolution of the testing strategy, the usefulness of retrospective contact tracing, the rapid scientific risk assessment, a sluggish expansion of health system capacity and response in border control, and misunderstanding between risk communication and crisis communication are made evident by our analysis. Examining previous responses and gathering lessons learned in each country will improve global responses to COVID-19 and strengthen regional health security. Therefore, while investing in public health and ensuring transparency, Japan needs to clarify the previous decision-making process of each countermeasure towards COVID-19. Full article
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Open AccessArticle
Conceptualizing COVID-19 and Public Panic with the Moderating Role of Media Use and Uncertainty in China: An Empirical Framework
Healthcare 2020, 8(3), 249; https://doi.org/10.3390/healthcare8030249 - 02 Aug 2020
Cited by 1 | Viewed by 1116
Abstract
Uncertainty puts people in a binary state of mind, where every piece of external information can positively or negatively affect their state of health. Given the uncertain situation created by the new coronavirus pandemic, this study claims to be the first empirical analysis [...] Read more.
Uncertainty puts people in a binary state of mind, where every piece of external information can positively or negatively affect their state of health. Given the uncertain situation created by the new coronavirus pandemic, this study claims to be the first empirical analysis of the real-time status of public panic in China. It frames peoples’ intrinsic and extrinsic stimuli, creating a psychosocial analysis of public panic. We conducted an online survey of WeChat and QQ users in February 2020 and collected 1613 samples through a QR code questionnaire. We used the ordinary least squares (OLS) regression equation model to conceptualize public panic pathways in different gender and age groups. This underlines the psychological origins of fear and anxiety and points out how the media uses socially constructed public panic. The results show that the outbreak of COVID-19 created uncertainty among the public, and the official media intensified it because of the late dissemination of news about the outbreak’s real-time status. Hence, unofficial media remained faster in news reporting, but the news reporting remained contradictory with official reports. This created doubts about the authenticity of the given information and caused public mental health abnormalities. The study provides a conceptual framework based on lessons learned from physiology, psychology, and social psychology and real-time public analysis to inform policymakers and public administrators about the contextual dynamics of public panic in China. It provides useful insights into the wise handling of this uncertain time and controlling the fatal conditions of public panic created by COVID-19. It has implications for other countries as well. Full article
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Open AccessArticle
Knowledge and Attitude of Dental Practitioners Related to Disinfection during the COVID-19 Pandemic
Healthcare 2020, 8(3), 232; https://doi.org/10.3390/healthcare8030232 - 25 Jul 2020
Cited by 14 | Viewed by 3028
Abstract
The world is currently facing a pandemic crisis due to a novel coronavirus. For this purpose, acquiring updated knowledge regarding prevention and disinfection during the current pandemic is necessary for every dental practitioner. In our study, we aimed to evaluate globally the level [...] Read more.
The world is currently facing a pandemic crisis due to a novel coronavirus. For this purpose, acquiring updated knowledge regarding prevention and disinfection during the current pandemic is necessary for every dental practitioner. In our study, we aimed to evaluate globally the level of knowledge and the attitude of dental practitioners related to disinfection. A total of 385 participants out of 401 participants from 23 different countries across the world were included in the final analysis after the exclusion of incomplete responses. The majority of the dentists who responded were females (53.8%) and were practicing at private health institutes (36.4%). The mean knowledge score of the participants was estimated to be 4.19 ± 1.88 out of 12, reflecting insufficient knowledge, and the mean attitude score of the participants was estimated to be 12.24 ± 3.23 out of 15, which shows a positive attitude toward disinfection practices during coronavirus 2019 (COVID-19). Thus, the current study indicated a lack of knowledge in fundamental aspects of disinfection protocols with a significant and positive attitude from dental health professionals toward disinfection regarding the coronavirus 2019 (COVID-19) pandemic. Full article
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Open AccessCommunication
Factors Influencing Global Variations in COVID-19 Cases and Fatalities; A Review
Healthcare 2020, 8(3), 216; https://doi.org/10.3390/healthcare8030216 - 17 Jul 2020
Cited by 4 | Viewed by 1348
Abstract
Since the first cases of the novel corona virus disease (COVID-19) were diagnosed in China, outcomes associated with this infection in terms of total numbers of cases and deaths have varied widely between countries. While some countries had minimal rates of infections and [...] Read more.
Since the first cases of the novel corona virus disease (COVID-19) were diagnosed in China, outcomes associated with this infection in terms of total numbers of cases and deaths have varied widely between countries. While some countries had minimal rates of infections and deaths, other countries were hit hard by the pandemic. Countries with highest numbers of cases continued to change over time, but at the time of submission of this article they are: USA, Brazil, Russia, UK, India, Spain, Italy, Peru and Chile. This is in contrary to many countries in the Middle East, Far East, and Africa, which had lower cases or deaths/cases rates. This raised many questions pertaining to this variation. This overview explores the potential factors that contribute to spread, transmission and outcomes of the COVID-19 infection. It also uses an evidence-based approach in reviewing the available most recent literature that tackled the various factors that modify the populations’ response to COVID-19, namely, factors pertaining to population characteristics, environmental and geographic factors. Full article
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Open AccessArticle
Psycho-Emotional Approach to the Psychological Distress Related to the COVID-19 Pandemic in Spain: A Cross-Sectional Observational Study
Healthcare 2020, 8(3), 190; https://doi.org/10.3390/healthcare8030190 - 28 Jun 2020
Cited by 8 | Viewed by 2266
Abstract
Anxiety, depression, and stress are common and expected reactions to the coronavirus disease (COVID-19) pandemic. The objective of this study is to analyze psychological distress in a sample of Spanish population, identifying the predictive nature of the information received, the preventive measures taken, [...] Read more.
Anxiety, depression, and stress are common and expected reactions to the coronavirus disease (COVID-19) pandemic. The objective of this study is to analyze psychological distress in a sample of Spanish population, identifying the predictive nature of the information received, the preventive measures taken, level of concern, beliefs, and knowledge about the infection. A cross-sectional observational study was conducted on a sample of 4615 participants. Data were collected through a self-prepared questionnaire and the general health questionnaire (GHQ-12). Bivariate analyses and logistic regressions were performed. Of the total participants, 71.98% presented psychological distress. The study population actively sought information about coronavirus, expressed a high level of concern and knowledge, and the most frequent preventive behavior was hand washing. As predictive factors, the degree of concern for COVID-19 was identified (odds ratio (OR) = 1.244, 95% confidence interval (CI) = [1.179, 1.312]), the number of hours spent consulting information on COVID-19 (OR = 1.038, 95% CI = [1.009, 1.068]), or the need for psychological support (OR = 1.135, 95% CI = [1.094, 1.177]), among others. These results could help design more effective strategies towards a psycho-emotional approach for the population when in similar health crisis situations. There is a need for interventions aimed at the psychological well-being of the population that meet the needs of their reality. Full article
Open AccessCommunication
Increased Risk of COVID-19-Related Deaths among General Practitioners in Italy
Healthcare 2020, 8(2), 155; https://doi.org/10.3390/healthcare8020155 - 03 Jun 2020
Cited by 5 | Viewed by 1282
Abstract
To date, data on COVID-19-related death cases among physicians from different medical specialties are incomplete and scattered. In Italy, available data highlight that general practitioners (GPs) are, apparently, the most heavily affected group. Indeed, they currently represent 44.1% of the total COVID-19 related [...] Read more.
To date, data on COVID-19-related death cases among physicians from different medical specialties are incomplete and scattered. In Italy, available data highlight that general practitioners (GPs) are, apparently, the most heavily affected group. Indeed, they currently represent 44.1% of the total COVID-19 related death cases occurred among physicians, whereas they constitute about 15% of the total number of doctors. This high proportion is most likely the consequence of a work-related contagion happening especially during the first weeks of the epidemic, and persisting also in the following weeks, after the national lockdown. There are various reasons for these higher contagion rates: GPs perform a lot of medical examinations daily, usually in close contact with patients. Especially at the beginning of the epidemic, GPs might have had scant information on the specific safety procedures for the prevention of SARS-CoV-2 transmission (e.g., there was limited knowledge on the possibility of contagions deriving from asymptomatic patients) and, moreover, the availability of personal protective equipment was insufficient. Furthermore, the risk of infection is highly increased by the virus’ characteristics, like its survival for several hours/days on different surfaces and its persistence in the air after an aerosolization process, with possibilities to be transmitted over distances longer than two meters. Following these observations, and considering the high cost in term of GPs’ lives, the COVID-19 pandemic will probably revolutionize the approach to patients in general practice. Clear and effective guidelines are absolutely and urgently needed for the refinement of adequate measures to prevent SARS-CoV-2 infections among GPs. Full article
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Open AccessArticle
Analysis of Outbreak and Global Impacts of the COVID-19
Healthcare 2020, 8(2), 148; https://doi.org/10.3390/healthcare8020148 - 29 May 2020
Cited by 3 | Viewed by 2042
Abstract
Corona viruses are a large family of viruses that are not only restricted to causing illness in humans but also affect animals such as camels, cattle, cats, and bats, thus affecting a large group of living species. The outbreak of Corona virus in [...] Read more.
Corona viruses are a large family of viruses that are not only restricted to causing illness in humans but also affect animals such as camels, cattle, cats, and bats, thus affecting a large group of living species. The outbreak of Corona virus in late December 2019 (also known as COVID-19) raised major concerns when the outbreak started getting tremendous. While the first case was discovered in Wuhan, China, it did not take long for the disease to travel across the globe and infect every continent (except Antarctica), killing thousands of people. Since it has become a global concern, different countries have been working toward the treatment and generation of vaccine, leading to different speculations. While some argue that the vaccine may only be a few weeks away, others believe that it may take some time to create the vaccine. Given the increasing number of deaths, the COVID-19 has caused havoc worldwide and is a matter of serious concern. Thus, there is a need to study how the disease has been propagating across continents by numbers as well as by regions. This study incorporates a detailed description of how the COVID-19 outbreak started in China and managed to spread across the globe rapidly. We take into account the COVID-19 outbreak cases (confirmed, recovered, death) in order to make some observations regarding the pandemic. Given the detailed description of the outbreak, this study would be beneficial to certain industries that may be affected by the outbreak in order to take timely precautionary measures in the future. Further, the study lists some industries that have witnessed the impact of the COVID-19 outbreak on a global scale. Full article
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Open AccessArticle
Analysis of SARS-CoV-2 Screening Clinic (Including Drive-through System) Data at a Single University Hospital in South Korea from 27 January 2020 to 31 March 2020 During the COVID-19 Outbreak
Healthcare 2020, 8(2), 145; https://doi.org/10.3390/healthcare8020145 - 26 May 2020
Cited by 9 | Viewed by 1283
Abstract
In this study, we evaluated the efficiency of a drive-through (DT) screening system for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by comparing it with a conventional screening system. We reviewed and analyzed the SARS-CoV-2 screening data obtained at our university hospital. We [...] Read more.
In this study, we evaluated the efficiency of a drive-through (DT) screening system for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by comparing it with a conventional screening system. We reviewed and analyzed the SARS-CoV-2 screening data obtained at our university hospital. We compared the number of tests for SARS-CoV-2 (using real-time polymerase chain reaction) performed using two different specimen collection systems—DT and conventional—during the coronavirus disease 2019 (COVID-19) outbreak in Daegu. Based on the results, the DT screening system collected 5.8 times more specimens for testing than the conventional screening system. From 27 January to 31 March 2020, 6211 individuals were screened for SARS-CoV-2 infection using either the DT or conventional system. In total, 217 individuals tested positive for SARS-CoV-2 (positive rate: 3.50%). Of the 6211 individuals, 3368 were symptomatic or had a history of contact with COVID-19 patients, and 142 of them tested positive for SARS-CoV-2 (positive rate: 4.22%). Further, 2843 individuals were asymptomatic and had no history of contact with COVID-19 patients, and 75 of them tested positive for SARS-CoV-2 (positive rate: 2.64%). In conclusion, the DT system allowed clinicians to collect specimens for SARS-CoV-2 screening more efficiently than the conventional system. Furthermore, as there might be several COVID-19 patients who remain asymptomatic, expanding the screening test to asymptomatic individuals would be necessary. Full article
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Open AccessArticle
Does COVID-2019 have an Impact on the Purchase Intention of Commercial Long-Term Care Insurance among the Elderly in China?
Healthcare 2020, 8(2), 126; https://doi.org/10.3390/healthcare8020126 - 06 May 2020
Cited by 10 | Viewed by 2262
Abstract
Purpose: As an important measure to alleviate long-term care (LTC) costs for the disabled due to the aging of the population, long-term care insurance (LTCI) system has been paid more attention in China. In addition to the government-led public LTCI system that has [...] Read more.
Purpose: As an important measure to alleviate long-term care (LTC) costs for the disabled due to the aging of the population, long-term care insurance (LTCI) system has been paid more attention in China. In addition to the government-led public LTCI system that has been piloted in cities such as Qingdao, Chongqing and Shanghai, health insurers such as the China Life Insurance Company are also experimenting with various types of commercial LTCI in the private market. However, the commercial LTCI market is developing very slowly due to public awareness and other reasons. On the other hand, COVID-2019 has had an impact on the cognition of the importance of long-term care for the elderly due to the fact that the death cases of COVID-2019 have been mainly concentrated in the elderly population with chronic diseases such as hypertension. Therefore, the purpose of this study is to explore the differences in the purchase intention of commercial LTCI among the elderly in two different periods: before and after the outbreak of COVID-2019. Methods: By using the Andersen behavioral model and two investigations in two different periods before and after the outbreak of COVID-2019, this study explores the impacts of COVID-2019 on the purchase intention of commercial LTCI. Results: Some significant discoveries were found. For example, 25.8% of interviewees showed purchase intention in LTCI in the time before the COVID-2019 outbreak, while this proportion increased to 37.6% after the COVID-2019 outbreak. People who were younger (OR = 2.128, before COVID-2019; OR = 1.875, after COVID-2019) or who had more education (OR = 1.502, before COVID-2019; OR = 2.218, after COVID-2019) were more interested in commercial LTCI. Conclusion: This study shows that COVID-2019 has had an obvious impact on the purchase intention of commercial LTCI, which provides some enlightenment for China to improve the LTCI system in the future, especially to accelerate the development of commercial LTCI. For example, it is essential to promote the importance of long-term care among the elderly in a focused and targeted way. In terms of the key target audience, it can be developed gradually from the groups with higher education levels and the middle elderly aged 45–64 years old. Full article
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Open AccessFeature PaperArticle
Epidemiology of Coronavirus COVID-19: Forecasting the Future Incidence in Different Countries
Healthcare 2020, 8(2), 99; https://doi.org/10.3390/healthcare8020099 - 15 Apr 2020
Cited by 10 | Viewed by 3722
Abstract
This paper forecasts the future spread of COVID-19 by exploiting the identified lead-lag effects between different countries. Specifically, we first determine the past relation among nations with the aid of dynamic time warping. This procedure allows an elastic adjustment of the time axis [...] Read more.
This paper forecasts the future spread of COVID-19 by exploiting the identified lead-lag effects between different countries. Specifically, we first determine the past relation among nations with the aid of dynamic time warping. This procedure allows an elastic adjustment of the time axis to find similar but phase-shifted sequences. Afterwards, the established framework utilizes information about the leading country to predict the Coronavirus spread of the following nation. The presented methodology is applied to confirmed Coronavirus cases from 1 January 2020 to 28 March 2020. Our results show that China leads all other countries in the range of 29 days for South Korea and 44 days for the United States. Finally, we predict a future collapse of the healthcare systems of the United Kingdom and Switzerland in case of our explosion scenario. Full article
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Open AccessArticle
Effective Risk Communication for Public Health Emergency: Reflection on the COVID-19 (2019-nCoV) Outbreak in Wuhan, China
Healthcare 2020, 8(1), 64; https://doi.org/10.3390/healthcare8010064 - 21 Mar 2020
Cited by 27 | Viewed by 7221
Abstract
Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan [...] Read more.
Risk communication is critical to emergency management. The objective of this paper is to illustrate the effective process and attention points of risk communication reflecting on the COVID-19 (2019-nCoV) outbreak in Wuhan, China. We provide the timeline of risk communication progress in Wuhan and use a message-centered approach to identify problems that it entailed. It was found that the delayed decision making of the local government officials and the limited information disclosure should be mainly responsible for the ineffective risk communication. The principles for effective risk communication concerning Wuhan’s outbreak management were also discussed. The whole communication process is suggested to integrate the accessibility and openness of risk information, the timing and frequency of communication, and the strategies dealing with uncertainties. Based on these principles and lessons from Wuhan’s case, this paper employed a simplified Government–Expert–Public risk communication model to illustrate a collaborative network for effective risk communication. Full article
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Review

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Open AccessReview
What Will Be the Impact of the COVID-19 Quarantine on Psychological Distress? Considerations Based on a Systematic Review of Pandemic Outbreaks
Healthcare 2021, 9(1), 101; https://doi.org/10.3390/healthcare9010101 - 19 Jan 2021
Viewed by 440
Abstract
Background: The novel coronavirus (SARS-CoV-2) and related syndrome (COVID-19) has led to worldwide measures with severe consequences for millions of people. In the light of the psychopathological consequences of restrictive measures detected during previous outbreaks, a systematic review was carried out to [...] Read more.
Background: The novel coronavirus (SARS-CoV-2) and related syndrome (COVID-19) has led to worldwide measures with severe consequences for millions of people. In the light of the psychopathological consequences of restrictive measures detected during previous outbreaks, a systematic review was carried out to provide an evidence-based assessment of possible effects of the current COVID-19 quarantine on mental health. Methods: This review included studies that assessed mental health indexes (e.g., overall psychological distress, depressive and PTSD symptoms) during and after quarantine periods adopted to management different outbreaks (e.g., COVID-19, SARS, MERS). Results: Twenty-one independent studies were included for a total of 82,312 subjects. At least 20% of people exposed to restrictive measures for the management of pandemic infections reported clinically significant levels of psychological distress, especially PTSD (21%) and depressive (22.69%) symptoms. Overall, original studies highlighted relevant methodological limitations. Conclusions: Nowadays, almost one out of every five people is at risk of development of clinically significant psychological distress. Further research on mental health after the current COVID-19 quarantine measures is warranted. Full article
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Open AccessReview
The Possible Relationship between the Abuse of Tobacco, Opioid, or Alcohol with COVID-19
Healthcare 2021, 9(1), 2; https://doi.org/10.3390/healthcare9010002 - 22 Dec 2020
Viewed by 892
Abstract
Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in [...] Read more.
Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different substances (Tobacco, opioid, and Alcohol) with coronavirus disease (COVID-19). Tobacco: Multiple studies confirmed that cigarette smoking affects the respiratory system by increasing the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which have a significant association with COVID-19 infection rate and disease severity. Opioid: Studies conducted regarding the association of opioid use disorder (OUD) and COVID-19 infection severity are limited; however, opioids can lead to both respiratory depression and kidney injuries, causing poor prognosis for those with COVID-19 infections. Alcohol: People with alcohol use disorders are at risk of developing acute lung injury and severe COVID-19 infection. Alcohol consumption during the COVID-19 pandemic has two possible scenarios: either increased or decreased based on situations. Conclusion: SUD has been frequently reported to have a positive relationship with COVID-19 severity Further studies are needed to understand the effects of opioids and alcohol abuse on COVID-19. Full article
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Other

Open AccessCase Report
May Ibrutinib Have Activity in Respiratory Complications by SARS-CoV-2? Clinical Experience in a Patient with Chronic Lymphocytic Leukemia
Healthcare 2021, 9(1), 78; https://doi.org/10.3390/healthcare9010078 - 15 Jan 2021
Viewed by 319
Abstract
COVID-19 is affecting many countries all around the world. Unfortunately, no treatment has already been approved for the management of patients infected by SARS-CoV-2. It seems that SARS-CoV-2 can induce the activation of an exaggerated immune response against itself according to different mechanisms [...] Read more.
COVID-19 is affecting many countries all around the world. Unfortunately, no treatment has already been approved for the management of patients infected by SARS-CoV-2. It seems that SARS-CoV-2 can induce the activation of an exaggerated immune response against itself according to different mechanisms that are not really well known. Inflammatory interleukins, such as IL-6 among others, play a central role in this uncontrolled immune response. There is a strong rational under ibrutinib use in in the treatment of immune-based diseases, such a as GVHD or RA. Ibrutinib achieves a reduction in the production of TNFα, IL1, IL-6 and Monocyte chemo-attractant protein-1 (MCP-1) by neutrophils and macrophages, that are key players in keeping the inflammatory process. We present our clinical experience about ibrutinib use in ARDS secondary to SARS-CoV-2 in a patient with chronic lymphocytic leukemia (CLL). Full article
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Open AccessBrief Report
Remote Monitoring Empowerment of Patients with IBDs during the SARS-CoV-2 Pandemic
Healthcare 2020, 8(4), 377; https://doi.org/10.3390/healthcare8040377 - 01 Oct 2020
Viewed by 456
Abstract
Once the WHO declared the Sars-CoV-2 pandemic, the world had to reprogram numerous clinical activities, particularly those related to highly disabling diseases such as inflammatory bowel diseases (IBDs). In this study, 1083 IBD patients were assessed, affected by Crohn’s Disease (CD) and Ulcerative [...] Read more.
Once the WHO declared the Sars-CoV-2 pandemic, the world had to reprogram numerous clinical activities, particularly those related to highly disabling diseases such as inflammatory bowel diseases (IBDs). In this study, 1083 IBD patients were assessed, affected by Crohn’s Disease (CD) and Ulcerative Colitis (UC), and subdivided into two groups. The first group included patients who needed treatment in person at the outpatients clinic, while the second group could be tele-monitored because they were able to self-administer therapy. The tele-monitoring was based on telecommunication applications via smartphone, driven by a dedicated clinical control room in the IBD Clinic. The aim of this study was to assess the quality of life (using IBDQ32) of UC patients and tele-monitored CD patients (tele-monitoring group) as compared to those patients who underwent assessment in person in the outpatients clinic (control group). Despite observing a lower number of relapses in the control group than the tele-monitoring group, there were no statistically significant differences between the groups in terms of the IBD32Q scores. Tele-monitoring of patients who are able to self-administer the IBD therapy can be an effective vicarious system as compared to the clinical evaluation in person, that could lead to important changes to avoid the overcrowding of the IBD outpatients clinic, especially during public health crises like the present pandemic. Full article
Open AccessPerspective
Impact of COVID-19 on Alzheimer’s Disease Risk: Viewpoint for Research Action
Healthcare 2020, 8(3), 286; https://doi.org/10.3390/healthcare8030286 - 21 Aug 2020
Cited by 4 | Viewed by 1620
Abstract
In the middle of the coronavirus disease 19 (COVID-19) outbreak, the main efforts of the scientific community are rightly all focused on identifying efficient pharmacological treatments to cure the acute severe symptoms and developing a reliable vaccine. On the other hand, we cannot [...] Read more.
In the middle of the coronavirus disease 19 (COVID-19) outbreak, the main efforts of the scientific community are rightly all focused on identifying efficient pharmacological treatments to cure the acute severe symptoms and developing a reliable vaccine. On the other hand, we cannot exclude that, in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) positive subjects, the virus infection could have long-term consequences, leading to chronic medical conditions such as dementia and neurodegenerative disease. Considering the age of SARS-CoV-2 infected subjects, the neuroinvasive potential might lead/contribute to the development of neurodegenerative diseases. Here, we analyzed a possible link between SARS-CoV-2 infection and Alzheimer’s disease risk, hypothesizing possible mechanisms at the base of disease development. This reflection raises the need to start to experimentally investigating today the mechanistic link between Alzheimer’s disease (AD) and COVID-19 to be ready tomorrow. Full article
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