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Special Issue "The COVID-19 Pandemic in Europe: Response to Challenges"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 January 2021).

Special Issue Editors

Prof. Dr. Giovanni Gabutti
E-Mail Website
Guest Editor
Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
Interests: vaccine-preventable infectious diseases; epidemiology; vaccines; immunization; prevention; public health
Prof. Dr. Andrea Orsi
E-Mail Website
Assistant Guest Editor
Department of Health Sciences, University of Genoa, 16132 Genoa, Italy
Interests: vaccine-preventable infectious diseases; clinical and molecular epidemiology; prevention; surveillance and control of HAI
Prof. Dr. Armando Stefanati
E-Mail Website
Assistant Guest Editor
Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
Interests: biohazard of healthcare workers (HCWs); immunization of HCWs; health surveillance of HCWs; epidemiology; vaccine-preventable infectious diseases; chronic diseases
Prof. Dr. Jon Øyvind Odland
E-Mail Website
Assistant Guest Editor
Department of Community Medicine, Faculty of Health Sciences, The Norwegian University for Science and Technology, 7491 Trondheim, Norway
Interests: reproductive health; epidemiology; environmental health; contaminants; arctic areas; infectious diseases; climate change
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue entitled: “COVID-19 Pandemic in Europe: Response to Challenges” that will be published in the International Journal of Environmental Research and Public Health, which is an interdisciplinary, peer-reviewed, open-access journal in the area of public health. More information about the journal can be found at https://www.mdpi.com/journal/ijerph.

The spread of the SARS-CoV-2 virus is a global health emergency involving the health authorities of all countries in an attempt to fight this new pandemic.

Many aspects of the infection have been studied and available epidemiological, clinical and impact data have been used to design preventive interventions. Unfortunately, the spreading of the virus is ongoing, and the impact of the infection is still growing, despite the application of very restrictive preventive interventions. What is more, that impact is huge, both from a clinical and economic point of view.

Healthcare workers, who operate on the front line, and as such particularly at risk, have been greatly involved in terms of infection and unfortunately also of deaths.

Close observance of the rules issued by WHO and other international bodies is essential, as it is pivotal to understand in more detail the dynamics of virus spreading, to identify new diagnostic and therapeutic approaches, and to develop in a reasonably quick time a vaccine.

This Special Issue aims to publish evidence and observations in the field, regarding but not limited to: microbiological aspects; epidemiology; clinical aspects; case management; lab diagnosis; immunology; therapeutic options; vaccine design and development; public health approach; preventive measures; communication.

We welcome the submission of reviews, original research articles, short communications, systematic reviews, and case studies targeting any of these core research questions, as the main goal of this Special Issue is to address some of the core research questions related to the COVID-19 pandemic. High quality submissions from scholars based in Europe will be considered for a publication cost waiver after completion of the manuscript review process and as recommended by the Editorial Board.

Prof. Giovanni Gabutti
Prof. Andrea Orsi
Prof. Armando Stefanati
Prof. Jon Øyvind Odland
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • SARS-CoV-2
  • COVID-19
  • Epidemiology
  • Microbiology
  • Immunology
  • Clinical aspects
  • Therapeutic options
  • Lab diagnosis
  • Preventive measures
  • Case management

Published Papers (34 papers)

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Article
Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings
Int. J. Environ. Res. Public Health 2021, 18(8), 4358; https://doi.org/10.3390/ijerph18084358 - 20 Apr 2021
Viewed by 581
Abstract
Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) [...] Read more.
Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
Flexibility and Bed Margins of the Community of Madrid’s Hospitals during the First Wave of the SARS-CoV-2 Pandemic
Int. J. Environ. Res. Public Health 2021, 18(7), 3510; https://doi.org/10.3390/ijerph18073510 - 28 Mar 2021
Viewed by 1098
Abstract
Background: The COVID-19 pandemic has had global effects; cases have been counted in the tens of millions, and there have been over two million deaths throughout the world. Health systems have been stressed in trying to provide a response to the increasing demand [...] Read more.
Background: The COVID-19 pandemic has had global effects; cases have been counted in the tens of millions, and there have been over two million deaths throughout the world. Health systems have been stressed in trying to provide a response to the increasing demand for hospital beds during the different waves. This paper analyzes the dynamic response of the hospitals of the Community of Madrid (CoM) during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the period between 18 March and 31 May 2020. The aim was to model the response of the CoM’s health system in terms of the number of available beds. Methods: A research design based on a case study of the CoM was developed. To model this response, we use two concepts: “bed margin” (available beds minus occupied beds, expressed as a percentage) and “flexibility” (which describes the ability to adapt to the growing demand for beds). The Linear Hinges Model allowed a robust estimation of the key performance indicators for capturing the flexibility of the available beds in hospitals. Three new flexibility indicators were defined: the Average Ramp Rate Until the Peak (ARRUP), the Ramp Duration Until the Peak (RDUP), and the Ramp Growth Until the Peak (RGUP). Results: The public and private hospitals of the CoM were able to increase the number of available beds from 18,692 on 18 March 2020 to 23,623 on 2 April 2020. At the peak of the wave, the number of available beds increased by 160 in 48 h, with an occupancy of 90.3%. Within that fifteen-day period, the number of COVID-19 inpatients increased by 200% in non-intensive care unit (non-ICU) wards and by 155% in intensive care unit (ICU) wards. The estimated ARRUP for non-ICU beds in the CoM hospital network during the first pandemic wave was 305.56 beds/day, the RDUP was 15 days, and the RGUP was 4598 beds. For the ICU beds, the ARRUP was 36.73 beds/day, the RDUP was 20 days, and the RGUP was 735 beds. This paper includes a further analysis of the response estimated for each hospital. Conclusions: This research provides insights not only for academia, but also for hospital management and practitioners. The results show that not all of the hospitals dealt with the sudden increase in bed demand in the same way, nor did they provide the same flexibility in order to increase their bed capabilities. The bed margin and the proposed indicators of flexibility summarize the dynamic response and can be included as part of a hospital’s management dashboard for monitoring its behavior during pandemic waves or other health crises as a complement to other, more steady-state indicators. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Transmission Dynamics of SARS-CoV-2 during an Outbreak in a Roma Community in Thessaly, Greece—Control Measures and Lessons Learned
Int. J. Environ. Res. Public Health 2021, 18(6), 2878; https://doi.org/10.3390/ijerph18062878 - 11 Mar 2021
Viewed by 839
Abstract
A COVID-19 outbreak occurred among residents of a Roma settlement in Greece (8 April–4 June 2020). The aim of this study was to identify factors associated with an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to evaluate the [...] Read more.
A COVID-19 outbreak occurred among residents of a Roma settlement in Greece (8 April–4 June 2020). The aim of this study was to identify factors associated with an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to evaluate the effectiveness of control measures implemented. Data were analyzed from individuals that were tested for SARS-CoV-2 during contact tracing, population screening or hospital visits. RT-PCR was used for the detection of SARS-CoV-2 in oropharyngeal samples. Risk factors for household secondary attack rates (SAR) and hospitalization with COVID-19 were examined using chi-square tests, Fisher’s exact tests and logistic regression analyses. During the outbreak, 142 cases, 20 hospitalizations and 1 death were recorded, with a total of 2273 individuals tested. The risk of hospitalization was associated with age (OR: 1.04, 95% CI: 1.02–1.07) and Cycle threshold (Ct) values (OR for a decrease in Ct values by 1: 1.18, 95% CI: 1.07–1.31). Household SAR was estimated at 38.62% (95% CI: 32.50–45.01%). After the designation of an isolation facility for cases, household SAR declined from 74.42% to 31.03%. Household size was associated with the risk of infection (OR: 2.65, 95% CI: 1.00–7.07). The presence of COVID-19 symptoms among index cases was correlated with higher transmission (OR: 23.68, 95% CI 2.21–253.74) in multivariate analysis, while age was found to be associated with SAR only in univariate analysis. Roma communities can be particularly vulnerable to the spread of SARS-CoV-2. In similar settings, symptomatic cases are more important transmitters of SARS-CoV-2. Within these communities, immediate measures should be implemented to mitigate disease spread. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
COVID-19 Pandemic and Helsinki University Hospital Personnel Psychological Well-Being: Six-Month Follow-Up Results
Int. J. Environ. Res. Public Health 2021, 18(5), 2524; https://doi.org/10.3390/ijerph18052524 - 04 Mar 2021
Viewed by 796
Abstract
The COVID-19 pandemic has caused an unequally distributed extra workload to hospital personnel and first reports have indicated that especially front-line health care personnel are psychologically challenged. A majority of the Finnish COVID-19 patients are cared for in the Helsinki University Hospital district. [...] Read more.
The COVID-19 pandemic has caused an unequally distributed extra workload to hospital personnel and first reports have indicated that especially front-line health care personnel are psychologically challenged. A majority of the Finnish COVID-19 patients are cared for in the Helsinki University Hospital district. The psychological distress of the Helsinki University Hospital personnel has been followed via an electronic survey monthly since June 2020. We report six-month follow-up results of a prospective 18-month cohort study. Individual variation explained much more of the total variance in psychological distress (68.5%, 95% CI 65.2–71.9%) and negative changes in sleep (75.6%, 95% CI 72.2–79.2%) than the study survey wave (1.6%, CI 0.5–5.5%; and 0.3%, CI 0.1–1.2%). Regional COVID-19 incidence rates correlated with the personnel’s psychological distress. In adjusted multilevel generalized linear multiple regression models, potentially traumatic COVID-19 pandemic-related events (OR 6.54, 95% CI 5.00–8.56) and front-line COVID-19 work (OR 1.81, 95% CI 1.37–2.39) was associated with personnel psychological distress but age and gender was not. While vaccinations have been initiated, creating hope, continuous follow-up and psychosocial support is still needed for all hospital personnel. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
A Two-Phase Stochastic Dynamic Model for COVID-19 Mid-Term Policy Recommendations in Greece: A Pathway towards Mass Vaccination
Int. J. Environ. Res. Public Health 2021, 18(5), 2497; https://doi.org/10.3390/ijerph18052497 - 03 Mar 2021
Viewed by 840
Abstract
From 7 November 2020, Greece adopted a second nationwide lockdown policy to mitigate the transmission of SARS-CoV-2 (the first took place from 23 March to 4 May 2020), just as the second wave of COVID-19 was advancing, as did other European countries. To [...] Read more.
From 7 November 2020, Greece adopted a second nationwide lockdown policy to mitigate the transmission of SARS-CoV-2 (the first took place from 23 March to 4 May 2020), just as the second wave of COVID-19 was advancing, as did other European countries. To secure the full benefits of mass vaccination, which started in early January 2021, it is of utmost importance to complement it with mid-term non-pharmaceutical interventions (NPIs). The objective was to minimize human losses and to limit social and economic costs. In this paper a two-phase stochastic dynamic network compartmental model (a pre-vaccination SEIR until 15 February 2021 and a post-vaccination SVEIR from 15 February 2021 to 30 June 2021) is developed. Three scenarios are assessed for the first phase: (a) A baseline scenario, which lifts the national lockdown and all NPIs in January 2021; (b) a “semi-lockdown” scenario with school opening, partial retail sector operation, universal mask wearing, and social distancing/teleworking in January 2021; and (c) a “rolling lockdown” scenario combining a partial lifting of measures in January 2021 followed by a third nationwide lockdown in February 2021. In the second phase three scenarios with different vaccination rates are assessed. Publicly available data along with some first results of the SHARE COVID-19 survey conducted in Greece are used as input. The results regarding the first phase indicate that the “semi-lockdown” scenario clearly outperforms the third lockdown scenario (5.7% less expected fatalities); the second phase is extremely sensitive on the availability of sufficient vaccine supplies and high vaccination rates. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
IgM and IgG Profiles Reveal Peculiar Features of Humoral Immunity Response to SARS-CoV-2 Infection
Int. J. Environ. Res. Public Health 2021, 18(3), 1318; https://doi.org/10.3390/ijerph18031318 - 01 Feb 2021
Viewed by 944
Abstract
The emergence of coronavirus disease 2019 (COVID-19) is globally a major healthcare threat. There is little information regarding the mechanisms and roles of the humoral response in SARS-CoV-2 infection. The aim of this study was to analyze the antibody levels (IgM and IgG) [...] Read more.
The emergence of coronavirus disease 2019 (COVID-19) is globally a major healthcare threat. There is little information regarding the mechanisms and roles of the humoral response in SARS-CoV-2 infection. The aim of this study was to analyze the antibody levels (IgM and IgG) by chemiluminescence immunoassay in 54 subjects positive to SARS-CoV-2 swab test in relation to their clinical status (whether asymptomatic, pauci-symptomatic or with mild, sever or critical symptoms), the time from the symptom onset, sex, age, and comorbidities. Overall, the presence of comorbidities and the age of subjects were associated with their clinical status. The IgG concentrations were significantly higher in patients who developed critical and severe symptoms and seemed to be independent from age, sex and comorbidities. IgG titers peaked around day 60, and then began gradually to drop, decreasing by approximately 50% on the 180th day, while the IgM titers progressively decreased as early as the tenth day, but they could be detected even at later time points. Despite the small number of individuals, some peculiar characteristics of the humoral response in COVID-19 emerged. We observed a high inter-individual variability, an ephemeral IgG half-life in several patients, and a persistence of IgM in others. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Early Phase Management of the SARS-CoV-2 Pandemic in the Geographic Area of the Veneto Region, in One of the World’s Oldest Populations
Int. J. Environ. Res. Public Health 2020, 17(23), 9045; https://doi.org/10.3390/ijerph17239045 - 04 Dec 2020
Cited by 1 | Viewed by 1072
Abstract
The first cases of Coronavirus disease-2019 (COVID-19) were reported on 21 February in the small town of Vo’ near Padua in the Veneto region of Italy. This event led to 19,286 infected people in the region by 30 June 2020 (39.30 cases/10,000 inhabitants). [...] Read more.
The first cases of Coronavirus disease-2019 (COVID-19) were reported on 21 February in the small town of Vo’ near Padua in the Veneto region of Italy. This event led to 19,286 infected people in the region by 30 June 2020 (39.30 cases/10,000 inhabitants). Meanwhile, Rovigo Local Health Unit n. 5 (ULSS 5), bordering areas with high epidemic rates and having one of the world’s oldest populations, registered the lowest infection rates in the region (19.03 cases/10,000 inhabitants). The aim of this study was to describe timing and event management by ULSS 5 in preventing the propagation of infection within the timeframe spanning from 21 February to 30 June. Our analysis considered age, genetic clusters, sex, orography, the population density, pollution, and economic activities linked to the pandemic, according to the literature. The ULSS 5 Health Director General’s quick decision-making in the realm of public health, territorial assistance, and retirement homes were key to taking the right actions at the right time. Indeed, the number of isolated cases in the Veneto region was the highest among all the Italian regions at the beginning of the epidemic. Moreover, the implementation of molecular diagnostic tools, which were initially absent, enabled health care experts to make quick diagnoses. Quick decision-making, timely actions, and encouraging results were achieved thanks to a solid chain of command, despite a somewhat unclear legislative environment. In conclusion, we believe that the containment of the epidemic depends on the time factor, coupled with a strong sense of awareness and discretion in the Health Director General’s decision-making. Moreover, real-time communication with operating units and institutions goes hand in hand with the common goal of protecting public health. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
The Evolution of Covid-19 in Italy after the Spring of 2020: An Unpredicted Summer Respite Followed by a Second Wave
Int. J. Environ. Res. Public Health 2020, 17(23), 8708; https://doi.org/10.3390/ijerph17238708 - 24 Nov 2020
Cited by 2 | Viewed by 2522
Abstract
The coronavirus (COVID-19) pandemic was particularly invasive in Italy during the period between March and late April 2020, then decreased in both the number of infections and in the seriousness of the illness throughout the summer of 2020. In this work, we measure [...] Read more.
The coronavirus (COVID-19) pandemic was particularly invasive in Italy during the period between March and late April 2020, then decreased in both the number of infections and in the seriousness of the illness throughout the summer of 2020. In this work, we measure the severity of the disease by the ratio of Intensive Care Units (ICU) spaces occupied by COVID-19 patients and the number of Active Cases (AC) each month from April to October 2020. We also use the ratio of the number of Deaths (D) to the number of Active Cases. What clearly emerges, from rigorous statistical analysis, is a progressive decrease in both ratios until August, indicating progressive mitigation of the disease. This is particularly evident when comparing March–April with July–August; during the summer period the two ratios became roughly 18 times lower. We test such sharp decreases against possible bias in counting active cases and we confirm their statistical significance. We then interpret such evidence in terms of the well-known seasonality of the human immune system and the virus-inactivating effect of stronger UV rays in the summer. Both ratios, however, increased again in October, as ICU/AC began to increase in September 2020. These ratios and the exponential growth of infections in October indicate that the virus—if not contained by strict measures—will lead to unsustainable challenges for the Italian health system in the winter of 2020–2021. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Preparedness and Responses Faced during the COVID-19 Pandemic in Belgium: An Observational Study and Using the National Open Data
Int. J. Environ. Res. Public Health 2020, 17(21), 7985; https://doi.org/10.3390/ijerph17217985 - 30 Oct 2020
Cited by 1 | Viewed by 935
Abstract
This study aimed to descript the Belgian COVID-19 responses process according to the WHO’s (World Health Organization) Health Emergency and Disaster Risk Management Framework (Health EDRM Framework) and to present the measures taken and epidemic impact in the different phases of COVID-19 in [...] Read more.
This study aimed to descript the Belgian COVID-19 responses process according to the WHO’s (World Health Organization) Health Emergency and Disaster Risk Management Framework (Health EDRM Framework) and to present the measures taken and epidemic impact in the different phases of COVID-19 in Belgium. The WHO’s EDRM Framework was used for reviewing the Belgian Public health emergency preparedness and responses in the context of COVID-19. Information on the measures taken was collected through the literature review including all government’s communication, reports, and scientific papers. All epidemic data were extracted from a national open database managed and published by the Sciensano. Additionally, two authors closely followed the Belgian situation since the beginning of the pandemic and updated the data every day. During the COVID-19 pandemic, the anti-epidemic strategy was mainly to avoid medical resources exceeding the upper limit. Belgium issued a series of emergency decrees to limit the spread of the virus. An existing structure of “federal-region-municipal” as the framework of public health emergency preparedness and response was adapted. The emergency response process in Belgium was divided into four phases: information-evaluation-coordination-decision-making at the region level and the final decision-making at the federal level. Belgium also implemented a phased plan in the process of setting up and lifting the lockdown. However, it was vulnerable in early response, due to the shortage of medical equipment supplies in general, and more particularly for the long term care facilities (LTCFs). Belgium has achieved an intensive cooperation between stakeholders based on an existing multisectoral emergency organization framework. Legislation, medical insurance, and good communication also played a role in limiting the spread of viruses. However, the authorities underestimated the risk of an epidemic and did not take quarantine measures among people suspected affected by SARS-COV-2 in the early stages, resulting in insufficient medical equipment supply and a large number of deaths in the LTCF. The implementation of the lockdown measure in Belgium also encountered obstacles. The lockdown and its exit strategy were both closely related to the pandemic situation and social and economic life. The authorities should strengthen information management, improve the public awareness of the measures, and find out the balance points between the social and economic life and infection control measures. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Personnel Well-Being in the Helsinki University Hospital during the COVID-19 Pandemic—A Prospective Cohort Study
Int. J. Environ. Res. Public Health 2020, 17(21), 7905; https://doi.org/10.3390/ijerph17217905 - 28 Oct 2020
Cited by 3 | Viewed by 1178
Abstract
In March 2020, strict measures took place in Finland to limit the COVID-19 pandemic. Majority of Finnish COVID-19 patients have been located in southern Finland and consequently cared for at the Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital. During the [...] Read more.
In March 2020, strict measures took place in Finland to limit the COVID-19 pandemic. Majority of Finnish COVID-19 patients have been located in southern Finland and consequently cared for at the Hospital District of Helsinki and Uusimaa (HUS) Helsinki University Hospital. During the pandemic, HUS personnel’s psychological symptoms are followed via an electronic survey, which also delivers information on psychosocial support services. In June 2020, the baseline survey was sent to 25,494 HUS employees, 4804 (19%) of whom answered; altogether, 62.4% of the respondents were nursing staff and 8.9% were medical doctors. While the follow-up continues for a year and a half, this report shares the sociodemographic characteristics of the respondents and the first results of psychological symptoms from our baseline survey. Out of those who were directly involved in the pandemic patient care, 43.4% reported potentially traumatic COVID-19 pandemic-related events (PTEs) vs. 21.8% among the others (p < 0.001). While over a half of the personnel were asymptomatic, a group of respondents reported PTEs and concurrent depression, insomnia, and anxiety symptoms. This highlights the need to ensure appropriate psychosocial support services to all traumatized personnel; especially, nursing staff may require attention. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
Impact of COVID-19 on Dental Emergency Services in Cluj-Napoca Metropolitan Area: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2020, 17(21), 7716; https://doi.org/10.3390/ijerph17217716 - 22 Oct 2020
Cited by 5 | Viewed by 971
Abstract
This study aimed to assess dental care needs in Cluj region during the State of Emergency, declared due to the COVID-19 pandemic, compared to the same period of the year 2019. A descriptive retrospective analysis was conducted, which retrieved patients seeking emergency dental [...] Read more.
This study aimed to assess dental care needs in Cluj region during the State of Emergency, declared due to the COVID-19 pandemic, compared to the same period of the year 2019. A descriptive retrospective analysis was conducted, which retrieved patients seeking emergency dental services at the Emergency Department of County General Hospital and “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania, the only dental service available in April 2020. Recorded data cover the month of April 2020 and is compared with the same period of 2019. During April 2020, 724 patients received dental care, whereas only 160 patients were treated in April 2019 in the same facility. The number of patients with acute apical periodontitis, abscess, and acute pulpitis was significantly higher in 2020. The percentage of patients receiving sedative filling for the treatment of acute pulpitis in 2020 was significantly higher than in 2019, while the proportion of patients receiving pulpectomy was higher in 2019. The percentage of patients receiving endodontic drainage for the treatment of acute periapical periodontitis in 2020 was higher. This study demonstrates that the COVID-19 pandemic impacted the use of medical care services and could further impact the oral health and quality of life of patients. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Time between Symptom Onset, Hospitalisation and Recovery or Death: Statistical Analysis of Belgian COVID-19 Patients
Int. J. Environ. Res. Public Health 2020, 17(20), 7560; https://doi.org/10.3390/ijerph17207560 - 17 Oct 2020
Cited by 14 | Viewed by 2230
Abstract
There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. We investigate the time from symptom onset to diagnosis and hospitalization or the length of stay (LoS) in the hospital, and whether there are differences in [...] Read more.
There are different patterns in the COVID-19 outbreak in the general population and amongst nursing home patients. We investigate the time from symptom onset to diagnosis and hospitalization or the length of stay (LoS) in the hospital, and whether there are differences in the population. Sciensano collected information on 14,618 hospitalized patients with COVID-19 admissions from 114 Belgian hospitals between 14 March and 12 June 2020. The distributions of different event times for different patient groups are estimated accounting for interval censoring and right truncation of the time intervals. The time between symptom onset and hospitalization or diagnosis are similar, with median length between symptom onset and hospitalization ranging between 3 and 10.4 days, depending on the age of the patient (longest delay in age group 20–60 years) and whether or not the patient lives in a nursing home (additional 2 days for patients from nursing home). The median LoS in hospital varies between 3 and 10.4 days, with the LoS increasing with age. The hospital LoS for patients that recover is shorter for patients living in a nursing home, but the time to death is longer for these patients. Over the course of the first wave, the LoS has decreased. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
The Timing and Intensity of Social Distancing to Flatten the COVID-19 Curve: The Case of Spain
Int. J. Environ. Res. Public Health 2020, 17(19), 7283; https://doi.org/10.3390/ijerph17197283 - 06 Oct 2020
Cited by 2 | Viewed by 976
Abstract
The continued spread of COVID-19 suggests a significant possibility of reimposing the lockdowns and stricter social distancing similar to the early phase of pandemic control. We present a dynamic model to quantify the impact of isolation for the contagion curves. The model is [...] Read more.
The continued spread of COVID-19 suggests a significant possibility of reimposing the lockdowns and stricter social distancing similar to the early phase of pandemic control. We present a dynamic model to quantify the impact of isolation for the contagion curves. The model is calibrated to the COVID-19 outbreak in Spain to study the effects of the isolation enforcement following the declaration of the state of alarm (14 March 2020). The simulations indicate that both the timing and the intensity of the isolation enforcement are crucial for the COVID-19 spread. For example, a 4-day earlier intervention for social distancing would have reduced the number of COVID-19 infected people by 67%. The model also informs us that the isolation enforcement does not delay the peak day of the epidemic but slows down its end. When relaxing social distancing, a reduction of the contagion probability (with the generalization of preventive actions, such as face mask wearing and hands sanitizing) is needed to overcome the effect of a rise in the number of interpersonal encounters. We report a threshold level for the contagion pace to avoid a second COVID-19 outbreak in Spain. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
How to Improve Compliance with Protective Health Measures during the COVID-19 Outbreak: Testing a Moderated Mediation Model and Machine Learning Algorithms
Int. J. Environ. Res. Public Health 2020, 17(19), 7252; https://doi.org/10.3390/ijerph17197252 - 04 Oct 2020
Cited by 26 | Viewed by 2031
Abstract
In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was [...] Read more.
In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18–22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82–0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Unveiling COVID-19 from CHEST X-Ray with Deep Learning: A Hurdles Race with Small Data
Int. J. Environ. Res. Public Health 2020, 17(18), 6933; https://doi.org/10.3390/ijerph17186933 - 22 Sep 2020
Cited by 22 | Viewed by 1966
Abstract
The possibility to use widespread and simple chest X-ray (CXR) imaging for early screening of COVID-19 patients is attracting much interest from both the clinical and the AI community. In this study we provide insights and also raise warnings on what is reasonable [...] Read more.
The possibility to use widespread and simple chest X-ray (CXR) imaging for early screening of COVID-19 patients is attracting much interest from both the clinical and the AI community. In this study we provide insights and also raise warnings on what is reasonable to expect by applying deep learning to COVID classification of CXR images. We provide a methodological guide and critical reading of an extensive set of statistical results that can be obtained using currently available datasets. In particular, we take the challenge posed by current small size COVID data and show how significant can be the bias introduced by transfer-learning using larger public non-COVID CXR datasets. We also contribute by providing results on a medium size COVID CXR dataset, just collected by one of the major emergency hospitals in Northern Italy during the peak of the COVID pandemic. These novel data allow us to contribute to validate the generalization capacity of preliminary results circulating in the scientific community. Our conclusions shed some light into the possibility to effectively discriminate COVID using CXR. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Chest CT Computerized Aided Quantification of PNEUMONIA Lesions in COVID-19 Infection: A Comparison among Three Commercial Software
Int. J. Environ. Res. Public Health 2020, 17(18), 6914; https://doi.org/10.3390/ijerph17186914 - 22 Sep 2020
Cited by 8 | Viewed by 1287
Abstract
Purpose: To compare different commercial software in the quantification of Pneumonia Lesions in COVID-19 infection and to stratify the patients based on the disease severity using on chest computed tomography (CT) images. Materials and methods: We retrospectively examined 162 patients with confirmed COVID-19 [...] Read more.
Purpose: To compare different commercial software in the quantification of Pneumonia Lesions in COVID-19 infection and to stratify the patients based on the disease severity using on chest computed tomography (CT) images. Materials and methods: We retrospectively examined 162 patients with confirmed COVID-19 infection by reverse transcriptase-polymerase chain reaction (RT-PCR) test. All cases were evaluated separately by radiologists (visually) and by using three computer software programs: (1) Thoracic VCAR software, GE Healthcare, United States; (2) Myrian, Intrasense, France; (3) InferRead, InferVision Europe, Wiesbaden, Germany. The degree of lesions was visually scored by the radiologist using a score on 5 levels (none, mild, moderate, severe, and critic). The parameters obtained using the computer tools included healthy residual lung parenchyma, ground-glass opacity area, and consolidation volume. Intraclass coefficient (ICC), Spearman correlation analysis, and non-parametric tests were performed. Results: Thoracic VCAR software was not able to perform volumes segmentation in 26/162 (16.0%) cases, Myrian software in 12/162 (7.4%) patients while InferRead software in 61/162 (37.7%) patients. A great variability (ICC ranged for 0.17 to 0.51) was detected among the quantitative measurements of the residual healthy lung parenchyma volume, GGO, and consolidations volumes calculated by different computer tools. The overall radiological severity score was moderately correlated with the residual healthy lung parenchyma volume obtained by ThoracicVCAR or Myrian software, with the GGO area obtained by the ThoracicVCAR tool and with consolidation volume obtained by Myrian software. Quantified volumes by InferRead software had a low correlation with the overall radiological severity score. Conclusions: Computer-aided pneumonia quantification could be an easy and feasible way to stratify COVID-19 cases according to severity; however, a great variability among quantitative measurements provided by computer tools should be considered. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
A Universal Physics-Based Model Describing COVID-19 Dynamics in Europe
Int. J. Environ. Res. Public Health 2020, 17(18), 6525; https://doi.org/10.3390/ijerph17186525 - 08 Sep 2020
Cited by 3 | Viewed by 918
Abstract
The self-organizing mechanism is a universal approach that is widely followed in nature. In this work, a novel self-organizing model describing diffusion over a lattice is introduced. Simulation results for the model’s active lattice sites demonstrate an evolution curve that is very close [...] Read more.
The self-organizing mechanism is a universal approach that is widely followed in nature. In this work, a novel self-organizing model describing diffusion over a lattice is introduced. Simulation results for the model’s active lattice sites demonstrate an evolution curve that is very close to those describing the evolution of infected European populations by COVID-19. The model was further examined against real data regarding the COVID-19 epidemic for seven European countries (with a total population of 290 million) during the periods in which social distancing measures were imposed, namely Italy and Spain, which had an enormous spread of the disease; the successful case of Greece; and four central European countries: France, Belgium, Germany and the Netherlands. The value of the proposed model lies in its simplicity and in the fact that it is based on a universal natural mechanism, which through the presentation of an equivalent dynamical system apparently documents and provides a better understanding of the dynamical process behind viral epidemic spreads in general—even pandemics, such as in the case of COVID-19—further allowing us to come closer to controlling such situations. Finally, this model allowed the study of dynamical characteristics such as the memory effect, through the autocorrelation function, in the studied epidemiological dynamical systems. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
The Light and Shadow of Rapid Serological Tests for SARS-CoV-2 Infection: Results from a Study in a Large Emergency Department
Int. J. Environ. Res. Public Health 2020, 17(18), 6493; https://doi.org/10.3390/ijerph17186493 - 07 Sep 2020
Viewed by 863
Abstract
A critical point in the management of the SARS-CoV-2 pandemic is the need to promptly identify the greatest number of infected people and to implement strict public health measures. In this study, the performance of a rapid serological test in a clinical setting [...] Read more.
A critical point in the management of the SARS-CoV-2 pandemic is the need to promptly identify the greatest number of infected people and to implement strict public health measures. In this study, the performance of a rapid serological test in a clinical setting was evaluated. Samples from 819 consecutive patients (with or without respiratory symptoms) admitted to a large Emergency Department were tested between 23 March and 21 April 2020. Patient samples were tested in a real-time PCR assay and a serological assay. In total, 148/819 patients (18.1%) tested positive for SARS-CoV-2 by real-time PCR. The serological test revealed that 70/819 patients (8.5%) had anti-SARS-CoV-2 IgM and/or IgG. The prevalence of anti-SARS-CoV-2 antibodies was significantly higher in patients with respiratory symptoms lasting for >7 days than in those with respiratory symptoms lasting for 0–7 days (p < 0.001). The serological assay had an overall sensitivity of 35.1% and an overall specificity of 97.3%. A high negative predictive value (96.7%) was reported for patients without respiratory symptoms. The results confirm that rapid serological assays alone are not sufficient for diagnosis of SARS-CoV-2 infection but can be incorporated into large-scale screening programs during periods in which the virus circulation is low. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
SARS-CoV-2 Infection in Children in Southern Italy: A Descriptive Case Series
Int. J. Environ. Res. Public Health 2020, 17(17), 6080; https://doi.org/10.3390/ijerph17176080 - 21 Aug 2020
Cited by 4 | Viewed by 1168
Abstract
At the beginning of the coronavirus-2019 (COVID-19) pandemic, Italy was one of the most affected countries in Europe. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is less frequent and less severe in children than in adults. This study analyzed the frequency of SARS-CoV-2 [...] Read more.
At the beginning of the coronavirus-2019 (COVID-19) pandemic, Italy was one of the most affected countries in Europe. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is less frequent and less severe in children than in adults. This study analyzed the frequency of SARS-CoV-2 infection among all children aged <18 years in the Apulia region of southern Italy and the characteristics of the infected children. Clinical and demographic data were collected through the national platform for COVID-19 surveillance. Of the 166 infected children in the Apulia region, 104 (62.6%) were asymptomatic, 37 (22.3%) had mild infections, 22 (13.3%) had moderate infections, and 3 (1.8%) had severe infections. Only ten children (6.0%) were hospitalized, but none required intensive care support and none died. SARS-CoV-2 infection was transmitted mainly from parents or relatives to children. Because of school closure during the lockdown, infection was unlikely to have been transmitted among children. It is unclear whether school reopening would enhance virus spread, leading the Italian government to develop guidelines for safe school reopening. The actual role of children in virus transmission remains unclear. A sensitive surveillance system, prompt identification of cases, testing, and contact tracing will be key to reducing the further spread of infection. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
An Integrated Strategy for the Prevention of SARS-CoV-2 Infection in Healthcare Workers: A Prospective Observational Study
Int. J. Environ. Res. Public Health 2020, 17(16), 5785; https://doi.org/10.3390/ijerph17165785 - 10 Aug 2020
Cited by 7 | Viewed by 1253
Abstract
Background: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and [...] Read more.
Background: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. Methods: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the “Advanced Triage” area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs’ personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. Results: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. Conclusions: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Baseline Chronic Comorbidity and Mortality in Laboratory-Confirmed COVID-19 Cases: Results from the PRECOVID Study in Spain
Int. J. Environ. Res. Public Health 2020, 17(14), 5171; https://doi.org/10.3390/ijerph17145171 - 17 Jul 2020
Cited by 22 | Viewed by 2304
Abstract
We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and [...] Read more.
We aimed to analyze baseline socio-demographic and clinical factors associated with an increased likelihood of mortality in men and women with coronavirus disease (COVID-19). We conducted a retrospective cohort study (PRECOVID Study) on all 4412 individuals with laboratory-confirmed COVID-19 in Aragon, Spain, and followed them for at least 30 days from cohort entry. We described the socio-demographic and clinical characteristics of all patients of the cohort. Age-adjusted logistic regressions models were performed to analyze the likelihood of mortality based on demographic and clinical variables. All analyses were stratified by sex. Old age, specific diseases such as diabetes, acute myocardial infarction, or congestive heart failure, and dispensation of drugs like vasodilators, antipsychotics, and potassium-sparing agents were associated with an increased likelihood of mortality. Our findings suggest that specific comorbidities, mainly of cardiovascular nature, and medications at the time of infection could explain around one quarter of the mortality in COVID-19 disease, and that women and men probably share similar but not identical risk factors. Nonetheless, the great part of mortality seems to be explained by other patient- and/or health-system-related factors. More research is needed in this field to provide the necessary evidence for the development of early identification strategies for patients at higher risk of adverse outcomes. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
Health Surveillance and Response to SARS-CoV-2 Mass Testing in Health Workers of a Large Italian Hospital in Verona, Veneto
Int. J. Environ. Res. Public Health 2020, 17(14), 5104; https://doi.org/10.3390/ijerph17145104 - 15 Jul 2020
Cited by 6 | Viewed by 1219
Abstract
Italy presented the first largest COVID-19 outbreak outside of China. Veneto currently ranks fourth among the Italian regions for COVID-19 confirmed cases (~19,000). This study presents health surveillance data for SARS-CoV-2 in 6100 health workers (HW) employed in a large public hospital. Workers [...] Read more.
Italy presented the first largest COVID-19 outbreak outside of China. Veneto currently ranks fourth among the Italian regions for COVID-19 confirmed cases (~19,000). This study presents health surveillance data for SARS-CoV-2 in 6100 health workers (HW) employed in a large public hospital. Workers underwent oropharyngeal and nasopharyngeal swabs, with a total of 5942 participants (97.5% of the population). A total of 11,890 specimens were tested for SARS-CoV-2 infection using PCR, identifying the viral genes E, RdRP, and N. Positive tests were returned for 238 workers (cumulative incidence of 4.0%, similar in both COVID and nonCOVID units). SARS-CoV-2 risk was not affected by gender, age, or job type, whereas work setting and occupation were both predictors of infection. The risk was higher in medical wards (OR 2.7, 95% CI 1.9–3.9) and health services (OR 4.3, 95% CI 2.4–7.6), and lower in surgical wards and administration areas. To our knowledge, this study represents the largest available HW case list swab-tested for SARS-CoV-2, covering almost the total workforce. Mass screening enabled the isolation of HW, improved risk assessment, allowed for close contacts of and infected HW to return to work, provided evidence of SARS-CoV-2 diffusion, and presented solid ground to prevent nosocomial SARS-CoV-2 infections. The ongoing concurrent sero-epidemiological study aims to enable the improvement of health surveillance to maintain the safety of HWs and the communities they serve. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
Modeling the Novel Coronavirus (SARS-CoV-2) Outbreak in Sicily, Italy
Int. J. Environ. Res. Public Health 2020, 17(14), 4964; https://doi.org/10.3390/ijerph17144964 - 09 Jul 2020
Cited by 8 | Viewed by 1041
Abstract
Italy was the first country in Europe which imposed control measures of travel restrictions, quarantine and contact precautions to tackle the epidemic spread of the novel coronavirus (SARS-CoV-2) in all its regions. While such efforts are still ongoing, uncertainties regarding SARS-CoV-2 transmissibility and [...] Read more.
Italy was the first country in Europe which imposed control measures of travel restrictions, quarantine and contact precautions to tackle the epidemic spread of the novel coronavirus (SARS-CoV-2) in all its regions. While such efforts are still ongoing, uncertainties regarding SARS-CoV-2 transmissibility and ascertainment of cases make it difficult to evaluate the effectiveness of restrictions. Here, we employed a Susceptible-Exposed-Infectious-Recovered-Dead (SEIRD) model to assess SARS-CoV-2 transmission dynamics, working on the number of reported patients in intensive care unit (ICU) and deaths in Sicily (Italy), from 24 February to 13 April. Overall, we obtained a good fit between estimated and reported data, with a fraction of unreported SARS-CoV-2 cases (18.4%; 95%CI = 0–34.0%) before 10 March lockdown. Interestingly, we estimated that transmission rate in the community was reduced by 32% (95%CI = 23–42%) after the first set of restrictions, and by 80% (95%CI = 70–89%) after those adopted on 23 March. Thus, our estimates delineated the characteristics of SARS-CoV2 epidemic before restrictions taking into account unreported data. Moreover, our findings suggested that transmission rates were reduced after the adoption of control measures. However, we cannot evaluate whether part of this reduction might be attributable to other unmeasured factors, and hence further research and more accurate data are needed to understand the extent to which restrictions contributed to the epidemic control. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Achieving a Covid-19 Free Country: Citizens Preventive Measures and Communication Pathways
Int. J. Environ. Res. Public Health 2020, 17(13), 4633; https://doi.org/10.3390/ijerph17134633 - 27 Jun 2020
Cited by 12 | Viewed by 1915
Abstract
The Coronavirus Disease 2019 (COVID-19) has spread on a global scale in an extremely short time, causing hundreds of thousands of deaths, and, at the same time, triggering extreme panic. Prevention in medicine is considered the best protection action for individuals in order [...] Read more.
The Coronavirus Disease 2019 (COVID-19) has spread on a global scale in an extremely short time, causing hundreds of thousands of deaths, and, at the same time, triggering extreme panic. Prevention in medicine is considered the best protection action for individuals in order to avoid infections. This study investigates whether Greek citizens (N = 3359) take the necessary precautions to prevent developing the COVID-19 disease, and it segments them based on homogenous behavior groups. Lastly, it provides communication techniques that should be implemented, targeting each citizen segment for a long-term COVID-19 free country. Data analysis revealed the extent of the applied precaution measures. The ones most applied by citizens were to avoid non-mandatory transportation, contact with individuals with respiratory symptoms, and individuals of high risk for severe illness (vulnerable groups). On the other hand, the least applied measures are daily checks of body temperature, monitoring for fever, cough, or dyspnea, use of a face mask when in public places, or when using public transportation. Additionally, cluster analysis revealed five groups of citizens based on self-reported behavior, namely, the Meticulous Proactive Citizens, the Self-isolated Citizens, the Cautious Citizens, the Occasionally Cautious Citizens, and the Unconcerned Citizens. Communication strategies targeting each segment are also discussed. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
Deaths in SARS-Cov-2 Positive Patients in Italy: The Influence of Underlying Health Conditions on Lethality
Int. J. Environ. Res. Public Health 2020, 17(12), 4450; https://doi.org/10.3390/ijerph17124450 - 21 Jun 2020
Cited by 12 | Viewed by 1322
Abstract
This study aims to underline the clinical characteristics of patients who died after testing positive for SARS-CoV-2 infection in one region of Italian and to evaluate the influence of underlying health conditions on the fatal outcome. A matched case-control study was designed by [...] Read more.
This study aims to underline the clinical characteristics of patients who died after testing positive for SARS-CoV-2 infection in one region of Italian and to evaluate the influence of underlying health conditions on the fatal outcome. A matched case-control study was designed by analyzing the data regarding positive subjects observed up to April 21, 2020. The case fatality rate was 7.9%, with a higher proportion of deaths in men than women. The specific standardized mortality ratio was 0.15—0.13 for males and 0.2 for females, showing that mortality is much lower than expected. Cardiovascular diseases, chronic lung diseases and diabetes mellitus showed a significant association with the outcome. Although the case fatality rate in Sardinia in regard to age and gender patterns seems to be similar to that for Italy as a whole, its quantitative value was far lower than the national one and possible explanations might include the genetic characteristics of the Sardinian population or the immediate closure of its borders as soon as the epidemic started. Our results highlighted that lethality is strongly dependent on the presence of multiple concomitant serious diseases. It is important to have epidemiological strategies for effective guidance on public health actions in order to improve chances of survival. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Italian Public Health Response to the COVID-19 Pandemic: Case Report from the Field, Insights and Challenges for the Department of Prevention
Int. J. Environ. Res. Public Health 2020, 17(10), 3666; https://doi.org/10.3390/ijerph17103666 - 22 May 2020
Cited by 14 | Viewed by 2103
Abstract
The coronavirus disease (COVID-19) outbreak is rapidly progressing globally, and Italy, as one of the main pandemic hotspots, may provide some hard lessons for other countries. In this paper, we summarize the current organizational capacity and provide a pragmatic and narrative account of [...] Read more.
The coronavirus disease (COVID-19) outbreak is rapidly progressing globally, and Italy, as one of the main pandemic hotspots, may provide some hard lessons for other countries. In this paper, we summarize the current organizational capacity and provide a pragmatic and narrative account of strategies and activities implemented by the Department of Prevention (Dipartimento di Prevenzione)—the regional entity of the Local Health Authority of the Italian National Health Service in charge of public health—since the beginning of the outbreak. We conduct a preliminary analysis of general strengths, weaknesses, opportunities, and threats (SWOT) of the response strategies from a local perspective. Furthermore, we provide firsthand insights on future directions and priorities to manage this unprecedented pandemic. Our case report gives a qualitative view of the healthcare response, based on the experience of frontline professionals, with the aim to generate hypotheses about factors which may promote or hinder the prevention and management of a pandemic locally. We highlight the importance of a public health approach for responding to COVID-19 and reshaping healthcare systems. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Article
Distribution of the SARS-CoV-2 Pandemic and Its Monthly Forecast Based on Seasonal Climate Patterns
Int. J. Environ. Res. Public Health 2020, 17(10), 3493; https://doi.org/10.3390/ijerph17103493 - 17 May 2020
Cited by 26 | Viewed by 6330
Abstract
This paper investigates whether the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) pandemic could have been favored by specific weather conditions and other factors. It is found that the 2020 winter weather in the region of Wuhan (Hubei, Central China)—where the virus first [...] Read more.
This paper investigates whether the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) pandemic could have been favored by specific weather conditions and other factors. It is found that the 2020 winter weather in the region of Wuhan (Hubei, Central China)—where the virus first broke out in December and spread widely from January to February 2020—was strikingly similar to that of the Northern Italian provinces of Milan, Brescia and Bergamo, where the pandemic broke out from February to March. The statistical analysis was extended to cover the United States of America, which overtook Italy and China as the country with the highest number of confirmed COronaVIrus Disease 19 (COVID-19) cases, and then to the entire world. The found correlation patterns suggest that the COVID-19 lethality significantly worsens (4 times on average) under weather temperatures between 4 °C and 12 °C and relative humidity between 60% and 80%. Possible co-factors such as median population age and air pollution were also investigated suggesting an important influence of the former but not of the latter, at least, on a synoptic scale. Based on these results, specific isotherm world maps were generated to locate, month by month, the world regions that share similar temperature ranges. From February to March, the 4–12 °C isotherm zone extended mostly from Central China toward Iran, Turkey, West-Mediterranean Europe (Italy, Spain and France) up to the United State of America, optimally coinciding with the geographic regions most affected by the pandemic from February to March. It is predicted that in the spring, as the weather gets warm, the pandemic will likely worsen in northern regions (United Kingdom, Germany, East Europe, Russia and North America) while the situation will likely improve in the southern regions (Italy and Spain). However, in autumn, the pandemic could come back and affect the same regions again. The Tropical Zone and the entire Southern Hemisphere, but in restricted colder southern regions, could avoid a strong pandemic because of the sufficiently warm weather during the entire year and because of the lower median age of their population. Google-Earth-Pro interactive-maps covering the entire world are provided as supplementary files. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Article
Understanding Knowledge and Behaviors Related to CoViD–19 Epidemic in Italian Undergraduate Students: The EPICO Study
Int. J. Environ. Res. Public Health 2020, 17(10), 3481; https://doi.org/10.3390/ijerph17103481 - 16 May 2020
Cited by 52 | Viewed by 5131
Abstract
Background: On February 2020, the novel coronavirus (2019−nCoV) epidemic began in Italy. In order to contain the spread of the virus, the Italian government adopted emergency measures nationwide, including closure of schools and universities, workplaces and subsequently lockdown. This survey was carried out [...] Read more.
Background: On February 2020, the novel coronavirus (2019−nCoV) epidemic began in Italy. In order to contain the spread of the virus, the Italian government adopted emergency measures nationwide, including closure of schools and universities, workplaces and subsequently lockdown. This survey was carried out among Italian undergraduates to explore their level of knowledge about the epidemic and the behaviors they adopted during the lockdown. Methods: An electronic questionnaire was administered to the students attending three Italian universities. Results: A good level of knowledge about the epidemic and its control was registered in the sample, mainly among students attending life sciences degree courses. The majority of the students did not modify their diet and smoking habits, while a great part of the sample reported a decrease in physical activity (PA). Conclusions: Students from life sciences courses showed a higher awareness regarding the infection and the control measures. The lockdown caused an important reduction of PA. Preventive interventions should transform the restrictive measures also as an opportunity to improve lifestyle. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)

Review

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Review
The Epidemiological Characteristics of the COVID-19 Pandemic in Europe: Focus on Italy
Int. J. Environ. Res. Public Health 2021, 18(6), 2942; https://doi.org/10.3390/ijerph18062942 - 13 Mar 2021
Cited by 1 | Viewed by 725
Abstract
Starting from December 2019, SARS-CoV-2 has forcefully entered our lives and profoundly changed all the habits of the world population. The COVID-19 pandemic has violently impacted the European continent, first involving only some European countries, Italy in particular, and then spreading to all [...] Read more.
Starting from December 2019, SARS-CoV-2 has forcefully entered our lives and profoundly changed all the habits of the world population. The COVID-19 pandemic has violently impacted the European continent, first involving only some European countries, Italy in particular, and then spreading to all member states, albeit in different ways and times. The ways SARS-CoV-2 spreads are still partly unknown; to quantify and adequately respond to the pandemic, various parameters and reporting systems have been introduced at national and European levels to promptly recognize the most alarming epidemiological situations and therefore limit the impact of the virus on the health of the population. The relevant key points to implement adequate measures to face the epidemic include identifying the population groups most involved in terms of morbidity and mortality, identifying the events mostly related to the spreading of the virus and recognizing the various viral mutations. The main objective of this work is to summarize the epidemiological situation of the COVID-19 pandemic in Europe and Italy almost a year after the first reported case in our continent. The secondary objectives include the definition of the epidemiological parameters used to monitor the epidemic, the explanation of superspreading events and the description of how the epidemic has impacted on health and social structures, with a particular focus on Italy. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Review
Value of Immunizations during the COVID-19 Emergency
Int. J. Environ. Res. Public Health 2021, 18(2), 778; https://doi.org/10.3390/ijerph18020778 - 18 Jan 2021
Cited by 2 | Viewed by 919
Abstract
Recent estimates by World Health Organization (WHO, Geneva, Switzerland) and United Nations International Children’s Emergency Fund (UNICEF) show a significant decline in vaccinal coverage rates in both pediatric and adult populations. The interruption of vaccination services is reported in at least 68 countries, [...] Read more.
Recent estimates by World Health Organization (WHO, Geneva, Switzerland) and United Nations International Children’s Emergency Fund (UNICEF) show a significant decline in vaccinal coverage rates in both pediatric and adult populations. The interruption of vaccination services is reported in at least 68 countries, with the involvement of about 80 million children worldwide. The situation is alarming if we consider that already in the period preceding the pandemic, immunization programs slowed down in various areas of the world. For these reasons, there is the risk of overloading health systems, already under pressure from the pandemic emergency, by employing human and economic resources for the management of epidemic outbreaks from vaccine-preventable diseases. The restoration and integration of vaccination services, the immunization of susceptible individuals as well as the adoption of adequate monitoring and surveillance measures are the main activities adopted by different countries to address the current global health emergency. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Review
Second Wave of COVID-19 Global Pandemic and Athletes’ Confinement: Recommendations to Better Manage and Optimize the Modified Lifestyle
Int. J. Environ. Res. Public Health 2020, 17(22), 8385; https://doi.org/10.3390/ijerph17228385 - 12 Nov 2020
Cited by 8 | Viewed by 2410 | Correction
Abstract
Coronavirus 2019 (COVID-19) is an infectious viral disease that has spread globally, resulting in the ongoing pandemic. Currently, there is no vaccine or specific treatment for COVID-19. Preventive measures to reduce the chances of contagion consist mainly of confinement, avoiding crowded places, social [...] Read more.
Coronavirus 2019 (COVID-19) is an infectious viral disease that has spread globally, resulting in the ongoing pandemic. Currently, there is no vaccine or specific treatment for COVID-19. Preventive measures to reduce the chances of contagion consist mainly of confinement, avoiding crowded places, social distancing, masks, and applying strict personal hygiene as recommended by the World Health Organization (WHO). After the first wave of infection in many countries, the potential effects of relaxing containment and physical distancing control measures suggest that as a result of these measures, a second wave of COVID-19 appears probable in these countries. In sport, the period of self-isolation, and quarantine, for COVID-19 affects the physical preparation of athletes as well as their mental health and quality of life to an even greater extent (i.e., nutrition, sleep, healthy lifestyle), and thus, relevant and practical recommendations are needed to help alleviate these physical and mental health concerns. Our review aims to summarize the physiological and psychological effects of detraining associated with athletes’ confinement during the proposed second wave of COVID-19. This article also proposes answers to questions that concern the advantages and disadvantages of different types of social media platforms, the importance of nutrition, and the effects of sleep disturbance on the health and modified lifestyle of athletes during this worldwide pandemic. Thus, this review provides some general guidelines to better manage their modified lifestyle and optimally maintain their physical and mental fitness with respect to measures taken during this restrictive proposed second wave of the COVID-19 confinement period. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Review
Can Air-Conditioning Systems Contribute to the Spread of SARS/MERS/COVID-19 Infection? Insights from a Rapid Review of the Literature
Int. J. Environ. Res. Public Health 2020, 17(17), 6052; https://doi.org/10.3390/ijerph17176052 - 20 Aug 2020
Cited by 21 | Viewed by 3420
Abstract
The airborne transmission of SARS-CoV-2 is still debated. The aim of this rapid review is to evaluate the COVID-19 risk associated with the presence of air-conditioning systems. Original studies (both observational and experimental researches) written in English and with no limit on time, [...] Read more.
The airborne transmission of SARS-CoV-2 is still debated. The aim of this rapid review is to evaluate the COVID-19 risk associated with the presence of air-conditioning systems. Original studies (both observational and experimental researches) written in English and with no limit on time, on the airborne transmission of SARS-CoV, MERS-CoV, and SARS-CoV-2 coronaviruses that were associated with outbreaks, were included. Searches were made on PubMed/MEDLINE, PubMed Central (PMC), Google Scholar databases, and medRxiv. A snowball strategy was adopted to extend the search. Fourteen studies reporting outbreaks of coronavirus infection associated with the air-conditioning systems were included. All studies were carried out in the Far East. In six out the seven studies on SARS, the role of Heating, Ventilation, and Air Conditioning (HVAC) in the outbreak was indirectly proven by the spatial and temporal pattern of cases, or by airflow-dynamics models. In one report on MERS, the contamination of HVAC by viral particles was demonstrated. In four out of the six studies on SARS-CoV-2, the diffusion of viral particles through HVAC was suspected or supported by computer simulation. In conclusion, there is sufficient evidence of the airborne transmission of coronaviruses in previous Asian outbreaks, and this has been taken into account in the guidelines released by organizations and international agencies for controlling the spread of SARS-CoV-2 in indoor environments. However, the technological differences in HVAC systems prevent the generalization of the results on a worldwide basis. The few COVID-19 investigations available do not provide sufficient evidence that the SARS-CoV-2 virus can be transmitted by HVAC systems. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
Review
The Global Emergency of Novel Coronavirus (SARS-CoV-2): An Update of the Current Status and Forecasting
Int. J. Environ. Res. Public Health 2020, 17(16), 5648; https://doi.org/10.3390/ijerph17165648 - 05 Aug 2020
Cited by 13 | Viewed by 2247
Abstract
Over the past two decades, there have been two major outbreaks where the crossover of animal Betacoronaviruses to humans has resulted in severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). In December 2019, a global public health concern [...] Read more.
Over the past two decades, there have been two major outbreaks where the crossover of animal Betacoronaviruses to humans has resulted in severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). In December 2019, a global public health concern started with the emergence of a new strain of coronavirus (SARS-CoV-2 or 2019 novel coronavirus, 2019-nCoV) which has rapidly spread all over the world from its origin in Wuhan, China. SARS-CoV-2 belongs to the Betacoronavirus genus, which includes human SARS-CoV, MERS and two other human coronaviruses (HCoVs), HCoV-OC43 and HCoV-HKU1. The fatality rate of SARS-CoV-2 is lower than the two previous coronavirus epidemics, but it is faster spreading and the large number of infected people with severe viral pneumonia and respiratory illness, showed SARS-CoV-2 to be highly contagious. Based on the current published evidence, herein we summarize the origin, genetics, epidemiology, clinical manifestations, preventions, diagnosis and up to date treatments of SARS-CoV-2 infections in comparison with those caused by SARS-CoV and MERS-CoV. Moreover, the possible impact of weather conditions on the transmission of SARS-CoV-2 is also discussed. Therefore, the aim of the present review is to reconsider the two previous pandemics and provide a reference for future studies as well as therapeutic approaches. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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Brief Report
The Expression and Polymorphism of Entry Machinery for COVID-19 in Human: Juxtaposing Population Groups, Gender, and Different Tissues
Int. J. Environ. Res. Public Health 2020, 17(10), 3433; https://doi.org/10.3390/ijerph17103433 - 14 May 2020
Cited by 22 | Viewed by 2351
Abstract
(1) Background: Combating viral disease outbreaks has doubtlessly been one of the major public health challenges for the 21st century. (2) Methods: The host entry machinery required for COVID-19 (SARS-CoV-2) infection was examined for the gene expression profiles and polymorphism. (3) [...] Read more.
(1) Background: Combating viral disease outbreaks has doubtlessly been one of the major public health challenges for the 21st century. (2) Methods: The host entry machinery required for COVID-19 (SARS-CoV-2) infection was examined for the gene expression profiles and polymorphism. (3) Results: Lung, kidney, small intestine, and salivary glands were among the tissues which expressed the entry machinery coding genes Ace2, Tmprss2, CtsB, and CtsL. The genes had no significant expression changes between males and females. The four human population groups of Europeans, Africans, Asians, and Americans had specific and also a common pool of rare variants for the X-linked locus of ACE2 receptor. Several specific and common ACE2 variants including S19P, I21T/V, E23K, A25T, K26R, T27A, E35D/K, E37K, Y50F, N51D/S, M62V, N64K, K68E, F72V, E75G, M82I, T92I, Q102P, G220S, H239Q, G326E, E329G, G352V, D355N, H378R, Q388L, P389H, E467K, H505R, R514G/*, and Y515C were of the utmost importance to the viral entry and infection. The variants of S19P, I21T, K26R, T27A, E37K, N51D, N64K, K68E, F72V, M82I, G326E, H378R, Q388L, and P389H also had significant differences in frequencies among the population groups. Most interestingly, the analyses revealed that more than half of the variants can exist in males, i.e., as hemizygous. (4) Conclusions: The rare variants of human ACE2 seem to be one of the determinant factors associated with fitness in the battle against SARS viruses. The hemizygous viral-entry booster variants of ACE2 describe the higher SARS-CoV-2 mortality rate in males. This is also supported by the lack of gender bias for the gene expression profiles of entry machinery. A personalized medicine strategy is conceived for isolating high-risk individuals in epidemic circumstances. Full article
(This article belongs to the Special Issue The COVID-19 Pandemic in Europe: Response to Challenges)
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