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Special Issue "Responding to COVID-19 from Local, Regional and Global Perspectives: Challenges and Solutions"

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 (28 February 2022) | Viewed by 110928

Special Issue Editors

Prof. Dr. Elena N. Naumova
E-Mail Website
Guest Editor
Division of Nutrition Epidemiology and Data Sciences, Freidman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA
Interests: development of statistical, mathematical and computational models for climate-sensitive infectious diseases; the use of big data, novel information sources and tools, including GIS and remote sensing in public health applications and environmental research
Special Issues, Collections and Topics in MDPI journals
Dr. Meghan A. Hartwick
E-Mail Website
Guest Editor
Data Scientist, Tufts Initiative for the Forecasting and Modeling of Infectious Diseases, Freidman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA
Interests: development of statistical, mathematical and computational models for zoonotic infectious diseases and antimicrobial resistance; the use of novel approaches, including bioinformatics in public health applications and environmental research

Special Issue Information

The ongoing pandemic of COVID-19 is affecting every aspect of the modern global community. This pandemic has revealed the bare-bones deficiencies of national health systems and unearthed issues many might have thought public health professionals had already resolved. The response to COVID-19 has already raised many questions as to who is affected, when and how these effects might manifest, and what public health interventions and strategies may help to control the infection. The delayed local and regional emergency responses, the crash of the global supply chain, the inequality in access to healthcare for the sick, the inequality in access to protective gear for medical personnel, the discordant and mixed messages of health officials and political leaders in establishing and releasing lockdowns–all aspects of the COVID-19 pandemic deserve serious attention and will be subjects for discussion for many years to come. In addition, there are many more questions which have not yet even been addressed, or which have only just emerged, for example: Will coronavirus-related infections settle into a predictable seasonal pattern? Will the transmission continue as hospital-acquired infections? Why are some communities affected more than others? Which prevention and control strategies are the likely to work in given conditions? What is needed to detect and control infection before it spreads? What can be learned from better understanding viral evolution in the context of emerging coronaviruses?

We hope to stir the discussion on how public health professionals, environmental health researchers, and data scientists, working together with domain experts, understand the challenges and lessons learned from the pandemic to prepare for emerging trends in infectious diseases. We aim to provide a broad range of examples focusing on temporal dynamics, clinical and psychosocial aspects, environmental factors, and socioeconomic determinants of COVID-19. In this context, the editors of the International Journal of Environmental Research and Public Health (IJERPH) have initiated a Special Issue of the journal on COVID-19 in North America, and we encourage the submission of interdisciplinary work and multicountry collaborative research, especially from the pandemic epicenters. We welcome original research papers using different study designs as well as brief reports, systematic reviews, and meta-analysis.

Prof. Elena N. Naumova
Dr. Meghan A. Hartwick
Guest Editors

Manuscript Submission Information

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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 2500 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

  • COVID-19 epidemiology
  • Environmental and socioeconomic risk factors
  • Disease modeling and forecasting
  • Preparedness planning
  • Seasonality
  • Disease tracking and monitoring
  • Surveillance systems
  • Public health and environmental policies
  • Coronavirus ecology

Published Papers (39 papers)

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Article
Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland
Int. J. Environ. Res. Public Health 2022, 19(11), 6872; https://doi.org/10.3390/ijerph19116872 - 04 Jun 2022
Viewed by 470
Abstract
COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic [...] Read more.
COVID-19 vaccination, apart from the sanitary regime, is the most efficient strategy to limit the spread of the SARS-CoV-2 virus and significantly reduce the severity of the disease following infection. A cross-sectional survey was conducted during the fourth wave of the COVID-19 pandemic among pregnant Polish women and women who have already given birth to evaluate the level and attitude to vaccination. Briefly, 1196 women (256 pregnant and 940 mothers) participated in the study; 68.0% of pregnant women and 66.2% of mothers declared that they had received COVID-19 vaccination. The most frequently stated reasons not to get vaccinated were possible adverse effects on the mother, fetus or breastfed child, post-vaccination complications and limited scientific evidence on the safety of the COVID-19 vaccine. The identified predictors of avoiding COVID-19 vaccination are young age, residing in small cities or rural areas, cohabitation, low anxiety level regarding SARS-CoV-2 infection, and little knowledge concerning maternal vaccine-induced immune protection delivered to offspring. Despite the unlimited access to COVID-19 vaccination, the declared level of vaccination is worryingly low. The knowledge concerning the benefits of vaccination to mothers and their offspring is not satisfactory and requires urgent educational action, particularly among young women living outside big cities and single motherhood. Full article
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Article
A New Compartment Model of COVID-19 Transmission: The Broken-Link Model
Int. J. Environ. Res. Public Health 2022, 19(11), 6864; https://doi.org/10.3390/ijerph19116864 - 03 Jun 2022
Viewed by 593
Abstract
We propose a new compartment model of COVID-19 spread, the broken-link model, which includes the effect from unconnected infectious links of the transmission. The traditional SIR-type epidemic models are widely used to analyze the spread status, and the models show the exponential growth [...] Read more.
We propose a new compartment model of COVID-19 spread, the broken-link model, which includes the effect from unconnected infectious links of the transmission. The traditional SIR-type epidemic models are widely used to analyze the spread status, and the models show the exponential growth of the number of infected people. However, even in the early stage of the spread, it is proven by the actual data that the exponential growth did not occur all over the world. We presume this is caused by the suppression of secondary and higher-order transmissions of COVID-19. We find that the proposed broken-link model quantitatively describes the mechanism of this suppression, which leads to the shape of epicurves of confirmed cases are governed by the probability of unconnected infectious links, and the magnitudes of the cases are proportional to expR0 in each infectious surge generated by a virus of the basic reproduction number R0, and is consistent with the actual data. Full article
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Article
A Global Sharing Mechanism of Resources: Modeling a Crucial Step in the Fight against Pandemics
Int. J. Environ. Res. Public Health 2022, 19(10), 5930; https://doi.org/10.3390/ijerph19105930 - 13 May 2022
Viewed by 489
Abstract
To face crises like the COVID-19 pandemic, resources such as personal protection equipment (PPE) are needed to reduce the infection rate and protect those in close contact with patients. The increasing demand for those products can, together with pandemic-related disruptions in the global [...] Read more.
To face crises like the COVID-19 pandemic, resources such as personal protection equipment (PPE) are needed to reduce the infection rate and protect those in close contact with patients. The increasing demand for those products can, together with pandemic-related disruptions in the global supply chain, induce major local resource scarcities. During the first phase of the COVID-19 pandemic, we witnessed a reflex of ‘our people first’ in many regions. In this paper, however, we show that a cooperative sharing mechanism can substantially improve the ability to face epidemics. We present a stylized model in which communities share their resources such that each can receive them whenever a local epidemic flares up. Our main finding is that cooperative sharing can prevent local resource exhaustion and reduce the total number of infected cases. Crucially, beneficial effects of sharing are found for a large range of possible community sizes and cooperation combinations, not only for small communities being helped by large communities. Furthermore, we show that the success of sharing resources heavily depends on having a sufficiently long delay between the onsets of epidemics in different communities. These results thus urge for the pairing of a global sharing mechanism with measures to slow down the spread of infections from one community to the other. Our work uses a stylized model to convey an important and clear message to a broad public, advocating that cooperative sharing strategies in international resource crises are the most beneficial strategy for all. It stresses essential underlying principles of and contributes to designing a resilient global supply chain mechanism able to deal with future pandemics by design, rather than being subjected to the coincidental and unequal distribution of opportunities per community that we see at present. Full article
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Article
Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles
Int. J. Environ. Res. Public Health 2022, 19(9), 5066; https://doi.org/10.3390/ijerph19095066 - 21 Apr 2022
Viewed by 596
Abstract
U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los [...] Read more.
U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens. Full article
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Article
Free PoC Testing for SARS-CoV-2 in Germany: Factors Expanding Access to Various Communities in a Medium-Sized City
Int. J. Environ. Res. Public Health 2022, 19(8), 4721; https://doi.org/10.3390/ijerph19084721 - 13 Apr 2022
Viewed by 539
Abstract
During the third wave of the COVID-19 (coronavirus disease 2019) pandemic in Germany, free SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) point-of-care (PoC) antigen tests were offered to citizens at least once a week to prevent spreading by asymptomatic infected individuals. This study [...] Read more.
During the third wave of the COVID-19 (coronavirus disease 2019) pandemic in Germany, free SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) point-of-care (PoC) antigen tests were offered to citizens at least once a week to prevent spreading by asymptomatic infected individuals. This study investigated user groups, timing, frequency, and test center locations in a typical medium-sized European city. We analyzed 27,369 pseudonymized datasets from eight centers over 12 weeks. Those were evaluated according to age, residence, appointment, and potential repeated test occurrence. The centers were visited by different groups; some centers were preferred by a predominantly younger demographic, whereas a mobile option attracted an older age group by reaching districts with few other testing possibilities. Elderly individuals were tested more spontaneously than younger individuals, and a test center at a ‘park and ride’ had more spontaneous visitors from outside of the city compared to other test locations. Only a small proportion of less than 4% came for testing more than five times. To preferably address many people for voluntary antigen testing, it is crucial to offer different test opportunities accounting for individual behavioral patterns, despite this requiring more complex and costly design than conventional forms. Full article
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Article
Job Demands, Work Functioning and Mental Health in Dutch Nursing Home Staff during the COVID-19 Outbreak: A Cross-Sectional Multilevel Study
Int. J. Environ. Res. Public Health 2022, 19(7), 4379; https://doi.org/10.3390/ijerph19074379 - 06 Apr 2022
Viewed by 737
Abstract
COVID-19 posed enormous challenges for nursing home staff, which may have caused stress and mental health problems. This study aimed to measure the prevalence of mental health problems among nursing home staff and investigate the differences in job demands, work functioning and mental [...] Read more.
COVID-19 posed enormous challenges for nursing home staff, which may have caused stress and mental health problems. This study aimed to measure the prevalence of mental health problems among nursing home staff and investigate the differences in job demands, work functioning and mental health between staff with and without COVID contact or COVID infection and across different levels of COVID worries. In this cross-sectional study, 1669 employees from 10 nursing home organizations filled in an online questionnaire between June and September 2020. The questionnaire measured the participants’ characteristics, COVID contact, infection and worries, job demands, work functioning, depressive symptoms and burnout. Differences were investigated with multilevel models to account for clustering at the organization level. Of the participants, 19.1% had high levels of depressive symptoms and 22.2% burnout. Job demands, work functioning, depressive symptoms and burnout differed between participants who never worried and participants who often or always worried about the COVID crisis. Differences were smaller for participants with and without COVID contact or infection. Most models improved when clustering was accounted for. Nursing homes should be aware of the impact of COVID worries on job demands, work functioning and mental health, both at the individual and organizational level. Full article
Article
SARS-CoV-2 Transmission Risk Model in an Urban Area of Mexico, Based on GIS Analysis and Viral Load
Int. J. Environ. Res. Public Health 2022, 19(7), 3840; https://doi.org/10.3390/ijerph19073840 - 24 Mar 2022
Viewed by 527
Abstract
The COVID-19 pandemic highlighted health systems vulnerabilities, as well as thoughtlessness by governments and society. Due to the nature of this contingency, the use of geographic information systems (GIS) is essential to understand the SARS-CoV-2 distribution dynamics within a defined geographic area. This [...] Read more.
The COVID-19 pandemic highlighted health systems vulnerabilities, as well as thoughtlessness by governments and society. Due to the nature of this contingency, the use of geographic information systems (GIS) is essential to understand the SARS-CoV-2 distribution dynamics within a defined geographic area. This work was performed in Tepic, a medium-sized city in Mexico. The residence of 834 COVID-19 infected individuals was georeferenced and categorized by viral load (Ct). The analysis took place during the maximum contagion of the first four waves of COVID-19 in Mexico, analyzing 158, 254, 143, and 279 cases in each wave respectively. Then heatmaps were built and categorized into five areas ranging from very low to very high risk of contagion, finding that the second wave exhibited a greater number of cases with a high viral load. Additionally, a spatial analysis was performed to measure urban areas with a higher risk of contagion, during this wave this area had 19,203.08 km2 (36.11% of the city). Therefore, a kernel density spatial model integrated by meaningful variables such as the number of infected subjects, viral load, and place of residence in cities, to establish geographic zones with different degrees of infection risk, could be useful for decision-making in future epidemic events. Full article
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Article
Effects of Socio-Familial Behavior on Sleep Quality Predictive Risk Factors in Individuals under Social Isolation
Int. J. Environ. Res. Public Health 2022, 19(6), 3702; https://doi.org/10.3390/ijerph19063702 - 20 Mar 2022
Viewed by 492
Abstract
Social confinement involves a series of temporary changes in the habits and lifestyles of individuals, severely affecting their regular activities and schedules and substantially modifying socio-familial behavior (SFB) and sleep quality (SQ). There is no literature reporting the effects of SFB changes on [...] Read more.
Social confinement involves a series of temporary changes in the habits and lifestyles of individuals, severely affecting their regular activities and schedules and substantially modifying socio-familial behavior (SFB) and sleep quality (SQ). There is no literature reporting the effects of SFB changes on SQ during social confinement due to the COVID-19 outbreak. An observational transversal research design, with group comparison and correlation methods, was used to perform the present study. The results were analyzed as follows: (1) An exploratory factor analysis (EFA); (2) A description of the sample was determined by proportions comparisons of sleep habits between the different variables of interest; and (3) A linear regression model was analyzed to explore the predictive association of the negative effects of social isolation during the COVID-19 pandemic on SFB and SQ. In addition to the global SFB score, two SFB factors were identified as predictors affecting the SQ, SF-Habits, and SF-Emotional scores, suggesting a close balance between daily life activities and sleep health during critical social changes. Furthermore, two main risk factors resulted from the regression analysis: economic concerns and increased alcohol consumption. Therefore, the predictive capacity of economic concerns showed statistical significance in anticipating negative sleep quality scores. Overall, this suggests that sleep quality, economic concerns, schedules, and substance use were associated with the self-perception of coping skills, elucidating the importance of fostering habits related to schedules within the home and ensuring that all family members participate. Full article
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Article
Critical Periods, Critical Time Points and Day-of-the-Week Effects in COVID-19 Surveillance Data: An Example in Middlesex County, Massachusetts, USA
Int. J. Environ. Res. Public Health 2022, 19(3), 1321; https://doi.org/10.3390/ijerph19031321 - 25 Jan 2022
Viewed by 830
Abstract
Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major [...] Read more.
Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University’s (JHU’s) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU’s data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90–2.69 [95%CI: 1.38–4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51–0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols. Full article
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Article
Sanitary Aspects of Countering the Spread of COVID-19 in Russia
Int. J. Environ. Res. Public Health 2021, 18(23), 12456; https://doi.org/10.3390/ijerph182312456 - 26 Nov 2021
Cited by 3 | Viewed by 648
Abstract
Due to the conditions that cause the spread of COVID-19, national health systems worldwide are under severe strain. Most countries face similar difficulties such as a lack of medical personnel and equipment and tools for diagnosis and treatment, overrun hospitals, and forced restriction [...] Read more.
Due to the conditions that cause the spread of COVID-19, national health systems worldwide are under severe strain. Most countries face similar difficulties such as a lack of medical personnel and equipment and tools for diagnosis and treatment, overrun hospitals, and forced restriction of planned medical care. Public authorities in healthcare take the following measures due to increased pressure: limiting the transmission and spread of the virus (social distancing and quarantine), mobilizing medical personnel, ensuring the availability of diagnostic and treatment tools, and providing a sufficient number of premises, which are not always suitable for the provision of medical care (buildings and structures). To date, the stages of management decision-making to counter coronavirus infection and the risk of COVID-19 transmission at various facilities have not been analyzed. The authors propose a methodology for assessing the COVID-19 transmission risk at various social and transport facilities. A survey of 1325 respondents from Moscow demonstrated the most significant risk factors, such as visitation avoidance, infection risk, and facemask wearing. Risk categories were determined and objects classified according to high, medium, and low-risk levels. Full article
Article
Diversity of COVID-19 News Media Coverage across 17 Countries: The Influence of Cultural Values, Government Stringency and Pandemic Severity
Int. J. Environ. Res. Public Health 2021, 18(22), 11768; https://doi.org/10.3390/ijerph182211768 - 09 Nov 2021
Cited by 6 | Viewed by 1437
Abstract
The current media studies of COVID-19 devote asymmetrical attention to social media; in contrast, newspapers have received comparatively less attention. Newspapers are an integral source of current information that are syndicated and amplified by social media to a wide global audience. This is [...] Read more.
The current media studies of COVID-19 devote asymmetrical attention to social media; in contrast, newspapers have received comparatively less attention. Newspapers are an integral source of current information that are syndicated and amplified by social media to a wide global audience. This is one of the first known studies to operationalize news media diversity and examine its association with cultural values during the pandemic. We tracked the global diversity of COVID-19 coverage in a news media database of 12 billion words, collated from 28 million articles over 7000 news websites, across 8 months. Media diversity was measured weekly by the number of unique descriptors of 10 target terms of the pandemic (e.g., COVID-19, coronavirus) and normalized by the corpus size for the respective countries per week. Government Stringency was taken from the Oxford COVID-19 Government Response Tracker and cultural scores were taken from Hofstede’s Cultural Values global database. Results showed that Media Diversity Rate increased 6.7 times over 8 months, from the baseline period (October–December 2019) to during the pandemic (January–May 2020). Mixed effects modelling revealed that higher COVID-19 prevalence rates and governmental stringency predicted this increase. Interestingly, collectivist cultures are linked to more diverse media coverage during COVID-19. It is possible that news outlets in collectivist societies are motivated to present a diverse array of topics given the impact of COVID-19 on every segment of society. Of broader significance, we provided a framework to design targeted public health communications that are culturally nuanced. Full article
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Article
A Statistical Model to Assess Risk for Supporting COVID-19 Quarantine Decisions
Int. J. Environ. Res. Public Health 2021, 18(17), 9166; https://doi.org/10.3390/ijerph18179166 - 31 Aug 2021
Cited by 1 | Viewed by 917
Abstract
In Germany, local health departments are responsible for surveillance of the current pandemic situation. One of their major tasks is to monitor infected persons. For instance, the direct contacts of infectious persons at group meetings have to be traced and potentially quarantined. Such [...] Read more.
In Germany, local health departments are responsible for surveillance of the current pandemic situation. One of their major tasks is to monitor infected persons. For instance, the direct contacts of infectious persons at group meetings have to be traced and potentially quarantined. Such quarantine requirements may be revoked, when all contact persons obtain a negative polymerase chain reaction (PCR) test result. However, contact tracing and testing is time-consuming, costly and not always feasible. In this work, we present a statistical model for the probability that no transmission of COVID-19 occurred given an arbitrary number of negative test results among contact persons. Hereby, the time-dependent sensitivity and specificity of the PCR test are taken into account. We employ a parametric Bayesian model which combines an adaptable Beta-Binomial prior and two likelihood components in a novel fashion. This is illustrated for group events in German school classes. The first evaluation on a real-world dataset showed that our approach can support important quarantine decisions with the goal to achieve a better balance between necessary containment of the pandemic and preservation of social and economic life. Future work will focus on further refinement and evaluation of quarantine decisions based on our statistical model. Full article
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Article
Individual and COVID-19-Specific Indicators of Compliance with Mask Use and Social Distancing: The Importance of Norms, Perceived Effectiveness, and State Response
Int. J. Environ. Res. Public Health 2021, 18(16), 8715; https://doi.org/10.3390/ijerph18168715 - 18 Aug 2021
Cited by 3 | Viewed by 1792
Abstract
COVID-19 is a global pandemic that has resulted in widespread negative outcomes. Face masks and social distancing have been used to minimize its spread. Understanding who will engage in protective behaviors is crucial for continued response to the pandemic. We aimed to evaluate [...] Read more.
COVID-19 is a global pandemic that has resulted in widespread negative outcomes. Face masks and social distancing have been used to minimize its spread. Understanding who will engage in protective behaviors is crucial for continued response to the pandemic. We aimed to evaluate factors that are indicative of mask use and social distancing among current and former college students prior to vaccine access. Participants (N = 490; 67% female; 60% White) were current and former U.S. undergraduate college students. Perceived effectiveness and descriptive norms regarding COVID-19 safety measures, COVID-19-related news watching and seeking, state response timing to stay-at-home mandates, impulsivity-like traits, affect (mood), and demographic variables were assessed. Results found that greater perceived effectiveness indicated increased personal compliance within and across behaviors. Greater norms related to compliance within behaviors (e.g., indoor norms related to indoor compliance). Increased perceived stress, anxiety, and negative affect indicated greater compliance. More positive affect was associated with less compliance. Being non-White, compared to White (p < 0.001), and female, compared to male (p < 0.001), were associated with greater compliance. Overall, early implementation of stay-at-home orders, exposure to COVID-19-related news, and increased perceived effectiveness are crucial for health safety behavior compliance. Findings are important for informing response to health crises, including COVID-19. Full article
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Article
Impact of Three Waves of the COVID-19 Pandemic on the Rate of Elective Cataract Surgeries at a Tertiary Referral Center: A Polish Perspective
Int. J. Environ. Res. Public Health 2021, 18(16), 8608; https://doi.org/10.3390/ijerph18168608 - 14 Aug 2021
Cited by 4 | Viewed by 1048
Abstract
The aim of this study was to assess the effect of three waves of the COVID-19 pandemic on the number of elective cataract surgeries. A retrospective single-center consecutive case series study was performed. We included all 12,464 patients who received cataract surgery in [...] Read more.
The aim of this study was to assess the effect of three waves of the COVID-19 pandemic on the number of elective cataract surgeries. A retrospective single-center consecutive case series study was performed. We included all 12,464 patients who received cataract surgery in the period between 1 January 2016 and 31 May 2021. Monthly numbers of cataract surgeries during the pandemic were compared with monthly numbers in the reference years 2016–2019. In the pandemic the number of cataract surgeries decreased by 53.4%. The monthly numbers during the first, second and third wave of the pandemic were 77.5%, 51.5% and 29.7% lower, respectively, compared with the reference level. No rebound effect was observed once the pandemic restrictions were eased. Simultaneous bilateral cataract surgeries (SBCS) constituted 6.5% of cataract procedures performed in April and May 2021 compared with 0.77% carried out between May 2019 and March 2021. While the pandemic-affected monthly numbers of cataract surgeries tend to increase recently, they are still below the prepandemic level. Patients should be encouraged to weigh the risks of COVID-19-related morbidity and mortality against the benefits of cataract surgery. Reorganization of the logistics of cataract services is advisable with consideration of SBCS as one of the options. Full article
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Article
Post-Lockdown Effects on Students’ Mental Health in Romania: Perceived Stress, Missing Daily Social Interactions, and Boredom Proneness
Int. J. Environ. Res. Public Health 2021, 18(16), 8599; https://doi.org/10.3390/ijerph18168599 - 14 Aug 2021
Cited by 4 | Viewed by 1592
Abstract
The rapid spread of COVID-19 worldwide was accompanied by intense fears, confusion, worries, anger, and stress threatening people’s mental health. Unprecedented measures to slow down and prevent the transmission of COVID-19 have had various impacts on the population’s health behaviour and mental health. [...] Read more.
The rapid spread of COVID-19 worldwide was accompanied by intense fears, confusion, worries, anger, and stress threatening people’s mental health. Unprecedented measures to slow down and prevent the transmission of COVID-19 have had various impacts on the population’s health behaviour and mental health. The main purpose of the present study is to investigate the lockdown’s effects on university students’ mental health in Romania. Based on a cross-sectional design, the survey data were collected from a sample of 722 participants (247 males; M = 21.1 years; SD ± 1.73). A path analysis was performed to verify the hypothesised direct and indirect effects included in the multiple mediation model. The findings showed a positive association between stress and boredom proneness, missing daily social interactions, spending more time on phone conversations, and the increasing interest in following news about the pandemic. The path analysis revealed an excellent fit between the proposed multiple mediation model and the sample data. Boredom proneness and missing daily social interactions both affected stress, directly and indirectly, through more time spent on phone conversations. In addition, it was found that the increased interest in following news about the pandemic mediated the relationship between boredom proneness and perceived stress. In terms of gender differences, our findings revealed that female students experienced significantly higher stress levels than male students, perceived to a greater extent the lack of daily social interactions, and spent more time on phone conversations. Overall, the findings further extend the empirical evidence on university students’ mental health in the context of the COVID-19 pandemic. Therefore, universities need to organise support programmes focused on developing university students’ coping strategies to maintain their mental health even in adverse contexts. Full article
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Article
Study on Multi-Agent Evolutionary Game of Emergency Management of Public Health Emergencies Based on Dynamic Rewards and Punishments
Int. J. Environ. Res. Public Health 2021, 18(16), 8278; https://doi.org/10.3390/ijerph18168278 - 05 Aug 2021
Cited by 7 | Viewed by 1232
Abstract
In the context of public health emergency management, it is worth studying ways to mobilize the enthusiasm of government, community, and residents. This paper adopts the method of combining evolutionary game and system dynamics to conduct a theoretical modeling and simulation analysis on [...] Read more.
In the context of public health emergency management, it is worth studying ways to mobilize the enthusiasm of government, community, and residents. This paper adopts the method of combining evolutionary game and system dynamics to conduct a theoretical modeling and simulation analysis on the interactions of the behavioral strategies of the three participants. In response to opportunistic behavior and inadequate supervision in the static reward and punishment mechanism, we introduced a dynamic reward and punishment mechanism that considers changes in the social environment and the situation of epidemic prevention and control. This paper proves that the dynamic reward and punishment mechanism can effectively suppress the fluctuation problem in the evolutionary game process under static scenarios and achieve better supervision results through scenario analysis and simulation experiments. Full article
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Article
Excess Risk of COVID-19 to University Populations Resulting from In-Person Sporting Events
Int. J. Environ. Res. Public Health 2021, 18(16), 8260; https://doi.org/10.3390/ijerph18168260 - 04 Aug 2021
Cited by 2 | Viewed by 1208
Abstract
Background: One of the consequences of COVID-19 has been the cancelation of collegiate sporting events. We explore the impact of sports on COVID-19 transmission on a college campus. Methods: Using a compartmental model representing the university, we model the impact of influxes of [...] Read more.
Background: One of the consequences of COVID-19 has been the cancelation of collegiate sporting events. We explore the impact of sports on COVID-19 transmission on a college campus. Methods: Using a compartmental model representing the university, we model the impact of influxes of 10,000 visitors attending events and ancillary activities (dining out, visiting family, shopping, etc.) on 20,000 students. We vary the extent visitors interact with the campus, the number of infectious visitors, and the extent to which the campus has controlled COVID-19 absent events. We also conduct a global sensitivity analysis. Results: Events caused an increase in the number of cases ranging from a 25% increase when the campus already had an uncontrolled COVID-19 outbreak and visitors had a low prevalence of COVID-19 and mixed lightly with the campus community to an 822% increase where the campus had controlled their COVID-19 outbreak and visitors had both a high prevalence of COVID-19 and mixed heavily with the campus community. The model was insensitive to parameter uncertainty, save for the duration a symptomatic individual was infectious. Conclusion: Sporting events represent a threat to the health of the campus community. This is the case even in circumstances where COVID-19 seems controlled both on-campus and among the general population. Full article
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Article
Determinant Factors in Personal Decision-Making to Adopt COVID-19 Prevention Measures in Chile
Int. J. Environ. Res. Public Health 2021, 18(15), 8131; https://doi.org/10.3390/ijerph18158131 - 31 Jul 2021
Cited by 1 | Viewed by 1012
Abstract
The pandemic has challenged countries to develop stringent measures to reduce infections and keep the population healthy. However, the greatest challenge is understanding the process of adopting self-care measures by individuals in different countries. In this research, we sought to understand the behavior [...] Read more.
The pandemic has challenged countries to develop stringent measures to reduce infections and keep the population healthy. However, the greatest challenge is understanding the process of adopting self-care measures by individuals in different countries. In this research, we sought to understand the behavior of individuals who take self-protective action. We selected the risk homeostasis approach to identify relevant variables associated with the risk of contagion and the Protective Action Decision Model to understand protective decision-making in the pandemic. Subsequently, we conducted an exploratory survey to identify whether the same factors, as indicated in the literature, impact Chile’s adoption of prevention measures. The variables gender, age, and trust in authority behave similarly to those found in the literature. However, socioeconomic level, education, and media do not impact the protection behaviors adopted to avoid contagion. Furthermore, the application of the Protective Action Decision Model is adequate to understand the protective measures in the case of a pandemic. Finally, women have a higher risk perception and adopt more protective measures, and in contrast, young people between 18 and 30 years of age are the least concerned about COVID-19 infection. Full article
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Article
The Study on Public-Interest Short Message Service (SMS) in China during the COVID-19 Pandemic: Mobile User Survey and Content Analysis
Int. J. Environ. Res. Public Health 2021, 18(15), 7915; https://doi.org/10.3390/ijerph18157915 - 26 Jul 2021
Viewed by 1137
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has greatly threatened the global health system and triggered the public health emergency. In order to manage the COVID-19 pandemic, healthcare and prevention information have been delivered through omni-media channels (e.g., television, radio, social platform, etc.). [...] Read more.
The outbreak of coronavirus disease 2019 (COVID-19) has greatly threatened the global health system and triggered the public health emergency. In order to manage the COVID-19 pandemic, healthcare and prevention information have been delivered through omni-media channels (e.g., television, radio, social platform, etc.). As a traditional outlet, the short message service (SMS) can timely provide abundant anti-epidemic alerts to mobile users. In this paper, we aim to investigate mobile users’ attitudes toward COVID-19 public-interest SMS sent from government authorities and then explore the insight from messaging texts collected between January and April 2020 in China. In general, respondents show a positive attitude towards content and the necessity of public-interest SMS during the pandemic. However, we find that gender and age differences not only affect content evaluation, but also influence reading and forwarding behaviors. For the necessity of SMS, it shows significant difference between the 18–25-year-old and over 40-year-old group, with the middle and elder group showing serious attitudes and giving higher remarks than the youth due to the habits of media usage. However no significant difference is presented between females and males. In terms of content, the category of topics and releasing institutions are analyzed, respectively. Due to the centralized responses and coordination of prevention and control in China, the messages from COVID-19 disposal organizations (e.g., municipal steering group and provincial CDC) account for more than 70% among four cities. Full article
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Article
Cross-Platform Comparative Study of Public Concern on Social Media during the COVID-19 Pandemic: An Empirical Study Based on Twitter and Weibo
by and
Int. J. Environ. Res. Public Health 2021, 18(12), 6487; https://doi.org/10.3390/ijerph18126487 - 16 Jun 2021
Cited by 2 | Viewed by 1783
Abstract
The COVID-19 pandemic has created a global health crisis that has affected economies and societies worldwide. During these times of uncertainty and crisis, people have turned to social media platforms as communication tools and primary information sources. Online discourse is conducted under the [...] Read more.
The COVID-19 pandemic has created a global health crisis that has affected economies and societies worldwide. During these times of uncertainty and crisis, people have turned to social media platforms as communication tools and primary information sources. Online discourse is conducted under the influence of many different factors, such as background, culture, politics, etc. However, parallel comparative research studies conducted in different countries to identify similarities and differences in online discourse are still scarce. In this study, we combine the crisis lifecycle and opinion leader concepts and use data mining and a set of predefined search terms (coronavirus and COVID-19) to investigate discourse on Twitter (101,271 tweets) and Sina Weibo (92,037 posts). Then, we use a topic modeling technique, Latent Dirichlet Allocation (LDA), to identify the most common issues posted by users and temporal analysis to research the issue’s trend. Social Network Analysis (SNA) allows us to discover the opinion leader on the two different platforms. Finally, we find that online discourse reflects the crisis lifecycle according to the stage of COVID-19 in China and the US. Regarding the status of the COVID-19 pandemic, users of Twitter tend to pay more attention to the economic situation while users of Weibo pay more attention to public health. The issues focused on in online discourse have a strong relationship with the development of the crisis in different countries. Additionally, on the Twitter platform many political actors act as opinion leaders, while on the Weibo platform official media and government accounts control the release of information. Full article
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Article
How Trust in Information Sources Influences Preventative Measures Compliance during the COVID-19 Pandemic
Int. J. Environ. Res. Public Health 2021, 18(11), 5867; https://doi.org/10.3390/ijerph18115867 - 30 May 2021
Cited by 3 | Viewed by 1771
Abstract
This paper explores how trust in formal information sources (government and media) and informal information sources (interpersonal) about COVID-19 influences compliance with preventive measures. This cross-sectional study uses convenience sampling of 478 adult participants. Data analyses using structural equation modeling with multigroup comparisons [...] Read more.
This paper explores how trust in formal information sources (government and media) and informal information sources (interpersonal) about COVID-19 influences compliance with preventive measures. This cross-sectional study uses convenience sampling of 478 adult participants. Data analyses using structural equation modeling with multigroup comparisons examine hypothesized relationships between trust in information sources and preventative behaviors and social distancing. Results suggest that understanding of COVID-19 causes is related to trust in formal information sources, but not to trust in informal information. Self-efficacy for prevention is related to trust in informal information sources, but not to trust in formal information sources. Worry about contracting COVID-19 is related to trust in formal information sources, but not to informal ones. Engaging in preventive measures is linked to both self-efficacy for prevention and worry, while social distancing was related only to worry. These findings have important implications for public health policy guidelines centered on clear and truthful media messages. The findings also facilitate comparative analyses of reactions to information sources across a decade of evolving attitudes toward media and government, between two cultures (Hong Kong vs. the USA), and between two different global pandemics. Full article
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The Use of GIS Technology to Optimize COVID-19 Vaccine Distribution: A Case Study of the City of Warsaw, Poland
Int. J. Environ. Res. Public Health 2021, 18(11), 5636; https://doi.org/10.3390/ijerph18115636 - 25 May 2021
Cited by 9 | Viewed by 1791
Abstract
The COVID-19 pandemic is a global challenge, and the key to tackling it is vaccinating a specified percentage of the population to acquire herd immunity. The observed problems with the efficiency of the vaccination campaigns in numerous countries around the world, as well [...] Read more.
The COVID-19 pandemic is a global challenge, and the key to tackling it is vaccinating a specified percentage of the population to acquire herd immunity. The observed problems with the efficiency of the vaccination campaigns in numerous countries around the world, as well as the approach used at the initial stage of the National Immunization Program in Poland, prompted us to analyse the possibility of using GIS technology to optimize the distribution of vaccines to vaccination sites so as to minimize the period needed to vaccinate individual population groups. The research work was carried out on the example of Warsaw, the capital of Poland and the city with the largest population in the country. The analyses were carried out for the 60–70 and 50–60 age groups, in various approaches and for vaccines of different companies (Moderna, BioNTech, AstraZeneca), used to vaccinate people in Poland. The proposed approach to optimize vaccine distribution uses Thiessen’s tessellation to obtain information on the number of people in a given population group living in the area of each vaccination site, and then to estimate the time needed to vaccinate that group. Compared to the originally used vaccination scenario with limited availability of vaccines, the proposed approach allows practitioners to design fast and efficient distribution scenarios. With the developed methodology, we demonstrated ways to achieve uniform vaccination coverage throughout the city. We anticipate that the proposed approach can be easily automated and broadly applied to various urban settings. Full article
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Article
Does COVID-19 Affect the Behavior of Buying Fresh Food? Evidence from Wuhan, China
Int. J. Environ. Res. Public Health 2021, 18(9), 4469; https://doi.org/10.3390/ijerph18094469 - 22 Apr 2021
Cited by 9 | Viewed by 2234
Abstract
COVID-19 first appeared in Wuhan city of Hubei Province in China in December 2019. It has a substantial impact on human life all around the world, especially for citizens. The threat of COVID-19 has resulted in people shopping online to get fresh food [...] Read more.
COVID-19 first appeared in Wuhan city of Hubei Province in China in December 2019. It has a substantial impact on human life all around the world, especially for citizens. The threat of COVID-19 has resulted in people shopping online to get fresh food and reduce outdoor trips. Collecting data from adult internet users in Wuhan, China in 2020, this study aims to explore the influence of COVID-19 on fresh food shopping behavior. In addition, a comparison and ordered logit model are constructed to demonstrate the changes and effects of COVID-19. The results suggest that more citizens in Wuhan city will buy fresh food online and the cost and frequency are also increased. The experience of online shopping for fresh food during the lock-down days has promoted more online shopping. The factors, such as frequency of online shopping before the COVID-19 outbreak, frequency of online shopping during the COVID-19 pandemic, and age, have a negative effect on the proportion of online shopping after the lock-down days, while the proportion of online shopping before the COVID-19 outbreak, the proportion of online shopping during the COVID-19 pandemic, and travel time of in-store shopping before the COVID-19 outbreak have a positive effect. The results provide insights for managers, city planners, and policymakers. Full article
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Article
COVID-19 Pandemic and Quality of Life among Romanian Athletes
Int. J. Environ. Res. Public Health 2021, 18(8), 4065; https://doi.org/10.3390/ijerph18084065 - 12 Apr 2021
Cited by 1 | Viewed by 1864
Abstract
The aim of this study was to analyze athletes’ quality of life during the COVID-19 pandemic. The study involved 249 athletes between 15 and 35 of age, M = 21.22, SD = 5.12. The sample was composed of eight Olympic Games medalists, three [...] Read more.
The aim of this study was to analyze athletes’ quality of life during the COVID-19 pandemic. The study involved 249 athletes between 15 and 35 of age, M = 21.22, SD = 5.12. The sample was composed of eight Olympic Games medalists, three European medalists, 67 international medalists, and 63 national medalists. The instruments used were: (1) COVID-19 Anxiety Scale, (2) Athlete Quality of Life Scale, (3) Impact of Pandemic on Athletes Questionnaire, and (4) International Personality Item Pool (IPIP Anxiety, Depression, and Vulnerability Scales). The results indicate significant differences in COVID-19 anxiety depending on the sport practiced, F (9239) = 3.81, p < 0.01, showing that there were significant differences between sports. The negative impact of the COVID-19 pandemic mediates the relationship between trait anxiety and the athletes’ quality of life. The percentage of mediation was 33.9%, and the indirect effect was −0.11, CI 95% (−0.18, −0.03), Z = −2.82, p < 0.01. Trait anxiety has an increasing effect on the intensity of the negative impact of the COVID-19 pandemic, 0.23, CI 95% (.10, 0.35), Z = 3.56, p < 0.01, and the negative impact of the COVID-19 pandemic has a decreasing effect on quality of life, −0.47, CI 95% (−0.67, −0.27), Z = −4.62, p < 0.01. Gender and age did not moderate the relationship between the negative impact of COVID-19 and athletes’ quality of life. The results of the study highlighted the impact that social isolation and quarantine have on athletes’ affective well-being. Full article
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Article
Effects of Home Confinement on the Intensity of Physical Activity during the COVID-19 Outbreak in Team Handball According to Country, Gender, Competition Level, and Playing Position: A Worldwide Study
Int. J. Environ. Res. Public Health 2021, 18(8), 4050; https://doi.org/10.3390/ijerph18084050 - 12 Apr 2021
Cited by 7 | Viewed by 1876
Abstract
This study investigated effects of home confinement on physical activity (PA) in Team Handball during the COVID-19 outbreak. A total of 1359 handball players participated (age: 23 ± 6 years). Participants from Europe, Western Asia, and North Africa answered an online version of [...] Read more.
This study investigated effects of home confinement on physical activity (PA) in Team Handball during the COVID-19 outbreak. A total of 1359 handball players participated (age: 23 ± 6 years). Participants from Europe, Western Asia, and North Africa answered an online version of the International Physical Activity Questionnaire (IPAQ) considering “before” and “during” confinement. COVID-19 home confinement has had a negative effect on PA (vigorous, moderate, walking, and overall). The largest decrease was in the sum parameter “all PA” (MET (metabolic equivalent of task)-min/week, ηp2 = 0.903; min/week, ηp2 = 0.861). Daily sitting time increased from 2.7 to 5.0 h per weekday (p < 0.001, ηp2 = 0.669). For gender, continent, country, level of handball league, and playing position, no significant differences (group and interaction effects) were observed. The largest change in PA behavior was in walking (minutes per day: ηp2 = 0.755), with males displaying the greatest decrease (from 62 ± 11 to 30 ± 14 min per weekday; d = 2.67). In terms of magnitude, difference between genders was greatest for sitting time (difference in d = 1.20). In conclusion, while COVID-19 measures were essential to preserve public health, PA was compromised and sedentary behavior increased because of these public health measures regardless of gender, playing position, and competition level. Full article
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Effects of COVID-19 Lockdown on Physical Activity, Sedentary Behavior, and Satisfaction with Life in Qatar: A Preliminary Study
Int. J. Environ. Res. Public Health 2021, 18(6), 3093; https://doi.org/10.3390/ijerph18063093 - 17 Mar 2021
Cited by 13 | Viewed by 2185
Abstract
This study examined the effects of home confinement on physical activity (PA) and life satisfaction during the COVID-19 outbreak in Qatar. A total of 1144 subjects participated (male: n = 588; female: n = 556; age: 33.1 ± 11.1 years; mass: 76.1 ± [...] Read more.
This study examined the effects of home confinement on physical activity (PA) and life satisfaction during the COVID-19 outbreak in Qatar. A total of 1144 subjects participated (male: n = 588; female: n = 556; age: 33.1 ± 11.1 years; mass: 76.1 ± 16.4 kg; height: 1.70 ± 0.11 m; body mass index (BMI): 26.1 ± 4.44  kg/m2). Online survey questions considered “before” and “during” confinement. Confinement reduced all PA intensities (ηp2 = 0.27–0.67, p < 0.001) and increased daily sitting time from 3.57 ± 1.47 to 6.32 ± 1.33 h per weekday (ηp2 = 0.67, p < 0.001). The largest reduction was detected for the sum parameter all physical activity (minutes per week, ηp2 = 0.67, p < 0.001; MET (metabolic equivalent of task)-minutes/week, ηp2 = 0.69, p < 0.001). Life satisfaction decreased, with the score for “I am satisfied with my life” (ηp2 = 0.76, p < 0.001) decreasing from 28.1 ± 4.81 to 14.2 ± 6.41 arbitrary units (AU). Concerning life satisfaction, the largest change was detected for the statement “the conditions of my life are excellent” (dmale = 7.93). For all parameters, time effects were indicative of large negative effects in both genders. In terms of magnitude, the difference between gender was greatest for the parameter “the conditions of my life are excellent” (difference between groups, d = 4.84). In conclusion, COVID-19 confinement decreased PA, increased sitting time, and decreased life satisfaction in Qatar. These precautionary findings explicate the risk of psychosocial impairment and the potential physical harm of reducing physical activity during early COVID-19 confinement in 2020. Full article
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Article
Experience of the COVID-19 Pandemic in Rural Odisha, India: Knowledge, Preventative Actions, and Impacts on Daily Life
Int. J. Environ. Res. Public Health 2021, 18(6), 2863; https://doi.org/10.3390/ijerph18062863 - 11 Mar 2021
Cited by 10 | Viewed by 2599
Abstract
We conducted 131 semi-structured phone interviews with householders in rural Odisha, India to explore participants’ COVID-19 related knowledge, perceptions, and preventative actions, as well as how the pandemic affected their daily life, economic and food security, and the village-level response. Interviews were conducted [...] Read more.
We conducted 131 semi-structured phone interviews with householders in rural Odisha, India to explore participants’ COVID-19 related knowledge, perceptions, and preventative actions, as well as how the pandemic affected their daily life, economic and food security, and the village-level response. Interviews were conducted with 73 heads of household, 37 primary caregivers, and 21 members of village water and sanitation committees from 43 rural villages in Ganjam and Gajapati districts in Odisha state. The study took place between May–July 2020 throughout various lockdown restrictions and at a time when many migrant workers were returning to their villages and cases were rising. Most respondents could name at least one correct symptom of COVID-19 (75%), but there was lower knowledge about causes of the disease and high-risk groups, and overall COVID-19 knowledge was lowest among caregivers. Respondents reported high compliance with important preventative measures, including staying home as much as possible (94%), social distancing (91%), washing hands frequently (96%), and wearing a facial mask (95%). Additionally, many respondents reported job loss (31%), financial challenges (93%), challenges related to staying home whether as a preventative measure or due to lockdowns (57%), changes in types and/or amount of food consumed (61%), and adverse emotional effects as a result of the pandemic and lockdown. We also provide detailed summaries of qualitative responses to allow for deeper insights into the lived experience of villagers during this pandemic. Although the research revealed high compliance with preventative measures, the pandemic and associated lockdowns also led to many challenges and hardships faced in daily life particularly around job loss, economic security, food security, and emotional wellbeing. The results underscore the vulnerability of marginalized populations to the pandemic and the need for measures that increase resilience to large-scale shocks. Full article
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Article
Population Response to Air Pollution and the Risk of Coronavirus Disease in Chinese Cities during the Early Pandemic Period
Int. J. Environ. Res. Public Health 2021, 18(5), 2248; https://doi.org/10.3390/ijerph18052248 - 24 Feb 2021
Cited by 1 | Viewed by 1953
Abstract
Health behavior is a critical measure in controlling the coronavirus disease 2019 (COVID-19) pandemic. We estimated the effect of health behaviors against air pollution on reducing the risk of COVID-19 during the initial phase of the pandemic. The attack rates of COVID-19 in [...] Read more.
Health behavior is a critical measure in controlling the coronavirus disease 2019 (COVID-19) pandemic. We estimated the effect of health behaviors against air pollution on reducing the risk of COVID-19 during the initial phase of the pandemic. The attack rates of COVID-19 in 159 mainland Chinese cities during the first 2 weeks after the closure of major cities was estimated; air pollution level as a surrogate indicator of the mask-wearing rate. Data on air pollution levels and meteorologic factors 2 weeks prior to the closure were obtained. The attack rate was compared with the level of air pollution using a generalized linear model after adjusting for confounders. When fine particulates (PM2.5) and nitrogen dioxide (NO2) levels increased by one unit of air quality index (AQI), the infection risk decreased by 0.7% and 3.4%, respectively. When PM2.5 levels exceeded 150 (level 4), the infection risk decreased (relative risk, RR = 0.635, 95% confidence interval, CI: 0.442 to 0.912 for level 4; RR = 0.529, 95% CI: 0.337 to 0.830 for level 5; respectively). After controlling for the number of high-speed railway routes, when PM2.5 and NO2 levels increased by one AQI, relative risk for PM2.5 and NO2 was 0.990 (95% CI, 0.984 to 0.997) and 0.946 (95% CI, 0.911 to 0.982), respectively, demonstrating a consistently negative association. It is postulated that, during the early phase of the pandemic, the cities with higher air pollution levels may represent the higher practice of mask-wearing to protect from air pollution, which could have acted as a barrier to the transmission of the virus. This study highlights the importance of health behaviors, including mask-wearing for preventing infections. Full article
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Article
Transformation of a Ferry Ship into a Ship Hospital for COVID-19 Patients
Int. J. Environ. Res. Public Health 2020, 17(23), 8976; https://doi.org/10.3390/ijerph17238976 - 02 Dec 2020
Cited by 3 | Viewed by 2181
Abstract
Liguria is a northwestern region of Italy that, since the WHO has declared COVID-19 as a pandemic (11 March 2020), presented 108 patients hospitalized, 34 of which were in the intensive care unit. Due to this serious epidemiological emergency, the transformation of a [...] Read more.
Liguria is a northwestern region of Italy that, since the WHO has declared COVID-19 as a pandemic (11 March 2020), presented 108 patients hospitalized, 34 of which were in the intensive care unit. Due to this serious epidemiological emergency, the transformation of a long-distance ferry ship into a hospital ship for COVID-19 patients who were still positive after the acute phase of the illness was carried out to free up hospital beds for patients in the acute phase. The ship was moored in the port of Genoa, the capital of Liguria. The conversion was localized to a single deck, where designated healthcare areas were identified. From 23 March to 18 June 2020, 191 patients were admitted onto the ship; they were provided with high-level healthcare guaranteed by the multi-disciplinary nature of clinical competencies available. Patients had a favorable outcome in all cases, confirmed by their recovery and negative swab results. Moreover, no cases of voluntary discharge were recorded. To the best of our knowledge, this is the only example in the world in which a passenger ship was transformed into a ship hospital for COVID patients. Full article
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Article
Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments
Int. J. Environ. Res. Public Health 2020, 17(21), 8114; https://doi.org/10.3390/ijerph17218114 - 03 Nov 2020
Cited by 74 | Viewed by 29592
Abstract
The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we [...] Read more.
The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This “highly infective” category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that “super infective” subjects, representing the top 5–10% of subjects with a positive test, plus an unknown fraction of less—but still highly infective, high aerosol-emitting subjects—may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols. Full article
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Examining the Change of Human Mobility Adherent to Social Restriction Policies and Its Effect on COVID-19 Cases in Australia
Int. J. Environ. Res. Public Health 2020, 17(21), 7930; https://doi.org/10.3390/ijerph17217930 - 29 Oct 2020
Cited by 24 | Viewed by 2639
Abstract
The policy induced decline of human mobility has been recognised as effective in controlling the spread of COVID-19, especially in the initial stage of the outbreak, although the relationship among mobility, policy implementation, and virus spread remains contentious. Coupling the data of confirmed [...] Read more.
The policy induced decline of human mobility has been recognised as effective in controlling the spread of COVID-19, especially in the initial stage of the outbreak, although the relationship among mobility, policy implementation, and virus spread remains contentious. Coupling the data of confirmed COVID-19 cases with the Google mobility data in Australia, we present a state-level empirical study to: (1) inspect the temporal variation of the COVID-19 spread and the change of human mobility adherent to social restriction policies; (2) examine the extent to which different types of mobility are associated with the COVID-19 spread in eight Australian states/territories; and (3) analyse the time lag effect of mobility restriction on the COVID-19 spread. We find that social restriction policies implemented in the early stage of the pandemic controlled the COVID-19 spread effectively; the restriction of human mobility has a time lag effect on the growth rates of COVID-19, and the strength of the mobility-spread correlation increases up to seven days after policy implementation but decreases afterwards. The association between human mobility and COVID-19 spread varies across space and time and is subject to the types of mobility. Thus, it is important for government to consider the degree to which lockdown conditions can be eased by accounting for this dynamic mobility-spread relationship. Full article
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Global to USA County Scale Analysis of Weather, Urban Density, Mobility, Homestay, and Mask Use on COVID-19
Int. J. Environ. Res. Public Health 2020, 17(21), 7847; https://doi.org/10.3390/ijerph17217847 - 26 Oct 2020
Cited by 30 | Viewed by 12184
Abstract
Prior evaluations of the relationship between COVID-19 and weather indicate an inconsistent role of meteorology (weather) in the transmission rate. While some effects due to weather may exist, we found possible misconceptions and biases in the analysis that only consider the impact of [...] Read more.
Prior evaluations of the relationship between COVID-19 and weather indicate an inconsistent role of meteorology (weather) in the transmission rate. While some effects due to weather may exist, we found possible misconceptions and biases in the analysis that only consider the impact of meteorological variables alone without considering the urban metabolism and environment. This study highlights that COVID-19 assessments can notably benefit by incorporating factors that account for urban dynamics and environmental exposure. We evaluated the role of weather (considering equivalent temperature that combines the effect of humidity and air temperature) with particular consideration of urban density, mobility, homestay, demographic information, and mask use within communities. Our findings highlighted the importance of considering spatial and temporal scales for interpreting the weather/climate impact on the COVID-19 spread and spatiotemporal lags between the causal processes and effects. On global to regional scales, we found contradictory relationships between weather and the transmission rate, confounded by decentralized policies, weather variability, and the onset of screening for COVID-19, highlighting an unlikely impact of weather alone. At a finer spatial scale, the mobility index (with the relative importance of 34.32%) was found to be the highest contributing factor to the COVID-19 pandemic growth, followed by homestay (26.14%), population (23.86%), and urban density (13.03%). The weather by itself was identified as a noninfluential factor (relative importance < 3%). The findings highlight that the relation between COVID-19 and meteorology needs to consider scale, urban density and mobility areas to improve predictions. Full article
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Awareness, Risk Perception, and Stress during the COVID-19 Pandemic in Communities of Tamil Nadu, India
Int. J. Environ. Res. Public Health 2020, 17(19), 7177; https://doi.org/10.3390/ijerph17197177 - 30 Sep 2020
Cited by 33 | Viewed by 5631
Abstract
The health and economic consequences of the COVID-19 pandemic is expected to disproportionately impact residents of lower-middle income countries. Understanding the psychological impact of the pandemic is important to guide outreach interventions. In this study, we examined people’s awareness of COVID-19 symptoms, risk [...] Read more.
The health and economic consequences of the COVID-19 pandemic is expected to disproportionately impact residents of lower-middle income countries. Understanding the psychological impact of the pandemic is important to guide outreach interventions. In this study, we examined people’s awareness of COVID-19 symptoms, risk perception, and changes in behaviors and stress levels during the lockdown in peri-urban Tamil Nadu India. Field workers conducted phone call surveys (included n = 2044) in 26 communities from 20–25 May 2020. The majority perceived no (60%) or low (23%) level of risk of personally contracting coronavirus. Common fears were related to health and economic concerns, including loss of income (62%), inability to travel freely (46%), and becoming sick (46%). Residents were well aware of the common symptoms of COVID-19, such as fever (66%) and dry cough (57%), but not the asymptomatic transmission (24%). The majority experienced increased stress about finance (79%) and the lockdown (51%). Our findings emphasize the need to develop context-adequate education and communication programs to raise vigilance about asymptomatic transmission and to sustain preventative behaviors. The evidence on fear and changes in stress levels could inform designing coping strategies and programs focused on mental well-being. Full article
Article
The Role of Illness Perceptions, Coping, and Self-Efficacy on Adherence to Precautionary Measures for COVID-19
Int. J. Environ. Res. Public Health 2020, 17(18), 6540; https://doi.org/10.3390/ijerph17186540 - 08 Sep 2020
Cited by 31 | Viewed by 3989
Abstract
As the novel coronavirus disease 2019 (COVID-19) pandemic continues, engaging the public in adherence to precautionary measures for preventing COVID-19 spread or infection becomes difficult. The present study aims to extend our understanding of how illness perceptions, coping, and self-efficacy affect adherence to [...] Read more.
As the novel coronavirus disease 2019 (COVID-19) pandemic continues, engaging the public in adherence to precautionary measures for preventing COVID-19 spread or infection becomes difficult. The present study aims to extend our understanding of how illness perceptions, coping, and self-efficacy affect adherence to precautionary measures among the public. An online survey was administered between April and June 2020 to a sample of 514 Hong Kong citizens. Variables considered were illness perceptions toward COVID-19, problem-solving, avoidance-based coping, self-efficacy, as well as adherence to precautionary measures including physical distancing, limiting unnecessary travelling, and washing hands regularly with soap and water. Adjusted structural equation model showed that illness perceptions toward COVID-19 had significant direct effect on their adherence to precautionary measures (unstandardized β = 0.50, [95% CI, 0.28, 0.80], p = 0.001), and indirect effects through avoidance-based coping (β = −0.10 [95% CI, −0.26, −0.01], p = 0.016) and self-efficacy (β = −0.10, [95% CI, −0.18, −0.01], p = 0.025). These results imply that apart from emphasizing the health hazards of a novel infectious disease, an effective public health intervention and crisis communication should address avoidance-based coping and self-efficacy of the public in adherence to precautionary measures for COVID-19. Full article
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Article
Effectiveness of Social Measures against COVID-19 Outbreaks in Selected Japanese Regions Analyzed by System Dynamic Modeling
Int. J. Environ. Res. Public Health 2020, 17(17), 6238; https://doi.org/10.3390/ijerph17176238 - 27 Aug 2020
Cited by 12 | Viewed by 3478
Abstract
In Japan’s response to the coronavirus disease 2019 (COVID-19), virus testing was limited to symptomatic patients due to limited capacity, resulting in uncertainty regarding the spread of infection and the appropriateness of countermeasures. System dynamic modelling, comprised of stock flow and infection modelling, [...] Read more.
In Japan’s response to the coronavirus disease 2019 (COVID-19), virus testing was limited to symptomatic patients due to limited capacity, resulting in uncertainty regarding the spread of infection and the appropriateness of countermeasures. System dynamic modelling, comprised of stock flow and infection modelling, was used to describe regional population dynamics and estimate assumed region-specific transmission rates. The estimated regional transmission rates were then mapped against actual patient data throughout the course of the interventions. This modelling, together with simulation studies, demonstrated the effectiveness of inbound traveler quarantine and resident self-isolation policies and practices. A causal loop approach was taken to link societal factors to infection control measures. This causal loop modelling suggested that the only effective measure against COVID-19 transmission in the Japanese context was intervention in the early stages of the outbreak by national and regional governments, and no social self-strengthening dynamics were demonstrated. These findings may contribute to an understanding of how social resilience to future infectious disease threats can be developed. Full article
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Article
Space-Time Patterns, Change, and Propagation of COVID-19 Risk Relative to the Intervention Scenarios in Bangladesh
Int. J. Environ. Res. Public Health 2020, 17(16), 5911; https://doi.org/10.3390/ijerph17165911 - 14 Aug 2020
Cited by 28 | Viewed by 3917
Abstract
The novel coronavirus (COVID-19) pandemic continues to be a significant public health threat worldwide, particularly in densely populated countries such as Bangladesh with inadequate health care facilities. While early detection and isolation were identified as important non-pharmaceutical intervention (NPI) measures for containing the [...] Read more.
The novel coronavirus (COVID-19) pandemic continues to be a significant public health threat worldwide, particularly in densely populated countries such as Bangladesh with inadequate health care facilities. While early detection and isolation were identified as important non-pharmaceutical intervention (NPI) measures for containing the disease spread, this may not have been pragmatically implementable in developing countries due to social and economic reasons (i.e., poor education, less public awareness, massive unemployment). Hence, to elucidate COVID-19 transmission dynamics with respect to the NPI status—e.g., social distancing—this study conducted spatio-temporal analysis using the prospective scanning statistic at district and sub-district levels in Bangladesh and its capital, Dhaka city, respectively. Dhaka megacity has remained the highest-risk “active” cluster since early April. Lately, the central and south eastern regions in Bangladesh have been exhibiting a high risk of COVID-19 transmission. The detected space-time progression of COVID-19 infection suggests that Bangladesh has experienced a community-level transmission at the early phase (i.e., March, 2020), primarily introduced by Bangladeshi citizens returning from coronavirus epicenters in Europe and the Middle East. Potential linkages exist between the violation of NPIs and the emergence of new higher-risk clusters over the post-incubation periods around Bangladesh. Novel insights into the COVID-19 transmission dynamics derived in this study on Bangladesh provide important policy guidelines for early preparations and pragmatic NPI measures to effectively deal with infectious diseases in resource-scarce countries worldwide. Full article
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Review

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Review
Physical Activity Recommendations during COVID-19: Narrative Review
Int. J. Environ. Res. Public Health 2021, 18(1), 65; https://doi.org/10.3390/ijerph18010065 - 24 Dec 2020
Cited by 27 | Viewed by 4831
Abstract
Regular practice of physical activity plays a fundamental role in preventing and treating cardiovascular diseases such as obesity, hypertension, diabetes, and metabolic syndrome. During the pandemic caused by COVID-19 and the lockdown established, people have reduced considerably their mobility and motor activity, which [...] Read more.
Regular practice of physical activity plays a fundamental role in preventing and treating cardiovascular diseases such as obesity, hypertension, diabetes, and metabolic syndrome. During the pandemic caused by COVID-19 and the lockdown established, people have reduced considerably their mobility and motor activity, which has led to an increase in unhealthy lifestyle habits, raising the risk of suffering from diseases. This paper consists of reviewing the existing scientific literature on recommendations of physical activity during the pandemic and to establish specific guidelines according to the type of population to which the activity would be directed. A search strategy has been carried out in the different databases: Embase, PubMed, SCOPUS, SPORTDiscus, and Web of Science (WoS), including all the articles published until 14 May 2020, to find essays with recommendations on aerobic activity, muscle strengthening, flexibility-stretching, meditation-relaxation, and balance exercises. The articles found have been evaluated considering the following criteria: type of publication, proposals for physical exercise, language, and, if it appears, volume of activity, frequency, intensity, and rest. The results obtained 29 articles that discuss patterns of physical activity, although there is no common consensus on such recommendations during confinement, nor are they suitable for all people. From these results, we can conclude that physical activity is widely recommended during the confinement caused by COVID-19, mainly through the performance of aerobic, strength, flexibility, and balance exercises. Full article
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Other

Jump to: Research, Review

Brief Report
Improving Risk Management by Learning from Adverse Events: Report on One Year of COVID-19 Vaccination Campaign in Verona (Northeastern Italy)
Int. J. Environ. Res. Public Health 2022, 19(6), 3635; https://doi.org/10.3390/ijerph19063635 - 18 Mar 2022
Viewed by 499
Abstract
Background: The COVID-19 mass vaccination campaign posed new challenges not only from a healthcare perspective, but also in terms of distribution, logistics, and organization. Managing clinical risk in off-site vaccination centers during a pandemic provided a new opportunity for the training and acquisition [...] Read more.
Background: The COVID-19 mass vaccination campaign posed new challenges not only from a healthcare perspective, but also in terms of distribution, logistics, and organization. Managing clinical risk in off-site vaccination centers during a pandemic provided a new opportunity for the training and acquisition of competencies through continuous learning from adverse events. The aim of this report, based on a review of activity, was to identify the most recurrent and high-risk failures of the vaccination process in a mass vaccination center. Methods: Adverse events and near misses reported during the first 11 months of activity (February 2021–January 2022) in the mass vaccination center of Verona (Italy) were evaluated. Results: From 15 February 2021 to 17 January 2022 the center administered about 460,000 doses to the population and nine adverse events and one near miss were reported. Most of the events were errors in vaccine administration, either in principle, dosage, or timing with respect to the indicated schedule. All events had minor outcomes. Communication errors, inadequate training, and general organizational issues were the most recurrent factors contributing to the events. Conclusions: Risk mitigation during mass vaccination in temporary sites is an essential element of a successful vaccination campaign. The reporting of adverse events should be encouraged in order to obtain as much information as possible for a continuous improvement of the activity. Full article
Case Report
Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station
Int. J. Environ. Res. Public Health 2021, 18(14), 7430; https://doi.org/10.3390/ijerph18147430 - 12 Jul 2021
Viewed by 2824
Abstract
Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus [...] Read more.
Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments. Full article
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