Search Results (422)

Background/Objectives: The COVID-19 pandemic caused pronounced disorder in healthcare delivery globally, including ophthalmology. Our study explores how ophthalmologists in Puerto Rico (PR) altered their practices during the pandemic, confronting obstacles such as resource shortages, evolving public health mandates, and unique socio-economic and geographic constraints. The study aims to enhance preparedness for future public health crises. Methods: We conducted descriptive analyses on four online surveys distributed at crucial time points of the pandemic (March 2020, May 2020, August 2020, August 2021) to all practicing ophthalmologists in PR (N ≈ 200), capturing data on closures, patient volume, personal protective equipment (PPE) access, telemedicine use, and financial relief. Results: Survey responses ranged from 41% (n = 81) to 56% (n = 111). By March 2020, 22% (24/111) of respondents closed their offices. By May 2020, 20% (19/93) of respondents maintained a closed office, while 89% (64/72) of open offices reported seeing less than 25% of their usual patient volume. Access to PPE was a challenge, with 59% (65/111) reporting difficulty obtaining N95 masks in March 2020. Telemedicine usage increased initially, peaking in May 2020 and declining in July 2020. By August 2021, all respondents were fully vaccinated and most practices returned to pre-pandemic levels. Overall, 86% (70/81) of respondents found the surveys to be useful for navigating practice changes during the pandemic. Conclusions: PR ophthalmologists showed adaptability during the COVID-19 pandemic to maintain care given limited resources. Guidelines from professional organizations and real time surveys play an important role in future crisis preparedness. Full article

Since the onset of the COVID-19 pandemic, remarkable progress has been made in the development of antiviral therapies for SARS-CoV-2. Several direct-acting antivirals, such as remdesivir, molnupiravir, and nirmatrelvir/ritonavir, offer clinical benefits. These agents have significantly contributed to reducing the viral loads and duration of the illness, as well as the disease’s severity and mortality. However, despite these advances, important limitations remain. The continued emergence of resistant SARS-CoV-2 variants highlights the urgent need for adaptable and durable therapeutic strategies. Therefore, this review aims to provide an updated overview of the main antiviral strategies that are used and the discovery of new drugs against SARS-CoV-2, as well as the therapeutic limitations that have shaped clinical management in recent years. The major challenges include resistance associated with viral mutations, limited treatment windows, and unequal access to treatment. Moreover, there is an ongoing need to identify novel compounds with broad-spectrum activity, improved pharmacokinetics, and suitable safety profiles. Combination treatment regimens represent a promising strategy to increase the efficacy of treating COVID-19 while minimizing the potential for resistance. Ideally, these interventions should be safe, affordable, and easy to administer, which would ensure broad global access and equitable treatment and enable control of COVID-19 cases and preparedness for future threats. Full article

People living with HIV (PLWH) faced diverse challenges during the COVID-19 pandemic, including disruptions to care, housing instability, emotional distress, and economic hardship. This study used graph-based clustering methods to analyze pandemic-era experiences of PLWH in a national sample from the NIH’s All of Us dataset (n = 242). Across three graph configurations we identified consistent subgroups shaped by social connectedness, housing stability, emotional well-being, and engagement with preventive behaviors. Comparison with an earlier local study of PLWH in Illinois confirmed recurring patterns of vulnerability and resilience while also revealing additional national-level subgroups not observed in the smaller sample. Subgroups with strong social or institutional ties were associated with greater emotional stability and proactive engagement with COVID-19 preventive behaviors, while those facing isolation and structural hardship exhibited elevated distress and limited engagement with COVID-19 preventive measures. These findings underscore the importance of precision public health strategies that reflect the heterogeneity of PLWH and suggest that strengthening social support networks, promoting housing stability, and leveraging institutional connections may enhance pandemic preparedness and HIV care in future public health crises. Full article

Background/Objectives: mRNA vaccines introduced during the COVID-19 pandemic were a significant step forward in the rapid development and deployment of vaccines in a global pandemic context. These vaccines showed good protective efficacy, but—due to limited breadth of the immune response—they required frequent boosters with manufactured spike sequences that often lagged behind the circulating strains. In order to enhance the breadth, durability, and magnitude of immune responses, we studied the effect of combining priming with an RNA vaccine technology with boosting with protein/adjuvant using a TLR4-agonist based adjuvant. Methods: Specifically, four proprietary adjuvants (EmT4^TM, LiT4Q^TM, MiT4^TM, and AlT4^TM) were investigated in combination with multiple modes of SARS-CoV-2 vaccination (protein, peptide, RNA) for their effectiveness in boosting antibody responses to SARS-CoV-2 spike protein in murine models. Results: Results showed significant improvement in immune response strength and breadth—especially against more distant SARS-CoV-2 variants such as Omicron—when adjuvants were used in combination with boosters following an RNA vaccine prime. Conclusions: The use of novel TLR4 adjuvants in combination with protein or RNA vaccinations presents a promising strategy for improving the efficacy of vaccines in the event of future pandemics, by leveraging rapid response using an RNA vaccine prime and following up with protein/adjuvant-based vaccines to enhance the breadth of immunity. Full article

The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission’s implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access. This article explores the scientific, economic, political, and social aspects that could influence the mission’s success, relying on lessons learned from previous pandemics, such as the Spanish flu, H1N1, and COVID-19. We also examined important cornerstones like prototype vaccine libraries, accelerated clinical trial preparedness, early biomarkers identification, scalable manufacturing capabilities, and rapid pathogen characterization. The review also explores the World Health Organization (WHO) Pandemic Agreement and the significance of Phase 4 surveillance in ensuring vaccine safety. We additionally evaluate societal issues that disproportionately impact LMICs, like vaccine reluctance, health literacy gaps, and digital access limitations. Without intentional attempts to incorporate under-resourced regions into global preparedness frameworks, we argue that the 100-Day Mission carries the risk of exacerbating already-existing disparities. Ultimately, our analysis emphasizes that success will not only rely on a scientific innovation but also on sustained international collaboration, transparent governance, and equitable funding that prioritizes inclusion from the beginning. Full article

Background/Objectives: Epidemiological modeling is a vital tool for managing pandemics, including SARS-CoV-2. Advances in the understanding of epidemiological dynamics and access to new data sources necessitate ongoing adjustments to modeling techniques. In this study, we present a significantly expanded and updated version of our previous SARS-CoV-2 model formulated as input–output non-linear dynamical systems (IO-NLDS). Methods: This updated framework incorporates age-dependent contact patterns, immune waning, and new data sources, including seropositivity studies, hospital dynamics, variant trends, the effects of non-pharmaceutical interventions, and the dynamics of vaccination campaigns. Results: We analyze the dynamics of various datasets spanning the entire pandemic in Germany and its 16 federal states using this model. This analysis enables us to explore the regional heterogeneity of model parameters across Germany for the first time. We enhance our estimation methodology by introducing constraints on parameter variation among federal states to achieve this. This enables us to reliably estimate thousands of parameters based on hundreds of thousands of data points. Conclusions: Our approach is adaptable to other epidemic scenarios and even different domains, contributing to broader pandemic preparedness efforts. Full article

Background/Objectives: The COVID-19 pandemic highlighted the critical need for accurate predictive models to guide public health interventions and optimize healthcare resource allocation. This study evaluates how the complexity of compartmental infectious disease models influences their forecasting accuracy and utility for pandemic resource planning. Methods: We analyzed a range of compartmental models, including simple susceptible-infected-recovered (SIR) models and more complex frameworks incorporating asymptomatic carriers and deaths. These models were calibrated and tested using real-world COVID-19 data from the United States to assess their performance in predicting symptomatic and asymptomatic infection counts, peak infection timing, and resource demands. Both adaptive models (updating parameters with real-time data) and non-adaptive models were evaluated. Results: Numerical results show that while more complex models capture detailed disease dynamics, simpler models often yield better forecast accuracy, especially during early pandemic stages or when predicting peak infection periods. Adaptive models provided the most accurate short-term forecasts but required substantial computational resources, making them less practical for long-term planning. Non-adaptive models produced stable long-term forecasts useful for strategic resource allocation, such as hospital bed and ICU planning. Conclusions: Model selection should align with the pandemic stage and decision-making horizon. Simpler models are effective for rapid early-stage interventions, adaptive models excel in short-term operational forecasting, and non-adaptive models remain valuable for long-term resource planning. These findings can inform policymakers on selecting appropriate modeling approaches to improve pandemic response effectiveness. Full article

The COVID-19 pandemic has disrupted the progress toward Sustainable Development Goal 3, particularly in developing countries, exacerbating existing health disparities and creating new challenges for health systems worldwide. This study explores the role of university research in advancing SDG 3 targets in a post-pandemic context using the University of the Western Cape as a case study. Through qualitative data analysis of research titles and abstracts registered between 2020 and 2022, we applied the WHERETO model of McTighe and Bloom’s Taxonomy to categorize research according to the SDG 3 targets and indicators. This approach provides insight into which health priorities were addressed through scholarly research at UWC in alignment with the UN 2030 Agenda, particularly during pandemic recovery. Our findings indicate that research priorities largely corresponded with South Africa’s health challenges, with the highest concentration of studies addressing non-communicable diseases and mental health (Target 3.4), infectious diseases (Target 3.3), and medicine development (Target 3.b). These priorities align with the National Health Research Committee’s identified health priorities for disadvantaged communities in the Western Cape. Notably, research on mental health and emergency preparedness (Target 3.d) increased significantly during the pandemic period, reflecting shifting priorities in response to COVID-19. This study offers critical insights into how university research shifted priorities adapted during the pandemic and identifies areas requiring focused attention to support post-pandemic recovery. By highlighting research gaps and opportunities, our findings provide a foundation for developing more comprehensive approaches to health research that address the disparities exacerbated by COVID-19 while advancing the 2030 agenda. This model could inform research prioritization at other institutions facing similar challenges in both local and global contexts. Full article

Objectives: The objective of this study was to examine the impact of the COVID-19 pandemic on racialized communities and individuals in Canada. Methods: This review followed the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidance on reporting scoping reviews. Ovid MEDLINE ALL, Embase Classic + Embase, CINAHL (Ebsco platform), PsycINFO, and Cochrane were searched for documents that were published after March 2020 and that reported on the social and economic impacts and health outcomes of the COVID-19 pandemic on generally healthy racialized populations that reside in Canada. Synthesis: A total of 39 documents were included in this review. Our results show racialized communities faced greater social, economic, and health impacts from the pandemic. These impacts were manifested in the form of high COVID-19 morbidity and mortality rates, increased discrimination, worsening mental health, difficulty in accessing healthcare, and challenges related to accessing food and basic necessities. Conclusion: Canadian racialized groups have been inequitably affected by the COVID-19 pandemic due to pre-existing inequalities and emerging discrimination. Responsive policy action and robust pandemic preparedness efforts are indispensable in adopting a proactive stance to prevent racialized populations from bearing a disproportionate burden of negative health crises in the future. This necessitates addressing pre-existing disparities and targeting social and economic vulnerability areas. By doing so, we can mitigate the reported social, economic, and health impacts experienced by racialized groups, including challenges related to accessing basic necessities, deteriorating mental health, and barriers to healthcare access. Full article

This qualitative study explored the development of an innovative simulation training program designed to bolster the preparedness and resilience of healthcare teams during the unprecedented challenges of the COVID-19 pandemic. Focus groups with interprofessional clinicians illuminated key educational priorities, revealing a need for enhanced safety protocols, clear in communication, and targeted training to address knowledge gaps specific to the novel coronavirus. Recognizing the profound emotional toll of the pandemic, the program also emphasized cultivating compassion and fostering emotional resilience alongside the essential clinical skills. By immersing participants in realistic, evolving scenarios that were reflective of the dynamic COVID-19 landscape, the simulations offered a safe space to rehearse critical skills, practice crisis resource management, and build confidence in navigating the complexities of pandemic care. This tailored approach aimed to empower healthcare teams not only with enhanced knowledge and expertise but also with the emotional fortitude and resilience necessary to provide optimal patient care while safeguarding their own well-being throughout the ongoing COVID-19 pandemic. The findings highlight the profound potential of simulation-based training to strengthen both individual and systemic resilience within healthcare systems facing the enduring strain of this global health crisis. Full article

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly impacted healthcare systems worldwide. As a result, remote areas such as the Penghu Islands have encountered unique challenges related to pediatric care. This study examined the effects of the pandemic on the emergency air medical transport (EAMT) of pediatric patients from the Penghu Islands to Taiwan. Materials and Methods: This retrospective study analyzed 40 pediatric patients who received EAMT from the Penghu Islands to Taiwan between January 2017 and December 2022. This study compared patients before and during the COVID-19 pandemic and focused on patient demographics, reasons for EAMT, and clinical outcomes. Due to the small sample size, non-parametric statistical methods were applied, including the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Results: Among the 40 pediatric patients analyzed, the median age decreased from 3 years (IQR, 0–5 years) before the pandemic to 1 year (IQR, 0–5 years) during the pandemic. While the overall increase in hospital length of stay during the pandemic was not statistically significant, a significant prolongation was observed in preschool-aged children and neonates without trauma (20 days vs. 9 days; p < 0.05). The lack of specialist physicians became an increasingly prominent factor for EAMT during the pandemic (p = 0.056). The most common medical reasons for EAMT were critical illness (35%), neonatal diseases (30%), and neurological conditions (27.5%), with similar distributions across both time periods. Conclusions: The COVID-19 pandemic heightened existing healthcare disparities in the Penghu Islands, particularly by increasing reliance on EAMT due to a shortage of pediatric specialists. Hospital stays for preschool children and neonates significantly increased during the pandemic, suggesting delayed or prolonged care. These findings underscore the need to strengthen local pediatric infrastructure, decentralize specialist services, and improve emergency preparedness to better support vulnerable populations in remote areas during future public health emergencies. Full article

Background: The COVID-19 pandemic necessitated immediate regulatory vaccine approvals to facilitate timely global access. The prevailing differences in economies and resources and the varying maturity of the regulatory systems worldwide resulted in different levels of capacity to ensure vaccine quality, safety, and efficacy. In addition to the Emergency Use Authorization or equivalent by some advanced regulatory agencies, the WHO issued Emergency Use Listings (EULs), among other tools, to streamline and expedite regulatory approvals globally. This study aimed to assess the regulatory strategies and best practices adopted during the COVID-19 vaccine approvals and gather lessons for future emergency preparedness. Methods: A mixed-method approach employing qualitative desk reviews and a cross-sectional study collected data from 194 national regulatory authorities (NRAs) across all WHO regions. Results: Three main approval processes were identified: procurement-driven, reliance-based, and independent evaluations. Wealthier countries with more mature regulatory systems were found to spend a longer time issuing approvals, primarily due to being the initial assessors of the vaccines’ quality, safety, and efficacy. Furthermore, various regulatory flexibilities and best practices centered around regulatory reliance, rolling reviews, fast-tracking reviews, and employing digital tools were identified. Notably, the WHO’s EULs were essential in facilitating the timely approval of vaccines globally, including in low- and middle-income countries. Conclusions: The findings suggest a significant turn in vaccine regulation theories and practice, emphasizing balancing speed with scientific validity. This necessitates the creation of thorough provisions for emergency preparedness, regulatory reliance, and administrative flexibility in regulatory practices worldwide. Full article

Background: Although mental health among students has become a pressing public concern over recent years, the COVID-19 pandemic introduced new stressors, which may further increase the mental health burden for them. While past work has investigated links between pandemic related factors and student mental health and wellbeing, there is conflicting evidence around some symptoms (e.g., anxiety) and little work has focused on less common mental health conditions (e.g., eating disorders). Aims: The current study aimed to detail the prevalence of mental distress in the student population at an early stage of the COVID-19 pandemic and compare university students’ mental health before and during the COVID-19 pandemic. Specifically, we aimed to compare levels of depression, anxiety, and eating disorders in a large sample of students. Methods: We analysed data from a repeated cross-sectional survey on different samples of UK university students before the pandemic (n = 4812) and during the pandemic (n = 3817). Results: There were high levels of depression and anxiety during the COVID-19 pandemic, with more than 50% experiencing levels above the clinical cut-offs. Findings revealed a significant increase in symptoms of depression and anxiety from pre- to mid-pandemic as well as a significant increase in the prevalence of eating disorders. Conclusions: By late 2020, mental health in the student population had deteriorated compared to pre-pandemic levels. These findings provide evidence for increased levels of depression, anxiety, and eating disorders related to the COVID-19 pandemic. There is a need for better preparedness for future crises in order to mitigate the impact on student mental health. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Background/Objectives: The present study aimed to analyze changes in symptom intensity during the recovery period of COVID-19 survivors and patients with post-COVID syndrome. Methods: Initially, we described a new remote patient monitoring system to track the intensity of specific symptoms in individuals’ home environments. Remote patient monitoring (RPM) was implemented over 15 days in a cohort of 133 individuals aged 20 to 78 years, divided into four groups: mild (MG, n = 40), Hospital Discharge Without Invasive Mechanical Ventilation (WIMV, n = 40), Hospital Discharge With Invasive Mechanical Ventilation (IMV, n = 13), and reinfected (RG, n = 40). Results: The most prevalent symptoms reported across all groups, based on average intensity, were shortness of breath, fatigue, cough, headache, and body pain. The WIMV group exhibited the highest average intensities in six symptoms (p < 0.01), while the IMV group reported the highest averages in four symptoms (p < 0.05). Fatigue was the symptom with the highest overall intensity, followed by memory lapses. The hospitalized groups demonstrated the highest intensities and most persistent symptoms (p < 0.05). Blood pressure was significantly higher in the MG group compared to the RG group (p < 0.0001), although all values remained within the normal range. Conclusions: These results provide novel insights, revealing distinct differences in the symptom profiles among the studied groups. These findings hold significant implications for developing more personalized care strategies and informing future pandemic preparedness and response efforts. Full article