03 May, 2021

Predicting behavioral intentions to prevent or mitigate COVID-19: A cross-cultural meta-analysis of attitudes, norms and perceived behavioral control effects -

We examined the effectiveness of attitudes, subjective norms and perceived behavioral control (PBC) of the Theory of Planned Behavior (TPB) on COVID-19 relevant behavioral intentions and behaviors. We conducted a meta-analysis of 335 effect sizes from 83 samples across 31 countries (N = 68,592). We found strongest effects for perceived behavioral control, but contrary to previous research also moderately strong effects of subjective norms. Focusing on systematic context effects: a) norm-behavior associations at individual level were strengthened if population norms were stronger, b) collectivism strengthened norm effects in line with cultural theories, but also attitude and PBC associations, suggesting that COVID-relevant behaviors show collective action properties, c) in line with cultural theory, tightness-looseness strengthened normative effects on behaviors, and d) contrary to post-modernization theory, national wealth weakened attitude and PBC associations. These analyses provide new theoretical and practical insights into behavioral dynamics during an acute public health crisis.

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Covid-19: acquired acute porphyria hypothesis -

Pandemic Covid-19 pneumonia, of SARS-CoV-2 aetiology, is of global importance to health systems, national economies and individual civil liberties. Multiple therapeutic and prophylactic agents are currently undergoing clinical trial and, while progress towards a curative agent is promising, the principal limiting factor in public health emergency is time. A pre-existing licensed therapeutic would offer reprieve to international citizens currently enduring the adverse consequences of lockdown policies. This brief communication serves as an update on the initial version of the acquired acute porphyria hypothesis and advocates for direct testing of the hypothesis.

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The 501Y.V2 SARS-CoV-2 variant has an intermediate viral load between the 501Y.V1 and the historical variants in nasopharyngeal samples from newly diagnosed COVID-19 patients -

The 501Y.V2 and the 501Y.V1 SARS-CoV-2 variants emerged and spread rapidly into the world. We analysed the viral load of 643 nasopharyngeal samples of COVID-19 patients at diagnosis and found that the 501Y.V1 and the 501Y.V2 variants presented a viral load three to ten times and two times higher than the historical variants, respectively..

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Predicting Emerging Themes in Rapidly Expanding COVID-19 Literature with Dynamic Word Embedding Networks and Machine Learning -

Evidence from peer-reviewed literature is the cornerstone for designing responses to global threats such as COVID-19. The collection of knowledge and interpretation in publications needs to be distilled into evidence by leveraging natural language in ways beyond standard meta-analysis. Several studies have focused on mining evidence from text using natural language processing, and have focused on a handful of diseases. Here we show that new knowledge can be captured, tracked and predicted using the evolution of unsupervised word embeddings and machine learning. Our approach to decipher the flow of latent knowledge in time-varying networks of word-vectors captured thromboembolic complications as an emerging theme in more than 77,000 peer-reviewed publications and more than 11,000 WHO vetted preprints on COVID-19. Furthermore, machine learning based prediction of emerging links in the networks reveals autoimmune diseases, multisystem inflammatory syndrome and neurological complications as a dominant research theme in COVID-19 publications starting March 2021.

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The impact of pandemic-related worry on cognitive functioning and risk-taking -

Here, we sought to quantify the effects of experienced fear and worry, engendered by the COVID-19 pandemic, on both cognitive abilities—speed of information processing, task-set shifting, and proactive control—as well as economic risk-taking. Leveraging a repeated-measures cross-sectional design, we examined the performance of 1517 participants, collected during the early phase of the pandemic in the US (April – June 2020), finding that self-reported pandemic-related worry predicted deficits in information processing speed and maintenance of goal-related context information. Cognitive performance was also impaired relative to pre-pandemic ‘baseline’ samples. In a classic economic risk-taking task, we also observed that more worried individuals’ choices were more sensitive to outcome probabilities of risky actions. Overall, these results elucidate the cognitive consequences of pandemic worry, which may play an important role in individuals’ understanding of—and adherence to—public health directives.

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A semi qualitative study on the perception of the general public to the presence of the first COVID-19 patient in the locality -

Introduction: Infectious diseases have had a significant role in shaping human history by engraving a subconscious sense of ‘fear of infection’. The three sequential stages of the rational response to fear- fear, denial, and frustration, have been reported as predominant among quarantined individuals during any outbreak. To our knowledge, this was one of the first studies to assess the impact of the first case of COVID-19 among the neighbouring dwellers. Methods: A semi-qualitative study was conducted through telephonic interviews. Detailed descriptions of the experiences of the inhabitants after coming to know about the first incidence of a patient of COVID-19 in the locality were obtained. Participants were recruited through purposive and snowball sampling. Semi-structured in-depth telephonic interviews were done at a time convenient for participants between April 9 to 11, 2020. Results: Source of information for all the participants was from a neighbour and the participants came to know about the news on 7th of April 2020. All the participants were aware of the correct attitudes and practices of the general public to be followed during the pandemic including hand hygiene, use of face masks, social distancing and adhering to the government lockdown rules. Mixed reactions of panic, fear and confusion were obtained. Most participants were concerned about children and elderly at home, financial constraints due to the blockage of the locality from adjoining areas, everyday hassles that they were about to experience, etc. Despite most participants having minimal fear of contracting the illness themselves, fear of a family member acquiring the same seemed to be significantly higher on hearing the news. Conclusion The study adds to the existing literature that fear and anxiety during a pandemic are mostly due to the uncertainty related to the disease spread and misinformation. There is a need for phased and well informed lockdown implementation and better knowledge propagation among the general public in order to mitigate unwanted fear and panic among the general public.

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COVID-19 and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes -

Background We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). Methods We searched literature databases and COVID-19 research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR9s results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. Results We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had “critically low” overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 clinical findings during pregnancy were fever (28-100%), mild respiratory symptoms (20-79%), raised C-reactive protein (28-96%), lymphopenia (34-80%), and pneumonia signs in diagnostic imaging (7-99%). The most frequent maternal outcomes were C-section (23-96%) and preterm delivery (14-64%). Most of their babies were asymptomatic (16-93%) or presented fever (0-50%), low birth weight (5-43%) or preterm delivery (2-69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 versus non-COVID-19 pregnant women was 1.88 (95% Confidence Interval [CI] 1.36-2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05-4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. Conclusion This comprehensive overview supports that pregnant women with COVID-19 may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.

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Modelling digital and manual contact tracing for COVID-19. Are low uptakes and missed contacts deal-breakers? -

Comprehensive testing schemes, followed by adequate contact tracing and isolation, represent the best public health interventions we can employ to reduce the impact of an ongoing epidemic when no or limited vaccines are available and the implications of a full lockdown are to be avoided. However, the process of tracing can prove feckless for highly-contagious viruses such as SARS-Cov-2. The interview-based approaches often miss contacts and involve significant delays, while digital solutions can suffer from insufficient adoption rates or inadequate usage patterns. Here we present a novel way of modelling different contact tracing strategies using a generalized multi-site mean-field model, which can naturally assess the impact of both manual and digital approaches. Our methodology can readily be applied to any compartmental formulation, thus enabling the study of several complex pathogens. We use this technique to simulate a new epidemiological model, SEIR-T, and show that, given the right conditions, tracing in a COVID-19 epidemic can be effective even when digital uptakes are sub-optimal or interviewers miss a fair proportion of the contacts.

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Hypercoagulation detected by Rotational Thromboelastometry predicts mortality in COVID-19: A risk model based on a prospective observational study. -

ABSTRACT Background: Severe disease due to COVID-19 has been shown to be associated with hypercoagulation. Early identification of prothrombotic patients may help guiding anticoagulant treatment and improve survival. The aim of this study was to assess Rotational Thromboelastmetry (ROTEM) as a marker of coagulopathy in hospitalized COVID-19 patients. Methods: This was a prospective, observational study. Patients hospitalized due to a COVID-19 infection were eligible for inclusion. Conventional coagulation tests and ROTEM were taken after hospital admission, and patients were followed for 30 days. Patient characteristics and outcome variables were collected, and a prediction model including variables age, respiratory frequency and ROTEM EXTEM-MCF, was developed using logistic regression to evaluate the probability of death. Results: Out of the 141 patients included, 18 (13%) died within 30 days. D-dimer (p=0.01) and Activated Partial Thromboplastin Time (APTT) (p=0.002) were increased, and ROTEM EXTEM-/INTEM-CT (p<0.001) were prolonged in non-survivors. In the final prediction model, the risk of death within 30 days for a patient hospitalized due to COVID-19 was increased with increased age, respiratory frequency and EXTEM-MCF. Longitudinal ROTEM data in the severely ill subpopulation showed enhanced hypercoagulation. In our in vitro analysis, no heparin effect on EXTEM-CT was observed, supporting a SARS-CoV-2 effect on initiation of coagulation. Conclusions: Here we show that hypercoagulation measured with ROTEM predicts 30-day mortality in COVID-19. Longitudinal ROTEM data strengthen the hypothesis of hypercoagulation as a driver of severe disease in COVID-19. Thus, ROTEM may be a useful tool to assess disease severity in COVID-19, and could potentially guide anticoagulation therapy.

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A 6-mRNA host response whole-blood classifier trained using patients with non-COVID-19 viral infections accurately predicts severity of COVID-19 -

Background Determining the severity of COVID-19 remains an unmet medical need. Our objective was to develop a blood-based host-gene-expression classifier for the severity of viral infections and validate it in independent data, including COVID-19. Methods We developed the classifier for the severity of viral infections and validated it in multiple viral infection settings including COVID-19. We used training data (N=705) from 21 retrospective transcriptomic clinical studies of influenza and other viral illnesses looking at a preselected panel of host immune response messenger RNAs. Results We selected 6 host RNAs and trained logistic regression classifier with a cross-validation area under curve of 0.90 for predicting 30-day mortality in viral illnesses. Next, in 1,417 samples across 21 independent retrospective cohorts the locked 6-RNA classifier had an area under curve of 0.91 for discriminating patients with severe vs. non-severe infection. Next, in independent cohorts of prospectively (N=97) and retrospectively (N=100) enrolled patients with confirmed COVID-19, the classifier had an area under curve of 0.89 and 0.87, respectively, for identifying patients with severe respiratory failure or 30-day mortality. Finally, we developed a loop-mediated isothermal gene expression assay for the 6-messenger-RNA panel to facilitate implementation as a rapid assay. Conclusions With further study, the classifier could assist in the risk assessment of COVID-19 and other acute viral infections patients to determine severity and level of care, thereby improving patient management and reducing healthcare burden.

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Is WHO International Standard for Anti-SARS-CoV-2 Immunoglobulin Clinically Useful? -

Background: The introduction of vaccination against SARS-CoV-2 infection needs precise instruments for quality control of vaccination procedure, detection of poor immunological response and estimation of the achieved protection against the disease but also against infection and being infective. Objective: To compare new automated SARS-CoV 2 Ig assay performance characteristics from the automated Elecsys SARS CoV 2 S (Roche) with the new LIAISON SARS-CoV-2 TrimericS IgG (DiaSorin) assay and their compatibility with WHO International Standard for anti-SARS-CoV-2 immunoglobulin. In the context of the mass vaccination programs, we undertook the investigation of clinical utility of the two new automated assays by analyzing results in samples collected at specified time points relative to the vaccination time. Design: Prospective assay evaluation. Patients: Medical staff undergoing vaccination with BioNTech/Pfizer Comirnaty vaccine between January and March 2021 (n = 79) and referred for serum antiSARS-CoV 2 Ig testing prior to vaccination, 21 days after the first dose, and 8, 14 and 30 days after the second dose. Main Outcome Measure(s): Serum antibody levels measured with Roche and DiaSorin assays. Results: Intra-assay imprecision was low with DiaSorin at 3.46%; and Roche at 2.5%. The Passing-Bablok regression equation for all tested samples was y (DiaSorin) = 184.61 + (1.03 x Roche) and the correlation between the assays (r=0.587; p < 0.0001). Conclusions: The novel automated assays exhibit strong concordance in calibration, with assay-specific interpretation required for routine clinical use. These results highlight the need for further work on the international standard of measurement of SARS-CoV 2 Ig especially in era of vaccination. The serological assays can be useful to detect IgG/IgM antibodies, to assess the degree of immunization, to trace the contacts, and to support the decision to readmit people to work or vaccinate them again. However, the values generated by both assays can be markedly different, and assay-specific and personalized interpretation is required.

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Rapid implementation of cross-sectional study: Post-acute sequelae of SARS-CoV-2 (PASC) in a racially and ethnically diverse sample in Illinois -

ABSTRACT Little is known about the pattern and course of recovery following acute COVID-19. Increasing numbers of reports describe persistent illness following infection with SARS-COV-2, also known as Post-Acute Sequelae of SARS-CoV-2 (PASC). This report describes the methods and results of a multi-pronged strategy to rapidly identify and enroll, over a one week period in April 2021, a racially and ethnically diverse sample of individuals and to characterize PASC among a this diverse sample. Participants were recruited through community outreach, clinical registries, and research registries across four cities in Illinois to complete an online survey. We examined presence of symptoms among 246 individuals who were at least three months past testing positive for SARS-CoV-2. Respondents were 70% female; 48% Hispanic/Latinx; 18% Black, and 28% White. Most had mild illness (78% were not hospitalized), and 26% reported they had not yet returned to their usual health within 3 months of their diagnosis. The most prevalent symptoms persisting 3-months following COVID-19 diagnosis included fatigue (20%), difficulty thinking (19%), problems with taste or smell (15%), and muscle or body aches (15%). In a multivariable logistic regression model, older age (40-59 vs. 18-39 years: adjusted odds ratio [aOR] = 0.46 [95% confidence interval, 0.24 to 0.90]) and having been hospitalized with COVID-19 (vs. not hospitalized: aOR = 0.28 [0.12 to 0.64]) were independently associated with a lower likelihood of recovery within 3 months. Compromised health continued well beyond the acute phase of COVID-19 in our ethnically diverse sample, especially among older individuals and those who were hospitalized. The partnerships with community- and faith-based organizations developed for the current study offer the potential to broadly disseminate study findings and to further understand and mitigate underlying determinants of risk, severity, and duration of PASC.

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The comparison of vaccine hesitancy of COVID-19 vaccination in China and the United States -

Background: To investigate the differences in vaccine hesitancy and preference of the currently available COVID-19 vaccines between two countries, viz. China and the United States (US). Method: A cross-national survey was conducted in both China and the US, and discrete choice experiments as well as Likert scales were utilized to assess vaccine preference and the underlying factors contributing to the vaccination acceptance. A propensity score matching (PSM) was performed to enable a direct comparison between the two countries. Results: A total of 9,077 (5,375 and 3,702, respectively, from China and the US) respondents have completed the survey. After propensity score matching, over 82.0% respondents from China positively accept the COVID-19 vaccination, while 72.2% respondents form the US positively accept it. Specifically, only 31.9% of Chinese respondents were recommended by a doctor to have COVID-19 vaccination, while more than half of the US respondents were recommended by a doctor (50.2%), local health board (59.4%), or friends and families (64.8%). The discrete choice experiments revealed that respondents from the US attached the greatest importance to the efficacy of COVID-19 vaccines (44.41%), followed by the cost of vaccination (29.57%), whereas those from China held a different viewpoint that the cost of vaccination covers the largest proportion in their trade-off (30.66%), and efficacy ranked as the second most important attribute (26.34%). Also, respondents from China tend to concern much more about the adverse effect of vaccination (19.68% vs 6.12%) and have lower perceived severity of being infected with COVID-19. Conclusion: While the overall acceptance and hesitancy of COVID-19 vaccination in both countries are high, underpinned distinctions between countries are observed. Owing to the differences in COVID-19 incidence rates, cultural backgrounds, and the availability of specific COVID-19 vaccines in two countries, the vaccine rollout strategies should be nation-dependent.

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Transition in Learning Approach for Undergraduate Medical Students of Bangladesh in Covid 19 Pandemic: A Situation Analysis -

Background and Objectives: The outbreak of Covid 19 pandemic has fundamentally transformed the landscape of medical education system upside down worldwide. And this unanticipated transition of medical education without any pre build infrastructure has made this altered prospect more challenging in Bangladesh. Though many countries across the world utilize web based learning along with traditional approach, but medical students of Bangladesh are mostly unfamiliar and unaccustomed with this newly imposed online learning avenue. Therefore, this study has evaluated the familiarity, usage, attitude of students towards online class and figured out the barriers witnessed by students in web based learning in Bangladesh prospect. Methods: This cross sectional, questionnaire based study was conducted in medical colleges across Bangladesh. A questionnaire linked to google form were distributed to undergraduate medical students all over Bangladesh through different social platforms. Students who showed interest, filled up the questionnaire with consent and submitted voluntarily. Those answered questionnaires were automatically stored in Google drive in a specific email ID. After completion of data collection, all data were transferred in a spread sheet and statistical analysis was done. Results: A total of 1709 students participated in this study willingly from around Bangladesh. Among the respondents 45.1% were satisfied with online class. Though most of the students (45.8%) think online class in medical education is not effective like traditional lectures but many of them (47.4%) agrees to the point that online class should have complementary role in medical education. One of the strong attitude of medical students regarding web based learning revealed in this study that, most of them undoubtedly in unison (49.5% disagree, 30.3% strongly disagree) with that web based learning can never replace traditional lecture class in medical education. 77.2% students responded that web based learning is interactive. 54.9% students pointed out that they experienced interrupted internet connections with low internet speed during class time which is a barrier to WBL. 83.2% of the respondents complained about facing audio visual problem during online class which is attributed to the poor network connectivity. Most students in Bangladesh (74.8%) found online classes costly and 53.8% of the students needed technical supports for continued online class. Conclusion: This study finding can suggest a potential reform for medical education system of Bangladesh addressing the obstacles and expectations of students which can execute a fruitful web based learning in Bangladesh.

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Quantifying COVID-19 vaccination hesitancy during early vaccination rollout in Canada -

Background: Understanding vaccination hesitancy during early vaccination rollout in Canada can help the government9s vaccination efforts in education and outreach, which may help eventually achieving herd immunity. This study uses an online survey to assess vaccination hesitancy in population subgroups in Canada. Method: Panel members from the nationally representative Angus Reid Forum were randomly invited to complete an online survey on their experiencing with COVID-19 symptoms and testing, as well as intention to vaccination against COVID-19. Respondents were asked “when a vaccine against the coronavirus becomes available to you, will you get vaccinated or not?” Vaccination hesitancy was defined as choosing “No - I will not get a coronavirus vaccination” as a response. Results: 14,621 panel members (46% male and 53% female) completed the survey. Although the respondents overrepresent age 60+ and higher levels of education, other demographics, the prevalences of smoking, obesity, diabetes and hypertension were comparable to the Canadian national census and health surveys. COVID-19 vaccination hesitancy is relatively low overall (9%). Being a resident of Alberta (predicted probability = 15%), aged 40-59 (OR = 0.87, 0.78-0.97, predicted probability = 12%), identifying as a visible minority (OR = 0.56, 0.37-0.84, predicted probability = 15%), having some college level education or lower (predicted probability = 14%), or living in households of at least 5 are related to greater vaccination hesitancy (OR = 0.82, 0.76-0.88, predicted probability = 13%). Conclusion: Our study enhances the understanding of COVID-19 vaccination hesitancy and identifies key population groups with higher vaccination hesitancy. As the Canadian COVID-19 vaccination effort continues, policymakers may focus outreach, education, and other efforts on these groups, which also represent groups with higher risks for contracting and dying from COVID-19. Furthermore, Canada would need to vaccinate virtually the entire population to reach herd immunity due to its relatively low infection level, and a high vaccination hesitancy would be a major hurdle to achieving that.

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Covid-19 Sentry

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