COVID-19 Reinfection Rate and Related Risk Factors in Fars Province, Iran: A Retrospective Cohort Study

Background: Reinfection with Coronavirus Diseases 2019 (COVID-19) has raised remarkable public health concerns globally. Therefore, the present retrospective cohort study intended to investigate COVID-19 reinfection in registered patients of Fars province in Iran from February 2020 to April 2021. Methods: The patients' data, including the COVID-19 infection, symptoms, comorbidities, and demographics, were collected using the Health Information Systems (HISs). The patients were divided into three groups in terms of the duration between the initial infection and reinfection, including 28-44, 45-89, and more than 90 days. Following the univariate analysis, logistic regression was used to investigate the factors effective on COVID-19 reinfection. Results: A total of 213768 patients had a positive Polymerase Chain Reaction (PCR) test. The reinfection rate was 0.97% (2079 patients). Of these re-infected individuals, 14.9%, 18.5%, and 66.6% had their second positive test 28-45, 45-89, and ≥90 days later, respectively. The mean duration between the initial infection and reinfection was 130.56 days (29-370 days). The chance of reinfection was significantly higher in the youths (Odds Ratio (OR)=2.055;P<0.001), men (OR=1.283;P<0.001), urban population (OR=1.313;P<0.001), and healthcare providers (OR=4.453;P<0.001). The patients with chronic pulmonary diseases, chronic kidney diseases, and malignancy were 1.421 (P=0.036), 2.239 (P<0.001), and 3.437 (P<0.001) times, respectively, more likely prone to reinfection. Conclusion: The results of this study showed that there is a higher risk of reinfection in several vulnerable groups including healthcare providers, young individuals, residents of urban areas, men, and individuals with underlying diseases.

Lockdown Effect on COVID-19 Incidence and Death: Iran Experience.

OBJECTIVE: Countries are trying several policy options for decreasing the incidence and burden of the coronavirus disease 2019 (COVID-19). One of these strategies is a lockdown, complete closure, to reduce the risk of distributing disease by means of social interactions. This study aimed to analyze the effect of a 3-week lockdown on the mortality and morbidity of COVID-19 in Iran. METHODS: Official daily data on COVID-19 incidence and death reported by the World Health Organization (WHO) were extracted from September 1, 2020, to January 14, 2021. Data were analyzed using interrupted time series analysis by means of STATA 14 software. RESULTS: Lockdown resulted in a significant reduction in the daily death from COVID-19 in the short-term (ß = -139; P < 0.01) and in the long-term (ß = -12; P < 0.01). Moreover, lockdown in the short-term insignificantly (ß = -21.58; P = 0.969), and in the long-term significantly (ß = -317.31; P < 0.01) reduced the COVID-19 daily incidence. CONCLUSIONS: The results showed that the lockdown has a significant effect on incidence and death numbers. Therefore, it could be a suitable short-term strategy for controlling the COVID-19 outbreak. On the other hand, its negative effects on households and businesses should be considered.

The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system.

Background: COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method: This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews' audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result: Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure," "research for evidence-based decision making," "dedicated financing to the pandemic," "prevention of disruption in the effective provision of services and medicines," "enriching the authority of the Ministry of Health by focusing on interactions," "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives," "reforming educational approaches in training students in medical universities," as well as "lessons learned from neglected aspects." Conclusion: To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.

The necessity revealed by COVID-19 pandemic: Paradigm shift of Iran's healthcare system

Background COVID-19 pandemic has resulted in drastic changes around the world, revealing vulnerable aspects of healthcare systems. This study aimed to explore how Iranian healthcare system experienced the paradigm shift during the pandemic and determine the aspects that need improvement during the pandemic era. Method This qualitative study was conducted in 2021. A framework analysis approach was used to analyze the content of the 19 semi-structured interviews with the healthcare system experts from Shiraz University of Medical Sciences (SUMS). The interviews‘ audio files changed into transcript after each session and data was saturated at the 19 interview. To increase the trustworthiness of the study, Guba and Lincoln's criteria including credibility, transferability, dependability, and confirmability were used. Goldsmith's five-step framework analysis was used applying MAX QDA version 10 software. Result Eight main themes and 20 subthemes were explored. The main themes included "strengthening the electronic health infrastructure,” "research for evidence-based decision making,” "dedicated financing to the pandemic,” "prevention of disruption in the effective provision of services and medicines,” "enriching the authority of the Ministry of Health by focusing on interactions,” "recruiting, managing and empowering health human resources with attention to financial and non-financial incentives,” "reforming educational approaches in training students in medical universities,” as well as "lessons learned from neglected aspects.” Conclusion To be ready to respond to a possible future pandemic and for a paradigm shift, bold steps must be taken to make fundamental changes in various aspects of the healthcare system including e-health development, evidence-based decision making, dedicated budgets for pandemics, reinforcement of interactions at the national and international level, as well as sufficient attention to healthcare workers from all financial, non-financial and educational aspects.

How Much Money Should be Paid for a Patient to Isolate During the COVID-19 Outbreak? A Discrete Choice Experiment in Iran.

INTRODUCTION: Isolation of COVID-19 patients is a vital strategy for preventing the spread of the virus. Isolation without any incentive or compensation for the patients cannot be effective. We sought to find the monetary value of the willingness to accept (WTA) being isolated for COVID-19 in Iran. METHODS: In this discrete choice experiment, scenarios were designed by reviewing the literature and semi-structural interviews. Fourteen choice sets with two scenarios were included in an internet-based questionnaire that was sent to the Telegram Social Network. A total of 617 individuals completed the questionnaire. A random-effects logistic regression model was used for the main analysis. RESULTS: The average monetary value of a WTA 7 days of isolation was US$51.71 (95% confidence interval [CI] 43.09-60.33). The WTA for one day of isolation was US$1.48 (95% CI 1.11-1.85) for unemployed groups, US$1.49 (95% CI 1.18-1.79) for office employees and US$1.36 (95% CI 0.73-2.01) for manual workers. The WTA was 0.44 (95% CI 0.35-0.53) US$ for low-income groups, US$0.68 (95% CI 0.52-0.84) for middle-income groups and US$0.77 (95% CI 0.35-1.18) for high-income groups. CONCLUSIONS: Our findings suggested that financial preferences for being isolated vary widely across individuals within different socioeconomic groups. Policymakers should consider these differences when designing effective intervention to increase compliance with the isolation protocols during infectious disease outbreaks.

An investigation of depression, anxiety, and stress and its relating factors during COVID-19 pandemic in Iran.

BACKGROUND: The COVID-19 (SARS-CoV-2) is an emerging epidemic caused by the new Coronavirus. It has affected more than 200 countries, infected 5,939,234 people, and killed 367,255 in the world until 1 June 2020. While the disease epidemic could affect population mental health, this study aimed to investigate stress, anxiety, and depression during the Corona pandemic in Iran. METHODS: An online survey was designed using the depression, anxiety, and stress scale (DASS-21) questionnaire. The questionnaire was available for all Iranian population from 18 to 28 April 2020. Finally, 1498 participants filled the questionnaire using snowball sampling. Data were analyzed using multivariate regression models. RESULTS: Findings showed that most participants had experienced a normal level of stress (36.6%), anxiety (57.9%) and depression (47.9%). About 2.5% of respondents report an extremely severe level of stress. This amount of anxiety and depression was 6.3 and 7.9%, respectively. Regression model showed being female (CI: - 1.299; - 0.248), living with a high risk family member (CI: 0.325; 1.400), health status (CI: - 0.857; - 0.595), economic status (CI: - 0.396; - 0.141), social capital (CI: - 0.475; - 0.244), risk of disease (CI: 0.081; 0.729), and following COVID-19 news (CI: 0.111; 0.551) have a relation with stress level. Education level (CI: - 0.252; - 0.017), living with a high risk family member (CI: 0.0301; 1.160), health status (CI: - 0.682; - 0.471), social capital (CI: - 0.236; - 0.048), risk of disease (CI: 0.154; 0.674), and following COVID-19 news (CI: 0.046; 0.401) have a relation with anxiety score. Depression score was in relation with education level (CI: - 0.263; - 0.022), having a high-risk family member (CI: 0.292; 1.155), health status (CI: - 0.687; - 0.476), social capital (CI: - 0.235; - 0.048), risk of disease (CI: 0.144; 0.667), and following Covid-19 news (CI: 0.053; 0.408). CONCLUSIONS: Most of the factors related to depression, anxiety, and stress are related to COVID-19, such as having a vulnerable person in the family, risk of disease, and following COVID-19 news. The findings suggest the factors that should be taken into consideration for improving population mental health during pandemics.