Indonesian medical frontliners during the coronavirus disease 2019 pandemic: Have we been protecting them enough?

Background and Aim: The coronavirus disease 2019 pandemic has brought deteriorating physical and mental burdens to health care workers (HCWs) in Indonesia, mainly attributed to the lack of protection and screening among HCWs, patients' concealment of their travel and medical history, and perceived social stigma and discrimination. Hence, we deliver our perspectives and recommendations based on the current situation in Indonesia to enforce their safeties. We encourage stakeholders to implement a systematic approach by employing stringent prevention strategies, ensuring adequate personal protective equipment (PPE) provision and equitable PPE distribution, and routine HCWs screening to prevent nosocomial clusters, in addition to the provision of psychosocial support to HCWs by offering social aids and psychological sessions. Furthermore, social stigma and discrimination toward HCWs and patients should also be addressed and mitigated, thus preventing concealments of patients' history and alleviating emotional burdens. We believe that providing continuous support to HCWs would lead to key benefits in ensuring a winning battle against the COVID-19 pandemic. Relevance for Patients: HCWs are pivotal players in winning the battle against the COVID- 19 pandemic. Ensuring their safety and well-being will enable them to deliver better healthcare services, thus resulting in mutual benefit for themselves, the patients, and the nation's recovery.

COVID-19: Prospective Challenges and Potential Vaccines

Context . RNA viruses exhibit an extraordinary ability to evolve in a changing environment and to switch from animal hosts to humans. The ongoing COVID-19 pandemic, recognized as a respiratory disease, is an example of zoonotic transmission of the RNA virus known as SARS-CoV-2. The development and regulatory approval of a vaccine against SARS-CoV-2 pose multiple preventive and therapeutic challenges, especially during an ongoing pandemic. Objective . The review intended to examine the challenges and recent achievements in the development of vaccine candidates against COVID-19. Design . The research team performed a literature review, searching relevant and up to date information from the literature. The sources of data included Google Scholar, PubMed, NCBI, and Yahoo. The search terms used were COVID-19 challenges, SARS-CoV-2 prospective challenges, RNA viruses adoptability, host switching by RNA viruses, COVID-19 vaccines. Setting . The study took place at the digital libraries of contributing institutions. The data was combined, selected for further analysis and manuscript preparation at King Abdulaziz University. Results . RNA viruses with high rate of genome alterations and evolution have better chances to survive in the adverse environmental conditions by adopting the alternate host species. The recent epidemics such as SARS, MERS, and COVID-19 are examples of zoonotic transmission of RNA viruses from animal species to the humans. However, the mechanisms involved in the switching-on to new host species need further investigations to control the zoonotic transmissions in near future. As of April 2020, 115 candidate vaccines were being evaluated;78 of them had been found to be active, and a few of them are in Phase I trials. In the development of different types of vaccine candidates against COVID19, multiple international pharmaceutical and biotechnology companies are involved. Conclusions . Emerging and re-emerging pathogenic RNA viruses pose a serious threat to human health. Little is known about the human-host adoptive mechanism for zoonotic transmission. Deep insights into the molecular mechanism responsible for the switching of animal or bird viruses to humans could provide target molecules or events to prevent such transmissions in the near future. Fast development and approval of efficacious and safe vaccines is key to the effort to provide preventive measures against COVID-19 and future viruses. However, the development and availability of a vaccine candidate is a time-consuming process and often can't be completed during an epidemic. Currently, several types of vaccines are under development, and most of them won't realistically be available in time for the present COVID-19 pandemic.