Trust during COVID-19: Which factors matter most?

The objective of this experiment was to offer a preliminary exploration into the key factors underlying trust in healthcare systems around the world, in light of the COVID-19 global pandemic. Participants were recruited across ten countries and were asked to complete a two-part questionnaire, in which they rated their country's healthcare system on a scale from 1-5, according to ten trust-related factors, translated specifically to pertain to healthcare, and 4 key pillars of trust: benevolence, reliability, competence and predictability. Correlation analyses between these two separate measures revealed that honesty, consistency, and reasonableness were the most impactful factors underlying trust across the entire population. All other findings are detailed in the main text. This study allowed us to arrive at a preliminary determination of the most impactful factors underlying trust, both at a global and national level.

Medical student satisfaction in online modified clinical clerkship curriculum during the COVID-19 pandemic

Objective: The COVID-19 pandemic has caused significant disruption to medical education and clinical training. This not only affected delivery of the clinical curriculum but also resulted in stressors which may impede learning. This study aimed to assess the impact of a modified on-line curriculum in selected clinical clerkships in the Faculty of Medical Sciences, UWI, Cave Hill Campus, during the COVID-19 pandemic. Design and Methods: Fourth and Fifth year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy (Online Learning Self-Efficacy Scale) and perceived effectiveness of online versus face-to-face learning. Students who agreed/strongly agreed to the statement "Overall, I was highly satisfied with the clerkship placement" were classified as satisfied. Result(s): 88 of 131 students completed the survey (response rate = 67 %). More than half of students (51%) were satisfied with online clerkship delivery. Fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% for face-to-face learning. Perception of effectiveness of online learning and face-to-face teaching of clinical skills was 18% and 89%, respectively (p < 0.0001). Fewer students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). Students satisfied with online learning were more likely to be female (OR = 2.6) and older respondents. Mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and social competencies. Students' perception of online learning was strongly associated with online selfefficacy. Conclusion(s): Students perceived online learning to be least effective for enhancing clinical skills. Students' perception of effectiveness of online learning was strongly associated with online self-efficacy. Further research to examine how the perception of online delivery impacts student performance in online learning is recommended. Educators have been challenged to design online programmes that facilitate development of clinical and social skills. Understanding medical students' experiences and identifying unmet needs will help improve clerkship curriculum and support medical students during and after the COVID-19 pandemic.

Risk communication and community engagement in COVID-19: Fighting infodemics among non-governmental/ community-based organizations in Africa.

As the world battles the latest strain of the coronavirus known as COVID-19 characterized as a pandemic by the World Health Organization (WHO), "infodemics" - an excessive amount of (mostly untrue) information about the pandemic that makes it difficult to discern essential information - has been identified by the health body as one of the major obstacles to be tackled to win the war against the raging pandemic. In a bid to control spread of the virus, the WHO published a guideline on Risk Communication and Community Engagement (RCCE) to COVID-19, noting these responses are vital for containment. The COVID-19 pandemic is testing and stretching health systems and their ability to effectively communicate with their populations. Failure to communicate accurate public health facts could lead to losses of trust, reputation, economy, and lives. This paper turns its searchlight on nongovernmental and community-based organizations (NGOs and CBOs) in Africa, and how they handle infodemics in an information environment battling not just a health pandemic, but a hoax pandemic too. Methods: The study employed mixed method, with data drawn from Africanbased NGOs and CBOs via online questionnaire and interviews against the backdrop of the Situational Theory of Publics. Findings reveal, based on what NGO/CBO survey respondents report their local clients think, that many at the grassroots still do not believe COVID-19 is real, while others view it as government's scheme to embezzle funds. NGO/CBOs therefore look to WHO and Health Ministries for accurate information. It concludes that RCCE with the public and atrisk populations help reduce confusion and builds trust in the public health guidance community members can take thereby restricting the disease spread as an outcome of the RCCE approach.

Socioecological vulnerability and the risk of zoonotic disease emergence in Brazil.

In developing countries, outbreaks of zoonotic diseases (ZDs) result from intertwined ecological, socioeconomic, and demographic processes that shape conditions for (i) increased contact between vulnerable human population and wildlife in areas undergoing environmental degradation and (ii) the rapid geographic spread of infections across socially vulnerable regions. In Brazil, recent increases in environmental and social vulnerabilities, amplified by economic and political crises, are potential triggers for outbreaks. We discuss Brazilian features that favor outbreaks and show a novel quantitative method for zoonotic risk assessment. Using data on nine ZDs from 2001 to 2019, we found that the most significant causal variables were vegetation cover and city remoteness. Furthermore, 8 of 27 states presented low-level risk of ZD outbreaks. Given the ZD-bushmeat connection, we identified central hunted mammals that should be surveilled to prevent spillover events. The current challenge is to coordinate intersectoral collaboration for effective One Health management in megadiverse countries with high social vulnerability and growing environmental degradation like Brazil.

The story of critical care in Asia: a narrative review.

BACKGROUND: Asia has more critically ill people than any other part of our planet. The aim of this article is to review the development of critical care as a specialty, critical care societies and education and research, the epidemiology of critical illness as well as epidemics and pandemics, accessibility and cost and quality of critical care, culture and end-of-life care, and future directions for critical care in Asia. MAIN BODY: Although the first Asian intensive care units (ICUs) surfaced in the 1960s and the 1970s and specialisation started in the 1990s, multiple challenges still exist, including the lack of intensivists, critical care nurses, and respiratory therapists in many countries. This is aggravated by the brain drain of skilled ICU staff to high-income countries. Critical care societies have been integral to the development of the discipline and have increasingly contributed to critical care education, although critical care research is only just starting to take off through collaboration across groups. Sepsis, increasingly aggravated by multidrug resistance, contributes to a significant burden of critical illness, while epidemics and pandemics continue to haunt the continent intermittently. In particular, the coronavirus disease 2019 (COVID-19) has highlighted the central role of critical care in pandemic response. Accessibility to critical care is affected by lack of ICU beds and high costs, and quality of critical care is affected by limited capability for investigations and treatment in low- and middle-income countries. Meanwhile, there are clear cultural differences across countries, with considerable variations in end-of-life care. Demand for critical care will rise across the continent due to ageing populations and rising comorbidity burdens. Even as countries respond by increasing critical care capacity, the critical care community must continue to focus on training for ICU healthcare workers, processes anchored on evidence-based medicine, technology guided by feasibility and impact, research applicable to Asian and local settings, and rallying of governments for support for the specialty. CONCLUSIONS: Critical care in Asia has progressed through the years, but multiple challenges remain. These challenges should be addressed through a collaborative approach across disciplines, ICUs, hospitals, societies, governments, and countries.

Risk management assessment of mobile crowds: The case of the Black Nazarene procession in Manila, Philippines

The Philippines is a highly Christianized country where religious events, such as the Black Nazarene procession, are celebrated on a massive scale. The annual procession, characterized by devotees pushing the carriage of the Black Nazarene, in the city of Manila attracts thousands of devotees. The 2019 procession took 21.35 h to traverse a 6.94-km route at an average speed of 0.33 km per hour. The extreme size and density of attending crowds make injuries and fatalities a common occurrence. Despite the usual risks that similar events entail, limited studies have been conducted to characterize and evaluate big crowds. This study developed methods and policies that aim to improve risk management planning for the event. Using video graphics, a static grid analysis was performed to systematically evaluate and capture actual participants' density and speed. The aggressiveness, density, and group formation of devotees at varying road widths were found to significantly influence the procession's movement throughout its duration;at least 56 pedestrians are needed to push the carriage from behind for smoother forward movement. Finally, proper allocation of human resources by local government departments involved in event management was recommended to potentially minimize the incidence of related injuries and deaths.

COVID-19: A Single-Center ICU Experience of the First Wave in the Philippines.

On January 30, 2020, the WHO declared the novel coronavirus of 2019 a pandemic, causing millions of cases and thousands of deaths worldwide, exposing the vulnerabilities of healthcare systems around the world with each country having its own experience. These ranged from patient clinical profiles to management recommendations and to government interventions. There is a paucity of published data regarding Philippine experience. This study is a retrospective, descriptive study of ninety-one COVID-19 probable patients admitted in the COVID ICU of The Medical City from March 16 to May 7, 2020. We described clinical and demographic characteristics amongst COVID-19-confirmed and -negative patients. Therapeutic interventions including COVID-19 investigational drug use and other organ failure strategies were noted and tested for association with ICU survivors and nonsurvivors. We observed that there was no therapeutic intervention that was associated with improved outcomes, with some interventions showing trends favoring the ICU nonsurvivor group. These interventions include, but are not limited to, the use of hydroxychloroquine and tocilizumab, and prone positioning. We also observed that a higher SAPS-3 score was associated with the COVID-19 positive group and the ICU nonsurvivor group. On PubMed search, there seems to be no Philippine-specific literature regarding COVID-19 ICU experience. Further investigations to include more variables are recommended.

Identification of potential inhibitors of SARS-CoV-2 main protease from Aloe vera compounds: A molecular docking study.

SARS-CoV-2 is the pathogen agent of the new corona virus disease that appeared at the end of 2019 in China. There is, currently, no effective treatment against COVID-19. We report in this study a molecular docking study of ten Aloe vera molecules with the main protease (3CLpro) responsible for the replication of coronaviruses. The outcome of their molecular simulation and ADMET properties reveal three potential inhibitors of the enzyme (ligands 6, 1 and 8) with a clear preference of ligand 6 that has the highest binding energy (-7.9 kcal/mol) and fully obeys the Lipinski's rule of five.