A cross-national study of multilevel determinants on public fully vaccination against COVID-19.

The pandemic caused by SARS-CoV-2 (COVID-19) has impacted the world for close to three years and led to substantial costs to public well-being. To mitigate the pandemic's damage, the most effective approach lies in the vaccine. This study aims to investigate multilevel predictors of the public decision to become fully vaccinated against COVID-19. Data from a cross-national survey on representative samples are merged with country-level indicators. Multilevel logistic regression models are estimated on populations from 15 countries. Findings show that people who agree the government handles the pandemic well, believe the health officials would provide an effective vaccine, perceive the virus's danger, and are older are more likely to get fully vaccinated than their counterparts. Meanwhile, the national case rate and vaccination rate also affect one's decision to become fully vaccinated. Furthermore, there are significant cross-level interactions as people are more inclined to become fully vaccinated if they agree with the government's performance, perceive the virus's danger, and also reside in countries with higher case and vaccination rates. This study shows cross-national evidence regarding multilevel determinants of public vaccine uptake. Knowing the profiles among populations who have become fully vaccinated or not helps public health experts leverage factors and maximize vaccination.

A SARS-CoV-2-Related Virus from Malayan Pangolin Causes Lung Infection without Severe Disease in Human ACE2-Transgenic Mice.

Coronavirus disease 2019 (COVID-19), which is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the most severe emerging infectious disease in the current century. The discovery of SARS-CoV-2-related coronaviruses (SARSr-CoV-2) in bats and pangolins in South Asian countries indicates that SARS-CoV-2 likely originated from wildlife. To date, two SARSr-CoV-2 strains have been isolated from pangolins seized in Guangxi and Guangdong by the customs agency of China, respectively. However, it remains unclear whether these viruses cause disease in animal models and whether they pose a transmission risk to humans. In this study, we investigated the biological features of a SARSr-CoV-2 strain isolated from a smuggled Malayan pangolin (Manis javanica) captured by the Guangxi customs agency, termed MpCoV-GX, in terms of receptor usage, cell tropism, and pathogenicity in wild-type BALB/c mice, human angiotensin-converting enzyme 2 (ACE2)-transgenic mice, and human ACE2 knock-in mice. We found that MpCoV-GX can utilize ACE2 from humans, pangolins, civets, bats, pigs, and mice for cell entry and infect cell lines derived from humans, monkeys, bats, minks, and pigs. The virus could infect three mouse models but showed limited pathogenicity, with mild peribronchial and perivascular inflammatory cell infiltration observed in lungs. Our results suggest that this SARSr-CoV-2 virus from pangolins has the potential for interspecies infection, but its pathogenicity is mild in mice. Future surveillance among these wildlife hosts of SARSr-CoV-2 is needed to monitor variants that may have higher pathogenicity and higher spillover risk. IMPORTANCE SARS-CoV-2, which likely spilled over from wildlife, is the third highly pathogenic human coronavirus. Being highly transmissible, it is perpetuating a pandemic and continuously posing a severe threat to global public health. Several SARS-CoV-2-related coronaviruses (SARSr-CoV-2) in bats and pangolins have been identified since the SARS-CoV-2 outbreak. It is therefore important to assess their potential of crossing species barriers for better understanding of their risk of future emergence. In this work, we investigated the biological features and pathogenicity of a SARSr-CoV-2 strain isolated from a smuggled Malayan pangolin, named MpCoV-GX. We found that MpCoV-GX can utilize ACE2 from 7 species for cell entry and infect cell lines derived from a variety of mammalian species. MpCoV-GX can infect mice expressing human ACE2 without causing severe disease. These findings suggest the potential of cross-species transmission of MpCoV-GX, and highlight the need of further surveillance of SARSr-CoV-2 in pangolins and other potential animal hosts.

Examining COVID-19 vaccine attitude using SEM-Artificial Neural Networks approach: a case from Reddit community.

As new coronavirus variants continue to emerge, in order to better address vaccine-related concerns and promote vaccine uptake in the next few years, the role played by online communities in shaping individuals' vaccine attitudes has become an important lesson for public health practitioners and policymakers to learn. Examining the mechanism that underpins the impact of participating in online communities on the attitude toward COVID-19 vaccines, this study adopted a two-stage hybrid structural equation modeling (SEM)-artificial neural networks (ANN) approach to analyze the survey responses from 1037 Reddit community members. Findings from SEM demonstrated that in leading up to positive COVID-19 vaccine attitudes, sense of online community mediates the positive effects of perceived emotional support and social media usage, and perceived social norm mediates the positive effect of sense of online community as well as the negative effect of political conservatism. Health self-efficacy plays a moderating role between perceived emotional support and perceived social norm of COVID-19 vaccination. Results from the ANN model showed that online community members' perceived social norm of COVID-19 vaccination acts as the most important predictor of positive COVID-19 vaccine attitudes. This study highlights the importance of harnessing online communities in designing COVID-related public health interventions and accelerating normative change in relation to vaccination.

Multilevel determinants on COVID-19 booster intention among Americans.

The pandemic has disrupted public health and social well-being for more than two years. With the vaccine efficacy waning over time and the spread of new variants, a booster becomes increasingly imperative. This study investigates predictors of the American public's COVID-19 booster intention. A national survey was conducted from September 23rd to October 31st, 2021, on a representative sample. The survey data is merged with state-level indicators of vaccination rate, case rate, political context, and economic recovery. Multilevel regression modeling is adopted for statistical estimation. Results show that a higher proportion of vaccinated people in the network is positively related to one's chance of getting the booster (ß = 0.593, p = 0.000). In comparison, a higher proportion of infected people in the network is negatively related to one's intention to become boosted (ß = -0.240, p = 0.039). Additionally, the higher educated (ß = 0.080, p = 0.001) and older (ß = 0.004, p = 0.013) were more likely to say they would get the booster than their counterparts. Meanwhile, the odds of people taking the COVID-19 booster decrease by 3.541 points (p = 0.002) for each unit increase in the case rate at the state level. This study articulates that individual intention to take the booster is a function of their personal characteristics and is also rooted in social networks. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who intend to take/refuse the booster provides essential information to leverage certain factors and maximize booster uptake to mitigate the pandemic's devastating impact.

The Impact of the COVID-19 Pandemic on China's Airline Industry.

Background: The COVID-19 pandemic has posed a great challenge to the development of China's airline industry. Although the existing literature has analyzed the economic impact of the pandemic on the airline industry from different perspectives, it remains to be further studied given the operating characteristics of different types of airlines in China. Methods: Using a new perspective of heterogeneous airline service models, this study collects high-frequency data on stock prices on six sample airline companies (including both full-service airlines and low-cost airlines) in China over 519 trading days, from August 1, 2019 to September 15, 2021, and identifies structural change points for each company's stock price using the Quandt-Andrews test. The outcome is used to construct an econometric model to quantify the economic impact of the pandemic on different airlines' stock prices under different structural changes. Results: All results have passed the Quandt-Andrews test. The impact coefficient of full-service airlines is negative, while that of low-cost airlines is positive. Most of them have passed the test at the significance level of 10%. Conclusions: All Chinese airlines experienced significant sudden changes in stock prices due to the pandemic, but there are sectoral differences in the order of the sudden changes, with full-service airlines experiencing structural changes much earlier than low-cost airlines. In addition, the impact of the pandemic on stock prices varies across airline types, with a negative impact on full-service airlines and a significant positive effect on most low-cost airlines.

The Glycan-Binding Trait of the Sarbecovirus Spike N-Terminal Domain Reveals an Evolutionary Footprint.

The spike protein on sarbecovirus virions contains two external, protruding domains: an N-terminal domain (NTD) with unclear function and a C-terminal domain (CTD) that binds the host receptor, allowing for viral entry and infection. While the CTD is well studied for therapeutic interventions, the role of the NTD is far less well understood for many coronaviruses. Here, we demonstrate that the spike NTD from SARS-CoV-2 and other sarbecoviruses binds to unidentified glycans in vitro similarly to other members of the Coronaviridae family. We also show that these spike NTD (S-NTD) proteins adhere to Calu3 cells, a human lung cell line, although the biological relevance of this is unclear. In contrast to what has been shown for Middle East respiratory syndrome coronavirus (MERS-CoV), which attaches sialic acids during cell entry, sialic acids present on Calu3 cells inhibited sarbecovirus infection. Therefore, while sarbecoviruses can interact with cell surface glycans similarly to other coronaviruses, their reliance on glycans for entry is different from that of other respiratory coronaviruses, suggesting sarbecoviruses and MERS-CoV have adapted to different cell types, tissues, or hosts during their divergent evolution. Our findings provide important clues for further exploring the biological functions of sarbecovirus glycan binding and adds to our growing understanding of the complex forces that shape coronavirus spike evolution. IMPORTANCE Spike N-terminal domains (S-NTD) of sarbecoviruses are highly diverse; however, their function remains largely understudied compared with the receptor-binding domains (RBD). Here, we show that sarbecovirus S-NTD can be phylogenetically clustered into five clades and exhibit various levels of glycan binding in vitro. We also show that, unlike some coronaviruses, including MERS-CoV, sialic acids present on the surface of Calu3, a human lung cell culture, inhibit SARS-CoV-2 and other sarbecoviruses. These results suggest that while glycan binding might be an ancestral trait conserved across different coronavirus families, the functional outcome during infection can vary, reflecting divergent viral evolution. Our results expand our knowledge on the biological functions of the S-NTD across diverse sarbecoviruses and provide insight on the evolutionary history of coronavirus spike.

The Impact of the COVID-19 Pandemic on China's Airline Industry

Background The COVID-19 pandemic has posed a great challenge to the development of China's airline industry. Although the existing literature has analyzed the economic impact of the pandemic on the airline industry from different perspectives, it remains to be further studied given the operating characteristics of different types of airlines in China. Methods Using a new perspective of heterogeneous airline service models, this study collects high-frequency data on stock prices on six sample airline companies (including both full-service airlines and low-cost airlines) in China over 519 trading days, from August 1, 2019 to September 15, 2021, and identifies structural change points for each company's stock price using the Quandt-Andrews test. The outcome is used to construct an econometric model to quantify the economic impact of the pandemic on different airlines' stock prices under different structural changes. Results All results have passed the Quandt-Andrews test. The impact coefficient of full-service airlines is negative, while that of low-cost airlines is positive. Most of them have passed the test at the significance level of 10%. Conclusions All Chinese airlines experienced significant sudden changes in stock prices due to the pandemic, but there are sectoral differences in the order of the sudden changes, with full-service airlines experiencing structural changes much earlier than low-cost airlines. In addition, the impact of the pandemic on stock prices varies across airline types, with a negative impact on full-service airlines and a significant positive effect on most low-cost airlines.

Acceptance of COVID-19 Vaccine Among High-Risk Occupations in a Port City of China and Multifaceted Strategies for Increasing Vaccination Coverage: A Cross-Sectional Study.

Purpose: Considering high risk of imported epidemic in port cities, it is necessary to estimate COVID-19 vaccine acceptability and to promote vaccination coverage of high-risk occupations. Methods: A cross-sectional survey was carried out among the occupations in Yantai city, China, using an online questionnaire service platform. Targeted strategies were developed based on the survey results. In addition, periodic monitoring of the vaccination rate was provided in order to evaluate the effectiveness of the strategies. Results: A total of 2231 (73.22%) of 3047 participants were willing to accept the vaccine, while 2.53% refused and 24.25% were not sure. Frontline port workers (133/152, 87.50%) and healthcare workers (999/1155, 86.49%) had higher intentions to accept, while public places and commercial service staff (584/1011, 57.76%) had the lowest. The reasons for refusal and hesitation were mainly "doubt of safety or effectiveness" (661/816, 81.00%) and "hearing previous news about vaccines" (455/816, 55.76%). Multilevel strategies such as adequate organizations, health education and promotion, and easy access to vaccination were promoted by local authorities in collaboration with schools, hospitals, enterprises and institutions. The study showed a significant increase in vaccination rate among these occupations after the implementation of these strategies (p<0.001), reaching 87.96%. Conclusion: COVID-19 vaccine acceptability among high-risk occupations was unsatisfactory before the stage of emergency vaccination. An advanced understanding of vaccine attitudes and acceptance can aid in the development of focused immunization promotion programs. It is worth emphasizing that wide strategies with the strong support and enthusiastic cooperation of the government and the industry executive can contribute to increasing occupations' acceptance of the ongoing COVID-19 immunization project.

Inactivated SARS-CoV-2 Vaccine Shows Cross-Protection against Bat SARS-Related Coronaviruses in Human ACE2 Transgenic Mice.

Severe acute respiratory syndrome coronavirus (SARS-CoV-1) and SARS-CoV-2 are highly pathogenic to humans and have caused pandemics in 2003 and 2019, respectively. Genetically diverse SARS-related coronaviruses (SARSr-CoVs) have been detected or isolated from bats, and some of these viruses have been demonstrated to utilize human angiotensin-converting enzyme 2 (ACE2) as a receptor and to have the potential to spill over to humans. A pan-sarbecovirus vaccine that provides protection against SARSr-CoV infection is urgently needed. In this study, we evaluated the protective efficacy of an inactivated SARS-CoV-2 vaccine against recombinant SARSr-CoVs carrying two different spike proteins (named rWIV1 and rRsSHC014S, respectively). Although serum neutralizing assays showed limited cross-reactivity between the three viruses, the inactivated SARS-CoV-2 vaccine provided full protection against SARS-CoV-2 and rWIV1 and partial protection against rRsSHC014S infection in human ACE2 transgenic mice. Passive transfer of SARS-CoV-2-vaccinated mouse sera provided low protection for rWIV1 but not for rRsSHC014S infection in human ACE2 mice. A specific cellular immune response induced by WIV1 membrane protein peptides was detected in the vaccinated animals, which may explain the cross-protection of the inactivated vaccine. This study shows the possibility of developing a pan-sarbecovirus vaccine against SARSr-CoVs for future preparedness. IMPORTANCE The genetic diversity of SARSr-CoVs in wildlife and their potential risk of cross-species infection highlight the necessity of developing wide-spectrum vaccines against infection of various SARSr-CoVs. In this study, we tested the protective efficacy of the SARS-CoV-2 inactivated vaccine (IAV) against two SARSr-CoVs with different spike proteins in human ACE2 transgenic mice. We demonstrate that the SARS-CoV-2 IAV provides full protection against rWIV1 and partial protection against rRsSHC014S. The T-cell response stimulated by the M protein may account for the cross protection against heterogeneous SARSr-CoVs. Our findings suggest the feasibility of the development of pan-sarbecovirus vaccines, which can be a strategy of preparedness for future outbreaks caused by novel SARSr-CoVs from wildlife.

Understanding the influence of political orientation, social network, and economic recovery on COVID-19 vaccine uptake among Americans.

The COVID-19 pandemic poses unprecedented risks to the well-being of Americans. To control the pandemic, a sufficient proportion of the population needs to be vaccinated promptly. Despite the proven efficacy and widespread availability, vaccine distribution and administration rates remain low. Thus, it is important to understand the public behavior of COVID-19 vaccination. This study aims to identify determinants at multiple levels that promote or inhibit one's vaccine uptake. We combine individual-level data from a national survey conducted in the summer of 2021 with corresponding state-level indicators. Findings of multilevel logistic regression show that political orientation, social network, and economic recovery altogether have significant influence. We articulate that individual decision to take the vaccine are a function of their personal characteristics and are also rooted in their home state's political, public health, and economic contexts. These findings contribute to the literature and have policy implications. Knowledge of the profiles among people who take/refuse the vaccine provides essential information to leverage certain factors and maximize vaccine uptake to mitigate the pandemic's devastating impact.

Belongingness is a Mediating Factor Between Religious Service Attendance and Reduced Psychological Distress During the COVID-19 Pandemic

This study aimed to test whether pre-pandemic religious service attendance relates to both lesser impact from the COVID-19 pandemic and lower levels of psychological distress among a sample of 645 American adults across nine US regions. A second aim was to test whether belongingness mediated these relationships. First, it was expected that more frequent pre-pandemic religious service attendance relates to belongingness, which mediates the religious service attendance and psychological distress association. Second, it was expected that people who felt greater belongingness also experienced less perceived impact from the pandemic. Results from a path model supported these hypotheses. This is among the first studies to provide empirical evidence for religion’s association with psychological distress during the COVID-19 pandemic.

Belongingness is a Mediating Factor Between Religious Service Attendance and Reduced Psychological Distress During the COVID-19 Pandemic.

This study aimed to test whether pre-pandemic religious service attendance relates to both lesser impact from the COVID-19 pandemic and lower levels of psychological distress among a sample of 645 American adults across nine US regions. A second aim was to test whether belongingness mediated these relationships. First, it was expected that more frequent pre-pandemic religious service attendance relates to belongingness, which mediates the religious service attendance and psychological distress association. Second, it was expected that people who felt greater belongingness also experienced less perceived impact from the pandemic. Results from a path model supported these hypotheses. This is among the first studies to provide empirical evidence for religion's association with psychological distress during the COVID-19 pandemic.

Understanding American Public Support for COVID-19 Risk Mitigation: The Role of Political Orientation, Socio-Demographic characteristics, Personal Concern, and Experience, the United States, 2020.

Objectives: COVID-19 is the most challenging public health crisis in decades in the United States. It is imperative to enforce social distancing rules before any safe and effective vaccines are widely available. Policies without public support are destined to fail. This study aims to reveal factors that determine the American public support for six mitigation measures (e.g., cancel gatherings, close schools, restrict non-essential travel). Methods: Based on a nationally representative survey, this study uses Structural Equation Modelling to reveal the relationships between various factors and public support for COVID-19 mitigation. Results: 1). Democrats are more likely than Republicans to support mitigation measures; 2).Favorability towards the political leader (Biden or Trump) can slant public support for COVID-19 mitigation measures among different segments of the public.; 3). Indirect experience, rather than direct experience with COVID-19 can motivate people to support mitigation; 4). Concern for COVID-19 is a strong motivator of support for mitigation. Conclusion: Political polarization poses an enormous challenge to societal well-being during a pandemic. Indirect experience renders COVID-19 an imminent threat.

Identification of a novel lineage bat SARS-related coronaviruses that use bat ACE2 receptor.

Severe respiratory disease coronavirus-2 (SARS-CoV-2) has been the most devastating disease COVID-19 in the century. One of the unsolved scientific questions of SARS-CoV-2 is the animal origin of this virus. Bats and pangolins are recognized as the most probable reservoir hosts that harbour highly similar SARS-CoV-2 related viruses (SARSr-CoV-2). This study identified a novel lineage of SARSr-CoVs, including RaTG15 and seven other viruses, from bats at the same location where we found RaTG13 in 2015. Although RaTG15 and the related viruses share 97.2% amino acid sequence identities with SARS-CoV-2 in the conserved ORF1b region, it only shows less than 77.6% nucleotide identity to all known SARSr-CoVs at the genome level, thus forming a distinct lineage in the Sarbecovirus phylogenetic tree. We found that the RaTG15 receptor-binding domain (RBD) can bind to ACE2 from Rhinolophus affinis, Malayan pangolin, and use it as an entry receptor, except for ACE2 from humans. However, it contains a short deletion and has different key residues responsible for ACE2 binding. In addition, we showed that none of the known viruses in bat SARSr-CoV-2 lineage discovered uses human ACE2 as efficiently as the pangolin-derived SARSr-CoV-2 or some viruses in the SARSr-CoV-1 lineage. Therefore, further systematic and longitudinal studies in bats are needed to prevent future spillover events caused by SARSr-CoVs or to understand the origin of SARS-CoV-2 better.

Identification of a novel lineage bat SARS-related coronaviruses that use bat ACE2 receptor (preprint)

Severe respiratory disease coronavirus-2 (SARS-CoV-2) causes the most devastating disease, COVID-19, of the recent century. One of the unsolved scientific questions around SARS-CoV-2 is the animal origin of this virus. Bats and pangolins are recognized as the most probable reservoir hosts that harbor the highly similar SARS-CoV-2 related viruses (SARSr-CoV-2). Here, we report the identification of a novel lineage of SARSr-CoVs, including RaTG15 and seven other viruses, from bats at the same location where we found RaTG13 in 2015. Although RaTG15 and the related viruses share 97.2% amino acid sequence identities to SARS-CoV-2 in the conserved ORF1b region, but only show less than 77.6% to all known SARSr-CoVs in genome level, thus forms a distinct lineage in the Sarbecovirus phylogenetic tree. We then found that RaTG15 receptor binding domain (RBD) can bind to and use Rhinolophus affinis bat ACE2 (RaACE2) but not human ACE2 as entry receptor, although which contains a short deletion and has different key residues responsible for ACE2 binding. In addition, we show that none of the known viruses in bat SARSr-CoV-2 lineage or the novel lineage discovered so far use human ACE2 efficiently compared to SARSr-CoV-2 from pangolin or some of the SARSr-CoV-1 lineage viruses. Collectively, we suggest more systematic and longitudinal work in bats to prevent future spillover events caused by SARSr-CoVs or to better understand the origin of SARS-CoV-2.

Understanding the Effects of Individual and State-Level Factors on American Public Response to COVID-19.

PURPOSE: To examine multilevel predictors on American public response to COVID-19. DESIGN: Multilevel study. SETTING: A national survey was conducted by Qualtrics from August 24 to September 11, 2020. The state-level variables were constructed on data from multiple sources. SUBJECTS: 2,440 respondents 18 years and older from all 50 states and D.C. MEASURES: The outcome variable is the public response to COVID-19 measured by threat perception, behavioral adjustment, and policy support. The predictors include individual-level sociodemographic factors and state-level indicators about public health conditions, political context, and economic recovery. ANALYSIS: Multilevel structural equation modeling is used for statistical estimation. RESULTS: People from states with more COVID-19 cases (ß = 0.020, p < 0.1), mandatory face mask policies (ß = 0.069, p < 0.05), and liberal governments (ß = 0.002, p < 0.05) are more likely to respond while people from states whose economies have recovered closer to the pre-pandemic level are less likely to do so (ß = -0.005, p < 0.05). Regarding individual-level predictors, older people (ß = 0.005, p < 0.001) and people with better education (ß = 0.029, p < 0.01), leaning toward the Democrat Party (ß = 0.066, p < 0.001) and liberal political ideology (ß = 0.094, p < 0.001), and have stronger generalized trust (ß = 0.033, p < 0.001) are more likely to respond than their counterparts. CONCLUSION: Differences in the public response to the pandemic stem from variations in individual characteristics and contextual factors of states where people live. These findings contribute to the rapidly growing literature and have implications for public health policies.