The Psychological and Wellbeing Impacts of Quarantine on Frontline Workers during COVID-19 and Beyond.

OBJECTIVE: The current study investigated the experiences, wellbeing impacts, and coping strategies of frontline workers who participated in "Hotels for Heroes", an Australian voluntary hotel quarantine program during the COVID-19 pandemic. The program was open to those who were COVID-19 positive or exposed to COVID-19 as part of their profession. METHODS: Frontline workers who had stayed in voluntary quarantine between April 2020 and March 2021 were invited to participate in a voluntary, anonymous, cross-sectional online survey including both quantitative and qualitative responses. Complete responses were collected from 106 participants, which included data on sociodemographic and occupational characteristics, experiences of the Hotels for Heroes program, and validated mental health measures. RESULTS: Mental health problems were prevalent amongst frontline workers (e.g., moderate anxiety symptoms, severe depression symptoms, and greater than usual impact of fatigue). For some, quarantine appeared to be helpful for anxiety and burnout, but quarantine also appeared to impact anxiety, depression, and PTSD negatively, and longer stays in quarantine were associated with significantly higher coronavirus anxiety and fatigue impacts. The most widely received support in quarantine was from designated program staff; however, this was reportedly accessed by less than half of the participants. CONCLUSIONS: The current study points to specific aspects of mental health care that can be applied to participants of similar voluntary quarantine programs in the future. It seems necessary to screen for psychological needs at various stages of quarantine, and to allocate appropriate care and improve its accessibility, as many participants did not utilise the routine support offered. Support should especially target disease-related anxiety, symptoms of depression and trauma, and the impacts of fatigue. Future research is needed to clarify specific phases of need throughout quarantine programs, and the barriers for participants receiving mental health supports in these contexts.

Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health?

BACKGROUND: The transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman's experience - with likely adverse effects on mental health and wellbeing. AIM: To explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. METHODS: Using a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. FINDINGS: Whilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (-1.17, 95% CI: -1.81, -0.53) and the EPDS (-0.83, 95% CI: -1.5, -0.15). DISCUSSION: The analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. CONCLUSION: This study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.

General wellbeing and work impacts among community pharmacists during crisis management.

BACKGROUND: Community pharmacists are highly accessible for advice, as most pharmacies are open long hours and no appointment is needed. Community pharmacists, as essential community health workers, play a critical role in the fight against coronavirus disease 2019 (COVID-19). This study aimed to determine the general wellbeing and work impacts of pharmacists and the factors important for adaptability and resilience during the COVID-19 pandemic. METHODS: This study adopted a cross-sectional design. Community pharmacists from various professional networks in Australia were invited through emails and social media posts to complete an anonymous online survey during the second wave of the COVID-19 pandemic in Victoria, Australia. RESULTS: Sixty-five community pharmacists completed the online survey. The respondents reported fair levels of general wellbeing during the COVID-19 pandemic, with a mean self-related health score of 33.57 (s.d.=13.19) out of a maximal of 96, despite relatively high levels of job stress and emotional labour. Lower levels of general wellbeing were correlated with higher levels of job stress (r=0.645, P<0.01) and emotional labour (r=0.513, P<0.01), and lower levels of occupational self-efficacy (r=-0.566, P<0.01). Leader member exchange was negatively correlated with job stress (r=-0.419, P<0.01) and positively correlated with psychological safety (r=0.693, P<0.01). The linear regression models showed that female pharmacists had lower occupational self-efficacy (ß=-0.286, P=0.024), but higher psychological safety (ß=0.234, P=0.042). Higher work ability was associated with lower job stress (ß=-0.529, P<0.001), higher occupational self-efficacy (ß=0.511, P=0.001), and poorer self-related health (ß=-0.659, P<0.001). CONCLUSIONS: The findings highlight the importance of a supportive work environment in helping community pharmacists to feel psychologically safe and reduce stress during a crisis.

Association Between Dimensions of Professional Burnout and Turnover Intention Among Nurses Working in Hospitals During Coronavirus Disease (COVID-19) Pandemic in Iran Based on Structural Model.

Purpose: This study was done to assess the dimensions of professional burnout and turnover intention among nurses working in hospitals during the coronavirus disease 2019 (COVID-19) pandemic in Iran based on a structural model. Methods: This cross-sectional study was performed among 170 nurses working in two referral hospitals of COVID-19 in Tehran Province, Iran, from September to December 2020. Data were collected using the sociodemographic form, Maslach Burnout Inventory (MBI), and Turnover Intention Questionnaire. Data were analyzed with SPSS and Amos software version 22 using independent t-test, ANOVA, and structural equation model. Results: The mean scores for burnout in emotional fatigue, depersonalization, and personal accomplishment dimensions were 25.38 ± 7.55, 9.47 ± 4.40, and 34.94 ± 7.80, respectively, moreover for the turnover intention, the score was 6.51 ± 3.17. The reduced personal accomplishment was identified as a positive predictor of turnover intention (p = 0.01). Work position and interest in attending the organization were significantly correlated with the turnover intention (p < 0.05). Conclusions: There is an immediate need to prepare nurses to cope better with the COVID-19 outbreak. Work-related stressors during the COVID-19 pandemic have led to an increase in nurses' burnout and turnover intention. Identifying and managing the factors related to professional burnout will make it possible to prevent the nurses' turnover intention in such critical situations.

Systematic Review of Existing Stroke Guidelines: Case for a Change.

Methods: We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and October 2020. Any other evidence of system biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of system biology. Results: The scoping review found 2,911 titles at the beginning of the search. Final review included with 15 guidelines. Stroke-related organizations wrote sixty-five percent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the system biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions: This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current "living stroke guidelines," stroke guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach, and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII) and serial systemic immune inflammatory indices (SSIIi) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data (continuous pulse, blood pressure, sleep, oxygen saturation, progressive changes in NLR, SII, SSIIi, etc.). Working with an interdisciplinary team also provides a distinct advantage. Recent adoption of historic WHO-IGAP calls for immediate action. The 2022 World Brain Day campaign on Brain Health for All is the perfect opportunity to raise awareness and start the process.

Association Between Dimensions of Professional Burnout and Turnover Intention Among Nurses Working in Hospitals During Coronavirus Disease (COVID-19) Pandemic in Iran Based on Structural Model

Purpose This study was done to assess the dimensions of professional burnout and turnover intention among nurses working in hospitals during the coronavirus disease 2019 (COVID-19) pandemic in Iran based on a structural model. Methods This cross-sectional study was performed among 170 nurses working in two referral hospitals of COVID-19 in Tehran Province, Iran, from September to December 2020. Data were collected using the sociodemographic form, Maslach Burnout Inventory (MBI), and Turnover Intention Questionnaire. Data were analyzed with SPSS and Amos software version 22 using independent t-test, ANOVA, and structural equation model. Results The mean scores for burnout in emotional fatigue, depersonalization, and personal accomplishment dimensions were 25.38 ± 7.55, 9.47 ± 4.40, and 34.94 ± 7.80, respectively, moreover for the turnover intention, the score was 6.51 ± 3.17. The reduced personal accomplishment was identified as a positive predictor of turnover intention (p = 0.01). Work position and interest in attending the organization were significantly correlated with the turnover intention (p < 0.05). Conclusions There is an immediate need to prepare nurses to cope better with the COVID-19 outbreak. Work-related stressors during the COVID-19 pandemic have led to an increase in nurses' burnout and turnover intention. Identifying and managing the factors related to professional burnout will make it possible to prevent the nurses' turnover intention in such critical situations.

High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a profound and prolonged impact on healthcare services and healthcare workers. AIMS: The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues, as well as the social, workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic. METHODS: A nationwide, voluntary, anonymous, single timepoint, online survey was conducted between 27 August and 23 October 2020. Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts and national media. Demographics, home and work situation, health and psychological well-being data were collected. RESULTS: A total of 9518 survey responses were received; of the 9518 participants, 7846 (82.4%) participants reported complete data. With regard to age, 4110 (52.4%) participants were younger than 40 years; 6344 (80.9%) participants were women. Participants were nurses (n=3088, 39.4%), doctors (n=2436, 31.1%), allied health staff (n=1314, 16.7%) or in other roles (n=523, 6.7%). In addition, 1250 (15.9%) participants worked in primary care. Objectively measured mental health symptoms were common: mild to severe anxiety (n=4694, 59.8%), moderate to severe burnout (n=5458, 70.9%) and mild to severe depression (n=4495, 57.3%). Participants were highly resilient (mean (SD)=3.2 (0.66)). Predictors for worse outcomes on all scales included female gender; younger age; pre-existing psychiatric condition; experiencing relationship problems; nursing, allied health or other roles; frontline area; being worried about being blamed by colleagues and working with patients with COVID-19. CONCLUSIONS: The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers. Crisis preparedness together with policies and practices addressing psychological well-being are needed.

Occupational Disruptions during the COVID-19 Pandemic and Their Association with Healthcare Workers' Mental Health.

BACKGROUND: The COVID-19 crisis has caused prolonged and extreme demands on healthcare services. This study investigates the types and prevalence of occupational disruptions, and associated symptoms of mental illness, among Australian frontline healthcare workers during the COVID-19 pandemic. METHODS: A national cross-sectional online survey was conducted between 27 August and 23 October 2020. Frontline healthcare workers were invited to participate via dissemination from major health organisations, professional associations or colleges, universities, government contacts, and national media. Data were collected on demographics, home and work situations, and validated scales of anxiety, depression, PTSD, and burnout. RESULTS: Complete responses were received from 7846 healthcare workers (82.4%). Most respondents were female (80.9%) and resided in the Australian state of Victoria (85.2%). Changes to working conditions were common, with 48.5% reporting altered paid or unpaid hours, and many redeployed (16.8%) or changing work roles (27.3%). Nearly a third (30.8%) had experienced a reduction in household income during the pandemic. Symptoms of mental illness were common, being present in 62.1% of participants. Many respondents felt well supported by their workplaces (68.3%) and believed that workplace communication was timely and useful (74.4%). Participants who felt well supported by their organisation had approximately half the risk of experiencing moderate to severe anxiety, depression, burnout, and PTSD. Half (50.4%) of respondents indicated a need for additional training in using personal protective equipment and/or caring for patients with COVID-19. CONCLUSIONS: Occupational disruptions during the COVID-19 pandemic occurred commonly in health organisations and were associated with worse mental health outcomes in the Australian health workforce. Feeling well supported was associated with significantly fewer adverse mental health outcomes. Crisis preparedness focusing on the provision of timely and useful communication and support is essential in current and future crises.

Coping strategies adopted by Australian frontline health workers to address psychological distress during the COVID-19 pandemic.

OBJECTIVES: The Australian COVID-19 Frontline Healthcare Workers Study investigated coping strategies and help-seeking behaviours, and their relationship to mental health symptoms experienced by Australian healthcare workers (HCWs) during the COVID-19 pandemic. METHODS: Australian HCWs were invited to participate a nationwide, voluntary, anonymous, single time-point, online survey between 27th August and 23rd October 2020. Complete responses on demographics, home and work situation, and measures of health and psychological wellbeing were received from 7846 participants. RESULTS: The most commonly reported adaptive coping strategies were maintaining exercise (44.9%) and social connections (31.7%). Over a quarter of HCWs (26.3%) reported increased alcohol use which was associated with a history of poor mental health and worse personal relationships. Few used psychological wellbeing apps or sought professional help; those who did were more likely to be suffering from moderate to severe symptoms of mental illness. People living in Victoria, in regional areas, and those with children at home were significantly less likely to report adaptive coping strategies. CONCLUSIONS: Personal, social, and workplace predictors of coping strategies and help-seeking behaviour during the pandemic were identified. Use of maladaptive coping strategies and low rates of professional help-seeking indicate an urgent need to understand the effectiveness of, and the barriers and enablers of accessing, different coping strategies.

Moral Distress and Perceived Community Views Are Associated with Mental Health Symptoms in Frontline Health Workers during the COVID-19 Pandemic.

BACKGROUND: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. METHODS: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations, or colleges, universities, government contacts, and national media. RESULTS: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%), or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with increased risk of anxiety, depression, post-traumatic stress disorder, and burnout. Conversely, feeling appreciated by the community protected against these risks in healthcare workers. CONCLUSIONS: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

The Experiences of Recovered COVID-19 Patients in Baqiyatallah Hospital: A Qualitative Study.

The emerging COVID-19 disease affects not only the physical health but also the emotional and psychological health of patients. This study aimed to explain the experiences of 22 recovered COVID-19 patients in Baqiyatallah hospital, Tehran, Iran. Data were collected through in-depth semi-structured interviews. All interviews were recorded and transcribed and then analyzed using the conventional content analysis method. This resulted in emergence of 3 themes "emotional-sensational paradox", "spiritual growth", and "experienced mental-psychological effects", with 11 main categories and 33 subcategories. The results of the study can be used to develop instructions and guidelines for the families of patients as well as healthcare teams to provide effective measures and interventions to minimize the suffering of patients and the damage to mental health.

Staff-Care by Chaplains during COVID-19.

The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.

"Essential Not Optional": Spiritual Care in Australia during a Pandemic.

This paper focuses on the impact of COVID19 in Australia. Three areas were investigated: professionalism, contrasting hospital and aged care services and "business as usual"? Impact was low overall, the timing being pre-second wave impact. Two areas of weakness were highlighted: depleted spiritual care teams due to standing down non-professional staff and uncertainty about the role of Chaplains in the care of other staff. Further study of second wave impact is recommended.

Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis.

BACKGROUND: Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. METHODS: Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. RESULTS: 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. CONCLUSION: COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.

Psychometric Evaluation of Stress in 17,414 Critical Care Unit Nurses: Effects of Age, Gender, and Working Conditions.

Recent events regarding the COVID-19 pandemic have demonstrated the importance of healthcare workers around the world and the stressful working conditions that are often associated with their profession. The severity of stress can be influenced by a number of factors such as age, seniority gender, family status, and position in the wards. Thus, it is important to monitor signs of stress and other psychiatric symptoms in order to understand the mediating factors and guide appropriate interventions. Here, we describe a cross-sectional study of 17,414 nurses from 31 Iranian cities carried out from 2011 to 2015, using a 22-item tool of work stressors. The tool examined interactive, managerial, and situational domains and the main objective was to identify the main background variables associated with the stress of nurses in critical care settings.

A Systematic Review of the Assessment of the Presence of SARS-CoV-2 in Human Semen.

Theoretically, human testes are highly expressive organs for angiotensin converting enzyme 2 (ACE2), the SARS-CoV-2 receptor. This study aimed to investigate whether the causative agent of COVID-19 is found in semen. The databases of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched using a combination of related keywords. All studies with original data, involving detection of SARS-CoV-2 in semen of male patients with COVID-19 or in those who have recovered from it, were included in the study. Six articles, including 136 samples, entered the systematic review. Most of the studies were performed in the recovery phase of COVID-19. In four articles, SARS-CoV-2 was not detected in semen, while in the other two articles semen testing showed the presence of the virus in some samples. Testicular discomfort, testicular cell damage, and spermogram disruption were also reported in some studies. We conclude that the study question cannot be answered with this number of studies. Since most of the samples were mild to moderate forms of COVID-19, it is not yet clear what the presence of the virus in semen will be in severe cases. The long-term effects are also vague. More original articles with better design and in different phases of the disease are needed to draw robust conclusions.

The 2019 Novel Coronavirus Disease in Pregnancy: A Systematic Review.

In December 2019, a respiratory disease caused by a coronavirus called SARS-CoV-2 (COVID-19) began in Wuhan, China, and quickly became a pandemic. In such situations, pregnant women are suspected of being among the vulnerable groups. The aim of this study was to report clinical symptoms, laboratory findings, and obstetrical complications, maternal, fetal, and neonatal complications of COVID-19 infection in pregnant women. We searched the Cochrane library, MEDLINE/PubMed, and Web of Sciences from their inception to April 5, 2020. Any study involving pregnant women with COVID-19 which evaluated the effect of the disease on pregnancy outcomes and fetal and neonatal complications was included in the study. The outcomes were the symptoms and laboratory findings, obstetrical complications, mode of delivery, and maternal, fetal, and neonatal complications. The search resulted in 69 titles and abstracts, which were narrowed down to 12 studies involving 68 women. The three most common symptoms of patients were fever, cough, and fatigue. The most common laboratory findings were an increase in C-reactive protein (CRP) and lymphopenia. The most common obstetrical complication was preterm labor (33.3%). No maternal deaths were reported. The Cesarean section rate was 83.3% and the vertical transition rate was 2.23%. The findings showed that the clinical symptoms and laboratory measures of pregnant women affected by COVID-19 did not differ from the general population. In general, the prognosis of mothers who suffered from COVID-19 and their newborns was satisfactory. However, there is a need for further rigorous studies to confirm these findings as the pandemic progresses.

A Systematic Review of 571 Pregnancies Affected by COVID-19.

The outbreak of the novel coronavirus 2019 (COVID-19) disease has been severe and a cause for major concern around the world. Due to immunological and physiological changes during pregnancy, pregnant women have a higher risk of COVID-19 morbidity and mortality. The aim of this study was to collect and integrate the results of previous studies to get an accurate representation and interpretation of the clinical symptoms, laboratory and radiological findings, and characteristics of pregnant women with COVID-19. We conducted a scientific search in main databases with a combination of related MESH terms and keywords. The outcomes included common clinical symptoms at the time of onset of the disease, common laboratory and radiological findings, the rates of vaginal delivery and Cesarean section, Cesarean section indications, maternal complications, and vertical transmission rates. A total of 51 studies comprising 571 pregnant women with COVID-19 pneumonia were included in the study. The most common symptoms were fever, cough, and dyspnea, respectively. Elevated C-reactive protein and ground-glass opacities were the most common laboratory and radiological findings of COVID-19 pneumonia, respectively. A total of 114 Cesarean sections were performed due to COVID-19-related concerns. There were 55 cases of intubation (11.6%) and 13 maternal deaths (2.3%). The vertical transmission rate was 7.9%. We conclude that the characteristics of pneumonia caused by COVID-19 in pregnant women do not appear to be different from those in the general population with COVID-19 infections. However, pregnant women with underlying diseases were more likely to develop COVID-19 than others, and, in those infected with the virus, the rate of Cesarean delivery and preterm birth increased.

Acute Respiratory Distress Syndrome and COVID-19: A Scoping Review and Meta-analysis.

Acute respiratory distress syndrome (ARDS) is a fatal complication of the new severe acute respiratory syndrome coronavirus (SARS-CoV-2), which causes COVID-19 disease. This scoping review was carried out with international, peer-reviewed research studies and gray literature published up to July 2020 in Persian and English languages. Using keywords derived from MESH, databases including Magiran, IranMedex, SID, Web of Sciences, PubMed, Embase via Ovid, Science Direct, and Google Scholar were searched. After screening titles and abstracts, the full texts of selected articles were evaluated, and those which passed the criteria were analyzed and synthesized with inductive thematic analysis. Study quality was also evaluated using a standard tool. The overall prevalence of ARDS was estimated using a random-effects model. This led to identification of 23 primary studies involving 2880 COVID-19 patients. All articles were observational with a cross-sectional, retrospective, case report, and cohort design with moderate to strong quality. The main findings showed that COVID-19-related ARDS has a high prevalence and is different to ARDS due to other etiologies. Elderly and patients with comorbidities and organ failure should be closely surveyed for respiratory organ indications for several weeks after the onset of respiratory symptoms. There is currently no definitive treatment for ARDS in COVID-19 disease, and supportive therapies and their effects are somewhat controversial.

Does SARS-CoV-2 Threaten Male Fertility?

In the continuing COVID-19 pandemic, one of the most important concerns in reproductive health is the issue of male fertility of recovered patients. In this study, we discuss the potential mechanisms that justify the possible impact of COVID-19 on male fertility. The main point of entry of SARS-CoV-2 into the host cells appears to be through the viral spike protein which permits entry into cells via the angiotensin-converting enzyme 2 (ACE2 receptor). In human testes, ACE2 is enriched in Sertoli and Leydig cells and spermatogonia. Also, it seems that there is a mild or severe cytokine storm in patients with severe COVID-19, and such changes may affect fertility. It should also be mentioned that the orchitis caused by the SARS-CoV-2 virus may have an important impact on fertility. Prolonged and high fever may lead to changes in testicular temperature and destroy germ cells. In general, there is little evidence for a definite conclusion, but there are facts that suggest that COVID-19 may affect male fertility. It is prudent for men of reproductive age who have recovered from COVID-19 to be evaluated for the presence of the virus in semen and fertility-related items. There is an urgent need to conduct quality studies on, in particular, the long-term effects of COVID-19 on the fertility of recovered males.