Efficacy of the Unani Regimen as an Add-On to Standard Treatment in Hospitalised RT-PCR-Confirmed Mild to Moderate COVID-19 Patients: An Open-Label Randomized Controlled Trial.

Background The coronavirus disease 2019 (COVID-19) pandemic resulted in mortality and morbidity worldwide. Many treatment modalities have been experimented with limited success. Therefore, the traditional system of medicine needs to be explored. Objective To evaluate the benefits of Unani regimensTiryaq-e-Arba and Unani Joshanda, as adjuvant therapy, were compared to standard treatment alone among reverse transcription polymerase chain reaction (RT-PCR)-confirmed mild to moderate COVID-19 cases. Materials and methods An open-label, double-arm, randomized, controlled interventional clinical study was conducted among 90 RT-PCR-confirmed mild to moderate COVID-19 inpatients admitted to a tertiary care hospital in New Delhi, India. Participants who fulfilled the criteria for inclusion were randomly assigned to two arms, with 43 subjects allocated to the Unani add-on arm and 47 subjects to the control arm receiving standard treatment alone. Results Clinical recovery was achieved in all patients of the Unani arm, while in the control arm, three (6.4%) patients deteriorated and had to be shifted to ICU following admission. In the intervention arm, a shorter duration of hospitalization was observed (mean 5.95 days {SD = 1.99}) than in the control arm (mean 7.62 days {SD, 4.06}); which was a statistically significant difference (p-value 0.017). The majority of the patients recovered within 10 days in the Unani add-on arm. The number of days taken for the reduction of symptoms was significantly less in the intervention arm (mean 5.14 days {SD, 2.39}) as compared with standard treatment (mean 6.53 days {SD, 3.06}) (p < 0.02). Renal and liver safety parameters were within the normal limits in both arms and no serious adverse event was reported. Conclusion Adding Unani formulations to standard treatment significantly reduced the duration of hospital stay and showed early recovery in COVID-19 patients compared with the control arm. It may be concluded that the synergistic effect of the Unani add-on with standard treatment gave more promising results in mild to moderate COVID-19 patients.

Depression and Associated Factors Among Older Adults in a North Indian State: A Cross-Sectional Study.

INTRODUCTION: India is currently experiencing a significant increase in its elderly population, and it is predicted to rise. Depression is prevalent among the elderly population. This study aimed at measuring the prevalence of depression among the elderly population in India. METHODOLOGY: This cross-sectional study was conducted in both urban and rural regions of Delhi, with a total of 230 participants recruited through systematic random sampling. This sampling method involved selecting households from a comprehensive list. The Patient Health Questionnaire 9 (PHQ-9) was used as a screening tool for depression. Participants with a PHQ-9 score above 9 were considered to potentially experience depression. RESULTS: The study findings revealed that 68.2% (95%CI: 61.8%-74.2%) of the total sample of 230 participants screened positive for depression. Gender (p = 0.02), age category (p < 0.01), place of residence (p < 0.01), and diabetes (p < 0.01) were significantly associated with depression. CONCLUSION: The study found a high prevalence of depression among the elderly population, with females, urban dwellers, and those with a history of diabetes being significantly associated with depression. Early detection through screening programs and community-based interventions could help manage depression in this vulnerable group.

Perception and Attitude Towards COVID-19 Vaccination Among the Elderly: A Community-Based Cross-Sectional Study.

Introduction COVID-19 is one of the most formidable obstacles that humanity has encountered in this century. The death rate was high among the elderly in India; therefore, getting the elderly vaccinated was one of the most important things to do. Objective We conducted this study to assess the perception and attitude about the COVID-19 vaccines among the elderly population. Methods This cross-sectional study was conducted at Fatehpur Beri, New Delhi. We selected 108 participants using systematic random sampling. We used a semi-structured questionnaire to collect the data. Results Out of 108 participants, 52.8% were men. Among them, 9.3% of participants had tested positive before. The average number of days of illness among the participants was 5.3 (SD + 3.5). Males had a higher average day of illness (5.5, SD +3.7) than females (4.9, SD +3.3). Among those who had not been vaccinated, 73.3% of participants said they would receive the vaccine, 6.7% were unsure, and 20% were not willing to receive the vaccine. Conclusion COVID vaccination in an elderly population showed a relatively high vaccine acceptance rate, and the willingness to get the vaccine was also high among the unvaccinated.

Lockdowns, Community Mobility Patterns, and COVID-19: A Retrospective Analysis of Data from 16 Countries.

OBJECTIVES: During the coronavirus disease 2019 (COVID-19) pandemic, countries around the world framed specific laws and imposed varying degrees of lockdowns to ensure the maintenance of physical distancing. Understanding changes in temporal and spatial mobility patterns may provide insights into the dynamics of this infectious disease. Therefore, we assessed the efficacy of lockdown measures in 16 countries worldwide by analyzing the relationship between community mobility patterns and the doubling time of COVID-19. METHODS: We performed a retrospective record-based analysis of population-level data on the doubling time for COVID-19 and community mobility. The doubling time for COVID-19 was calculated based on the laboratory-confirmed cases reported daily over the study period (from February 15 to May 2, 2020). Principal component analysis (PCA) of six mobility pattern-related variables was conducted. To explain the magnitude of the effect of mobility on the doubling time, a finite linear distributed lag model was fitted. The k-means clustering approach was employed to identify countries with similar patterns in the significant co-efficient of the mobility index, with the optimal number of clusters derived using Elbow's method. RESULTS: The countries analyzed had reduced mobility in commercial and social places. Reduced mobility had a significant and favorable association with the doubling time of COVID-19-specifically, the greater the mobility reduction, the longer the time taken for the COVID-19 cases to double. CONCLUSIONS: COVID-19 lockdowns achieved the immediate objective of mobility reduction in countries with a high burden of cases.

The impact of COVID-19 pandemic on rabies post-exposure prophylaxis services in Asia.

Human rabies is a preventable disease through post-exposure prophylaxis (PEP) in rabies endemic countries where enzootic cycle of dog rabies occurs. The COVID­19 pandemic has induced an unprecedented challenge for under-funded and already stretched health­care systems particularly in low- and middle-income countries, which are unfortunately bearing a huge burden of human rabies. An analysis of hospital-based PEP data in India, Nepal, Sri Lanka, and Thailand, focus group discussion and key informant interview have been carried out to better understand the impact of Covid-19 pandemic in human rabies prophylaxis. It is necessary to better prepare for human rabies prophylaxis in future pandemics based on lesson learnt from current pandemic. The PEP should be categorized as an emergency medical service, and it should be part of the hospital medical emergency. Mass dog vaccination against rabies should be accelerated to reduce the risk of potential bite of roaming dogs and pet dogs in communities. It is a wise decision to invest in cost-effective preparedness, i.e., mass dog vaccination rather than costly response, i.e., human rabies prophylaxis.

Psychological distress and burnout among healthcare worker during COVID-19 pandemic in India-A cross-sectional study.

BACKGROUND: COVID-19 has inundated the entire world disrupting the lives of millions of people. The pandemic has stressed the healthcare system of India impacting the psychological status and functioning of health care workers. The aim of this study is to determine the burnout levels and factors associated with the risk of psychological distress among healthcare workers (HCW) engaged in the management of COVID 19 in India. METHODS: A cross-sectional study was conducted from 1 September 2020 to 30 November 2020 by telephonic interviews using a web-based Google form. Health facilities and community centres from 12 cities located in 10 states were selected for data collection. Data on socio-demographic and occupation-related variables like age, sex, type of family, income, type of occupation, hours of work and income were obtained was obtained from 967 participants, including doctors, nurses, ambulance drivers, emergency response teams, lab personnel, and others directly involved in COVID 19 patient care. Levels of psychological distress was assessed by the General health Questionnaire -GHQ-5 and levels of burnout was assessed using the ICMR-NIOH Burnout questionnaire. Multivariable logistic regression analysis was performed to identify factors associated with the risk of psychological distress. The third quartile values of the three subscales of burnout viz EE, DP and PA were used to identify burnout profiles of the healthcare workers. RESULTS: Overall, 52.9% of the participants had the risk of psychological distress that needed further evaluation. Risk of psychological distress was significantly associated with longer hours of work (≥ 8 hours a day) (AOR = 2.38, 95% CI(1.66-3.41), income≥20000(AOR = 1.74, 95% CI, (1.16-2.6); screening of COVID-19 patients (AOR = 1.63 95% CI (1.09-2.46), contact tracing (AOR = 2.05, 95% CI (1.1-3.81), High Emotional exhaustion score (EE ≥16) (AOR = 4.41 95% CI (3.14-6.28) and High Depersonalisation score (DP≥7) (AOR = 1.79, 95% CI (1.28-2.51)). About 4.7% of the HCWs were overextended (EE>18); 6.5% were disengaged (DP>8) and 9.7% HCWs were showing signs of burnout (high on all three dimensions). CONCLUSION: The study has identified key factors that could have been likely triggers for psychological distress among healthcare workers who were engaged in management of COVID cases in India. The study also demonstrates the use of GHQ-5 and ICMR-NIOH Burnout questionnaire as important tools to identify persons at risk of psychological distress and occurrence of burnout symptoms respectively. The findings provide useful guide to planning interventions to mitigate mental health problems among HCW in future epidemic/pandemic scenarios in the country.

COVID Appropriate Behavior Compliance and Vaccine Hesitancy: Findings From a COVID-19 Health Education Campaign in a Government Tertiary Care Hospital in Delhi, India.

Public health measures remain the best available approach to tackle the coronavirus disease 2019 (COVID-19) pandemic. However, little is currently known about the compliance and acceptance of these measures by people in India. The Department of Community Medicine at Vardhman Mahavir Medical College (VMMC), and Safdarjung Hospital, a tertiary care hospital in New Delhi, organized a health education campaign for raising awareness on COVID-19 in the hospital premises over a period of 15 d in May 2021. Educational and interactive sessions were conducted by medical residents, interns, and staff. Data on compliance to public health measures were collected and analyzed using SPSS 21. All quantitative variables were descriptively analyzed while qualitative data were narratively analyzed. A total of 84 (12.57%) of those observed were wearing their mask incorrectly. Social distancing was inadequate at 16 sites. Sixty-nine (10.33%) reported to have received single or both doses of vaccine. Common reasons for not getting vaccinated included doubts about vaccine efficacy, eligibility, adverse events, availability, and accessibility. Mask use was universal, but directives on correct protocol of wearing masks needs to be widely circulated. Credible information about vaccine safety, efficacy, availability, and accessibility needs to be available to the community to build confidence in COVID-19 vaccination.

A brief psycho-social intervention for COVID-19 vaccine hesitancy among perinatal women in low-and middle-income countries: Need of the hour.

COVID-19 vaccines are one of the most effective strategies for preventing COVID-19 infection, as well as the associated mortality and morbidity. Despite the availability of COVID-19 vaccines, vaccine acceptance among perinatal women is challenging in low and middle-income countries (LMICs). Further, the vaccine hesitancy among perinatal women may have an impact on their children's vaccinations. The purpose of this paper is to briefly discuss the existing research on COVID-19 and non-COVID-19 vaccine hesitancy, psychosocial aspects, measures, and the individual level interventions for vaccine hesitancy among perinatal women. In our opinion, there is a need for further research with a specific focus on developing effective and feasible individual-level interventions to address COVID-19 vaccine hesitancy among perinatal women in LMICs.

Social Stigma of COVID-19 Experienced by Frontline Healthcare Workers of Department of Anaesthesia and Critical Care of a Tertiary Healthcare Institution in Delhi.

BACKGROUND: Social stigma is associated with Coronavirus Disease-2019 (COVID-19) particularly against people who have contracted the disease or have come in contact with it. There is paucity of studies regarding the prevalence of social stigma against healthcare workers (HCWs) in COVID-19 hospitals in India. The objective of this study was to measure social stigma faced by frontline HCWs of Department of Anaesthesia and Critical Care in a COVID-19 hospital and to assess the relationship between sociodemographic characteristics and social stigma. PATIENTS AND METHODS: A cross-sectional study using a questionnaire (sociodemographic characteristics along with modified Berger HIV Stigma Scale) was conducted from October 10, 2020 to October 30, 2020, in the Department of Anaesthesia and Critical Care. The survey was distributed among frontline HCWs using Google Forms as well as Bilingual Physical Form. Total stigma and subgroups of stigma scale were measured for different sociodemographic parameters and compared. Data were presented as mean ± standard deviation. p-value <0.05 was taken as significant. RESULTS: Out of 120 frontline HCWs participated in the study, 68 (56.6%) reported severe level of COVID-19-related stigma. The mean score of COVID-19-related stigma was 41 + 7.69. Mean scores for subgroups of stigma scale, i.e., personalized stigma, disclosure concerns, negative self-image, and concerns with public attitude, were 15.60 + 4.01, 6.68 + 3.21, 5.46 + 3.22, and 13.25 + 2.44, respectively. In the univariate analysis, the overall COVID-19-related stigma scores were associated with age >30 years, male gender, lower designation (technicians and nursing orderly), lesser education, and married HCWs. In logistic regression model, only male gender was significantly associated with severity of COVID-19 stigma. CONCLUSION: This study concluded that more than half of frontline HCWs in the Department of Anaesthesia and Critical Care experienced severe social stigma during COVID-19 pandemic, with highest stigma in concerns with public attitude subgroup. Severity of stigma was associated with age, male gender, designation, education, and marital status of HCW. HIGHLIGHTS: Frontline HCWs of Department Anaesthesia and Critical Care experienced significant stigma related to COVID-19. HOW TO CITE THIS ARTICLE: Jain S, Das AK, Talwar V, Kishore J, Heena, Ganapathy U. Social Stigma of COVID-19 Experienced by Frontline Healthcare Workers of Department of Anaesthesia and Critical Care of a Tertiary Healthcare Institution in Delhi. Indian J Crit Care Med 2021;25(11):1241-1246.

Mortality among adult hospitalized patients during the first wave and second wave of COVID-19 pandemic at a tertiary care center in India.

The similarities and differences between the mortality patterns of the two waves in India remain largely unknown. This was a retrospective study of medical records conducted in the COVID data center of our hospital This study analyzed data of patients who died in the month of August, 2020 to October 2020 (one month before and after the peak of first wave i.e., 16th September, 2020) and April 2021 to June 2021 (one month before and after the peak of second wave i.e., 6th May, 2021), corresponding to an equal part of the pandemic during first (2020) and second (2021) wave. Out of 1893 patients in the study, 764 patients were admitted during the first wave and 1129 patients during the second wave of pandemic. In total, 420 patients died during the entire study period. Of those, 147 (35%) deaths occurred during the first wave and 273 (65%) during the second wave, reflecting a case fatality rate (CFR) of 19.2% during the first wave and a CFR of 24.18%. There were no significant differences in the age group, gender, presenting complaints, duration of stay and comorbidities. However, the deceased COVID-19 patients had an increase in case fatality rate, average duration of symptoms from onset to hospital admission (DOSHA) and a major shift from MODS to ARDS being the cause of death during the second wave of pandemic. This study demonstrates increased CFR, average DOSHA and a paradigm shift to ARDS as cause of mortality during the second peak of the pandemic. It is necessary to remain vigilant of newer COVID-19 variants of concern, follow COVID-19 appropriate behaviors and keep emphasizing on care of high-risk groups including patients with comorbidities and elderly population to prevent mortality.

Perception and attitude towards COVID-19 vaccination: A preliminary online survey from India.

CONTEXT: Coronavirus disease 2019 (COVID-19) has rapidly become a global pandemic taking more than 1.7 million lives. While many developed countries are starting their vaccination drive, India is not far behind but still not much is known about the willingness to get a vaccination in India. AIMS: To find out the perception and attitude toward vaccination against COVID-19 among the adult population of India in order to know the proportion of people who are willing to get vaccinated against COVID-19. METHOD: A cross-sectional study was conducted between October 26, 2020 and November 10, 2020. Data were collected online using a self-administered and semi-structured questionnaire among adults aged 18 years or more in India via web-based links. The minimum sample size was calculated by considering the proportion of willingness to take the vaccination as 50%, 95% confidence interval, and 5% alpha error-the calculated sample size was 384. However, 467 participants completed the survey during the study period. Data were analyzed using SPSS version 21. RESULTS: A total of 467 participants responded, out of which 329 (70.44%) showed a willingness to get vaccinated and 138 (29.55%) were hesitant to get vaccinated against COVID-19. Only 49.4% believed that people can be protected by the vaccine; 63.1% of the people were willing to get their children vaccinated; and 59.31% felt the vaccine should be free for all. CONCLUSIONS: The pan India survey conducted online revealed that approximately 3 in 10 adults were not willing to get vaccinated against COVID-19. This can guide policymakers to make multipronged efforts to increase the willingness to get a vaccination against COVID-19.

Psychosocial impact of COVID-19 pandemic on healthcare workers in India & their perceptions on the way forward - A qualitative study.

Background & objectives: The healthcare system across the world has been overburdened due to the COVID-19 pandemic impacting healthcare workers (HCWs) in different ways. The present study provides an insight into the psychosocial challenges faced by the HCWs related to their work, family and personal well-being and the associated stigmas. Additionally, the coping mechanisms adopted by them and their perceptions on the interventions to address these challenges were also explored. Methods: A qualitative study was conducted between September and December 2020 through in-depth telephonic interviews using an interview guide among 111 HCWs who were involved in COVID-19 management across 10 States in India. Results: HCWs report major changes in work-life environment that included excessive workload with erratic timings accentuated with the extended duration of inconvenient personal protection equipment usage, periods of quarantine and long durations of separation from family. Family-related issues were manifold; the main challenge being separated from family, the challenge of caregiving, especially for females with infants and children, and fears around infecting family. Stigma from the community and peers fuelled by the fear of infection was manifested through avoidance and rejection. Coping strategies included peer, family support and the positive experiences manifested as appreciation and recognition for their contribution during the pandemic. Interpretation & conclusions: The study demonstrates the psychological burden of HCWs engaged with COVID-19 care services. The study findings point to need-based psychosocial interventions at the organizational, societal and individual levels. This includes a conducive working environment involving periodic evaluation of the HCW problems, rotation of workforce by engaging more staff, debunking of false information, community and HCW involvement in COVID sensitization to allay fears and prevent stigma associated with COVID-19 infection/transmission and finally need-based psychological support for them and their families.