Global Health priorities: repositioning routine immunization for infants.

The first year of the Coronavirus disease (COVID-19) pandemic registered the highest number of children under the age of one year who did not receive basic vaccines since 2009. The pronounced rise in vaccine-preventable diseases in 2020 and 2021 was largely attributable to the disruption of the vaccine schedule for children around the world. Routine vaccinations were missed in consideration of movement restrictions to prevent the spread of COVID-19. On the other hand, health resources were re-allocated to COVID-19, resulting in strained health care systems and the marginalization of essential health services like routine vaccination campaigns. The COVID-19 pandemic has clearly illustrated the potential of vaccines in saving lives and preventing disabilities. The unequal roll-out of vaccination programmes has simultaneously deepened the existing gaps between high and low-income countries. Disruption in other key life-saving immunization programmes is driving these inequalities even further. Prompt and sustainable investments in routine immunization programmes, including catch-up vaccination strategies, are essential to avert the impact of years of neglect of this important public health issue. In particular, the recent declining trends in vaccination coverage are putting decades of progress at risk.

Early treatment with low-molecular-weight heparin reduces mortality rate in SARS-CoV-2 patients.

BACKGROUND: Since the beginning of the SARS-CoV-2 pandemic, millions of people have been infected and died. Different therapeutic approaches have been recommended, but only a few have shown clinical advantages. Low-molecular-weight heparin (LMWH) has been recommended to prevent COVID-19-related thrombo-embolic events. We aim to evaluate the impact of early treatment with LMWH on hospital admission and death in patients with SARS-CoV-2 infection. METHODS: We conducted an observational monocentric retrospective study to evaluate the preventive role of LMWH on the mortality rate of COVID-19 patients. SARS-CoV-2 infected patients were recruited from the beginning of the Italian epidemic to March 31st, 2021. We excluded patients with missing data and those chronically exposed to LMWH. Treatment prescription was based on international and national guidelines and modified depending on clinical presentation and drug-drug interactions. RESULTS: of 734 SARS-CoV-2 infected patients were recruited, with 357 (48.6%) males and a median (IQR) age of 77.9 (65-85.7) years. 77.5% of people developed SARS-CoV-2-related symptoms and 62.8% were admitted to the hospital, and 20.2% died. Four hundred ninety-two (67%) started LMWH. In particular, 296 (40.3%) were treated within five days since symptoms onset. At logistic regression, early LMWH therapy was associated with lower mortality. Furthermore, remdesivir treatment showed a lower risk of death. On the contrary, age, BMI >30Kg/m2, neurological diseases, fever or dyspnea were associated with an increased risk of death. CONCLUSIONS: In conclusion, early treatment with LMWH was associated with lower mortality in our cohort. Further studies are needed to better assess the role of wider LMWH administration in terms of timing and regimen dose.

Are "cases", "waves", "tests" and "modeling" deceiving indicators to describe the COVID-19 pandemic?

This commentary elaborates on different methodological aspects complicating the interpretation of epidemiological data related to the current COVID-19 pandemic, thus preventing reliable within and across-country estimates. Firstly, an inaccuracy of epidemiological data maybe arguably be attributed to passive surveillance, a relatively long incubation period during which infected individuals can still shed high loads of virus into the surrounding environment and the very high proportion of cases not even developing signs and/or symptoms of COVID-19. The latter is also the major reason for the inappropriateness of the abused "wave" wording, which gives the idea that health system starts from scratch to respond between "peaks". Clinical data for case-management on the other hand often requires complex technology in order to merge and clean data from health care facilities. Decision-making is often further derailed by the overuse of epidemiological modeling: precise aspects related to transmissibility, clinical course of COVID-19 and effectiveness of the public health and social measures are heavily influenced by unbeknownst and unpredictable human behaviors and modelers try to overcome missing epidemiological information by relying on poorly precise or questionable assumptions. Therefore the COVID-9 pandemic may provide a valuable opportunity to rethink how we are dealing with the very basic principles of epidemiology as well as risk communication issues related to such an unprecedented emergency situation.

Predictors of infection, symptoms development, and mortality in people with SARS-CoV-2 living in retirement nursing homes.

INTRODUCTION: Since the start of the pandemic, millions of people have been infected, with thousands of deaths. Many foci worldwide have been identified in retirement nursing homes, with a high number of deaths. Our study aims were to evaluate the spread of SARS-CoV-2 in the retirement nursing homes, the predictors to develop symptoms, and death. METHODS AND FINDINGS: We conducted a retrospective study enrolling all people living in retirement nursing homes (PLRNH), where at least one SARS-CoV-2 infected person was present. Medical and clinical data were collected. Variables were compared with Student's t-test or Pearson chi-square test as appropriate. Uni- and multivariate analyses were conducted to evaluate variables' influence on infection and symptoms development. Cox proportional-hazards model was used to evaluate 30 days mortality predictors, considering death as the dependent variable. We enrolled 382 subjects. The mean age was 81.15±10.97 years, and males were 140(36.7%). At the multivariate analysis, mental disorders, malignancies, and angiotensin II receptor blockers were predictors of SARS-CoV-2 infection while having a neurological syndrome was associated with a lower risk. Only half of the people with SARS-CoV-2 infection developed symptoms. Chronic obstructive pulmonary disease and neurological syndrome were correlated with an increased risk of developing SARS-CoV-2 related symptoms. Fifty-six (21.2%) people with SARS-CoV-2 infection died; of these, 53 died in the first 30 days after the swab's positivity. Significant factors associated with 30-days mortality were male gender, hypokinetic disease, and the presence of fever and dyspnea. Patients' autonomy and early heparin treatment were related to lower mortality risk. CONCLUSIONS: We evidenced factors associated with infection's risk and death in a setting with high mortality such as retirement nursing homes, that should be carefully considered in the management of PLRNH.

The forgotten sub-regional COVID-19 response layer. The case of the WHO Eastern Mediterranean Region.

The response to the COVID-19 pandemic have been driven by epidemiology, health system characteristics and control measures in form of social/physical distancing. Guidance, information and best practices have been characterized by territorial thinking with concentration on national health system and social contexts. Information was to a large extent provided from global entities such as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and others. This bipolar response mechanism came to the detriment of regional and sub-regional levels. The development of the global pandemic was evaluated in terms of the performance of single countries without trying to reflect on possible regional or sub-regional results of similar characteristics in health system and social contexts. To have a clearer view of the issue of sub-regional similarities, we examined the WHO, Eastern Mediterranean Region. When examining the development of confirmed cases for countries in the region, we identified four different sub-groups similar in the development of the pandemic and the social distancing measure implemented. Despite the complicated situation, these groups gave space for thinking outside the box of traditional outbreaks or pandemic response. We think that this sub-regional approach could be very effective in addressing more characteristics and not geographically based analysis. Furthermore, this can be an area of additional conceptual approaches, modelling and concrete platforms for information and lessons learned exchange.

Severe acute respiratory syndrome coronavirus-2 medical solid waste treatment: A need for efficient and effective strategies in low-resourced settings.

Understanding infections related to handling healthcare waste products is of critical importance and the application of simple and low-cost strategies remain a priority in low-income and middle-income countries to protect healthcare workers. We examined the potential effect of relative humidity (RH), air temperature and ultraviolet irradiation (UI) to establish an efficient and effective way to facilitate disposal of medical waste. Literature is emerging on the effect of high RH and high temperature, which would increase airborne mass deposition and decrease the viability of viruses in both airborne particles and on surfaces. On the other hand, severe acute respiratory syndrome coronavirus-2 has been proven to be susceptible to UI when suspended in air like other coronaviruses. An innovative approach utilizing environmental conditions might represent an effective and efficient way to ensure better and sustainable protection of the healthcare workers in low-resourced settings.

Safe abortion amid the COVID-19 pandemic: The case of Italy

An estimated 56 million induced abortions occur globally every year, of which 54.9% are unsafe.[1] This is a major public health issue, especially where access to legal abortion is highly restricted, resulting in an estimated 7.9% of maternal deaths annually due to unsafe abortion.