Adaptation and Change in Practices in Neuro-Intervention during COVID-19 Pandemic: Experience from Department of Interventional Neurology at Referral Tertiary Care Hospital in Bangladesh

Background: Different adaptation and changes have been practiced during COVID-19 pandemic. Objective: In this paper we investigated the impact of the COVID-19 pandemic on service delivery in the department of interventional neurology and adaptation of the department to the changed environment. Methodology: This was a retrospective analysis of diagnostic digital subtraction angiography (DSA) procedures done from January 2018 to December 2020 and were analyzed to detect significant breaks in time trend. Results: A total of 358, 426 and 251 patients got admitted for DSA in consecutive three years from 2018 to 2020 respectively. There was a sudden drop in the number of DSA procedures from 30 to 50 patients per month in the pre-COVID era before March 2020 to less than 10 patients per month during the COVID period of March to June 2020. However, the situation gradually improved following the introduction of RT-PCR test for SARS CoV-2 in June 2020. A poison regression showed a significant increase in monthly DSA procedures in the year 2019 compared to the year 2018, but a significant decrease in the pandemic year of 2020. Conclusion: By incorporating COVID-19 testing as a pre-requisite test before DSA procedures, the department of interventional neurology recovered from experiencing a significant drop in the number of performed DSA procedures in the initial periods of the pandemic to reaching a level observed in the pre-COVID era.

Weather extremes associated with increased Ross River virus and Barmah Forest virus notifications in NSW: learnings for public health response.

OBJECTIVE: To examine the sequence of environmental and entomological events prior to a substantial increase in Ross River virus (RRV) and Barmah Forest virus (BFV) notifications with a view to informing future public health response. METHODS: Rainfall, tidal, mosquito and human arboviral notification data were analysed to determine the temporality of events. RESULTS: Following two extremely dry years, there was a substantial increase in the abundance of mosquitoes along coastal New South Wales (NSW) two weeks after a significant rainfall event and high tides in February 2020. Subsequently, RRV and BFV notifications in north east NSW began to increase eight and nine weeks respectively after the high rainfall, with RRV notifications peaking 12 weeks after the high rainfall. CONCLUSIONS: Mosquito bite avoidance messaging should be instigated within two weeks of high summer rainfall, especially after an extended dry period. IMPLICATIONS FOR PUBLIC HEALTH: Intense summertime rain events, which are expected to increase in frequency in south-east Australia with climate change, can lead to significant increases in arboviral disease. These events need to be recognised by public health practitioners to facilitate timely public health response. This has taken on added importance since the emergence of Japanese encephalitis virus in southeastern Australia in 2022.

Cholesterol Binds the Amphipathic Helix of IFITM3 and Regulates Antiviral Activity.

The interferon-induced transmembrane (IFITM) proteins broadly inhibit the entry of diverse pathogenic viruses, including Influenza A virus (IAV), Zika virus, HIV-1, and SARS coronaviruses by inhibiting virus-cell membrane fusion. IFITM3 was previously shown to disrupt cholesterol trafficking, but the functional relationship between IFITM3 and cholesterol remains unclear. We previously showed that inhibition of IAV entry by IFITM3 is associated with its ability to promote cellular membrane rigidity, and these activities are functionally linked by a shared requirement for the amphipathic helix (AH) found in the intramembrane domain (IMD) of IFITM3. Furthermore, it has been shown that the AH of IFITM3 alters lipid membranes in vitro in a cholesterol-dependent manner. Therefore, we aimed to elucidate the relationship between IFITM3 and cholesterol in more detail. Using a fluorescence-based in vitro binding assay, we found that a peptide derived from the AH of IFITM3 directly interacted with the cholesterol analog, NBD-cholesterol, while other regions of the IFITM3 IMD did not, and native cholesterol competed with this interaction. In addition, recombinant full-length IFITM3 protein also exhibited NBD-cholesterol binding activity. Importantly, previously characterized mutations within the AH of IFITM3 that strongly inhibit antiviral function (F63Q and F67Q) disrupted AH structure in solution, inhibited cholesterol binding in vitro, and restricted bilayer insertion in silico. Our data suggest that direct interactions with cholesterol may contribute to the inhibition of membrane fusion pore formation by IFITM3. These findings may facilitate the design of therapeutic peptides for use in broad-spectrum antiviral therapy.

Practice and Challenges of Bangladeshi Occupational Therapists during COVID-19: A Cross-Sectional Survey.

This descriptive study describes the practice and challenges of occupational therapists in Bangladesh during the COVID-19 pandemic using an online survey. Eighty-four participants who are practising in both clinical and community settings anonymously participated in the study between January - March 2021. About a third (38.5%) of participants continued hands-on service, 29.5% started working from home, 19.2% worked in both methods, and 12.8% stopped working and almost 12% commenced telerehabilitation service as a new practice. This paper describes the practice as well as the different challenges. Implications of the results are explored as well as future needs.

Public Confidence in COVID-19 Prevention and Response in Bangladesh.

Community confidence in institutional approaches to emergency management directs how they cooperate and comply with public policy responses. In the context of emerging COVID-19 pandemic risk management, this study aims to assess public confidence in the Government of Bangladesh (GoB) and private sector entities for the activities undertaken during preparedness, prevention, and response phases. A survey was conducted with 307 respondents who willingly took part in the study. Cronbach's alpha was calculated to assess the internal reliability and the Mann-Whitney U test was conducted to estimate the mean score difference between the observations. A confirmatory factor analysis (CFA) was applied in the study. The findings suggest that the participants were highly positive about the GoB efforts to organize and provide PPE for doctors in time as a safeguard against COVID-19 and coordination and informed decision making in relation to facing COVID-19. Overall, the participants showed a lower-level confidence in the preparedness and response measures taken by authorities in Bangladesh. The results explored how the GoB failed to reach the public satisfaction level regarding provision of food and financial support to low income and middle income people. A lack of collaboration and coordination among different inter-GoB and private sectors makes mitigation and recovery process difficult. This research provides a set of policy recommendations for future public health emergency management based on the participants' concerns and suggestions, and a review of consequences of policy responses in the early stage.

After Rana Plaza: Governing Exploitative Workplace Labour Regimes in Bangladeshi Garment Export Factories

In 2013, the Rana Plaza disaster highlighted the highly exploitative conditions of the global garment supply chain centred on Bangladesh. Global lead firms and other stakeholders responded by reforming the labour governance system comprising public and private regulations. How can the effects of this new multi-level governance system on worker outcomes (wages, working conditions and workers? rights) be conceptualized and explained? Using an inter-disciplinary framework integrating an industrial relations/sociology perspective and a global production network approach, we show how workplace relations (structural and relational workplace characteristics) mediate the relationship between the labour governance system and worker outcomes. A mixed methods research design that includes a factory management survey and case studies enables us to identify and analyse two predominant types of workplace labour regimes associated with different patterns of worker outcomes (procedural and substantive employment conditions). Referred to as the hardship and sweatshop regimes, respectively, these differ in the extent to which workers are exploited. With the emergence of the Covid-19 pandemic, we discuss the possibility that modern slavery, the worst form of worker exploitation, is emerging. The paper concludes by briefly considering several research and practical implications of our analysis.

Public Trust in COVID-19 Prevention and Responses Between January and May 2020 in Bangladesh.

BACKGROUND AND AIMS: Although the Government of Bangladesh (GoB) developed some policy initiatives during the first phase of COVID-19, their efforts were questioned due to indecision, late policy decisions and implementation, and a proliferation of fake testing and fake news. As such, this research aims to examine public trust in preparedness and response measures undertaken by both the GoB and private sector organisations in Bangladesh between January and May 2020. METHODS: A cross-sectional survey method was applied to a sample of Bangladeshi residents using a questionnaire distributed between April and June 2020. Three hundred and seven respondents participated in an online questionnaire that was disseminated on online outlets, such as e-mail, Facebook Messenger, and WhatsApp. The survey questionnaire was distributed to potential respondents, and continuous-chain messages were provided. Data were analyzed using exploratory factor analysis (EFA). FINDINGS: Of the 307 participants, 77% were male and 23% were female. Findings suggest that the participants showed greater approval of private sector responses than of governmental preparedness and response activities. For preparedness activities, participants were negative about both the GoB efforts to organize and provide personal protective equipment (PPE) for doctors in time as a safeguard against COVID-19, and also the lack of coordination and informed decision-making in relation to facing COVID-19. Respondents were asked to share their perception of the suitability of GoB pandemic management plans, as evidenced by plan effectiveness during the COVID-19 pandemic. CONCLUSION: A lower level of trust was demonstrated by the Bangladeshis with regard to preparedness and response measures taken in Bangladesh. Based on participants' concerns and suggestions and a review of drawback of policy responses in the early stage, a set of recommendations are provided for future pandemics like public health emergency risk management in Bangladesh.

Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings: A global analysis

OBJECTIVE: In the current absence of a vaccine for COVID-19, public health responses aim to break the chain of infection by focusing on the mode of transmission. We reviewed the current evidence on the transmission dynamics and on pathogenic and clinical features of COVID-19 to critically identify any gaps in the current infection prevention and control (IPC) guidelines. METHODS: In this study, we reviewed global COVID-19 IPC guidelines by organizations such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and the European Centre for Disease Prevention and Control (ECDC). Guidelines from 2 high-income countries (Australia and United Kingdom) and from 1 middle-income country (China) were also reviewed. We searched publications in English on 'PubMed' and Google Scholar. We extracted information related to COVID-19 transmission dynamics, clinical presentations, and exposures that may facilitate transmission. We then compared these findings with the recommended IPC measures. RESULTS: Nosocomial transmission of SARS-CoV-2 in healthcare settings occurs through droplets, aerosols, and the oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes, and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol-generating procedures. However, recommendations regarding the type of face mask varied, and the CDC recommends cloth masks when surgical masks are unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and should target all patient care activities involving risk of person-to-person transmission. This review may assist international health agencies in updating their guidelines.

Improving the impact of non-pharmaceutical interventions during COVID-19: examining the factors that influence engagement and the impact on individuals.

BACKGROUND: During an evolving outbreak or pandemic, non-pharmaceutical interventions (NPIs) including physical distancing, isolation, and mask use may flatten the peak in communities. However, these strategies rely on community understanding and motivation to engage to ensure appropriate compliance and impact. To support current activities for COVID-19, the objectives of this narrative review was to identify the key determinants impacting on engagement. METHODS: An integrative narrative literature review focused on NPIs. We aimed to identify published peer-reviewed articles that focused on the general community (excluding healthcare workers), NPIs (including school closure, quarantine, isolation, physical distancing and hygiene behaviours), and factors/characteristics (including social, physical, psychological, capacity, motivation, economic and demographic) that impact on engagement. RESULTS: The results revealed that there are a range of demographic, social and psychological factors underpinning engagement with quarantine, school closures, and personal protective behaviours. Aside from the factors impacting on acceptance and compliance, there are several key community concerns about their use that need to be addressed including the potential for economic consequences. CONCLUSION: It is important that we acknowledge that these strategies will have an impact on an individual and the community. By understanding the barriers, we can identify what strategies need to be adopted to motivate individuals and improve community compliance. Using a behavioural framework to plan interventions based on these key barriers, will also ensure countries implement appropriate and targeted responses.

Economic Consequences of the COVID-19 Outbreak: the Need for Epidemic Preparedness.

COVID-19 is not only a global pandemic and public health crisis; it has also severely affected the global economy and financial markets. Significant reductions in income, a rise in unemployment, and disruptions in the transportation, service, and manufacturing industries are among the consequences of the disease mitigation measures that have been implemented in many countries. It has become clear that most governments in the world underestimated the risks of rapid COVID-19 spread and were mostly reactive in their crisis response. As disease outbreaks are not likely to disappear in the near future, proactive international actions are required to not only save lives but also protect economic prosperity.

Examining the current intelligence on COVID-19 and infection prevention and control strategies in health settings: A global analysis

OBJECTIVE: In the current absence of vaccine for COVID-19, public health response target breaking the chain of infection by focusing on the mode of transmission. This paper summarizes current evidence-base around the transmission dynamics, pathogenic, and clinical features of COVID-19, to critically identify if there are any gaps in the current IPC guidelines. METHODS: This study involved a review of global COVID-19 IPC guidelines such as WHO, the CDC, and European Centre for Disease Prevention and Control (ECDC). Guidelines from two high income countries (Australia and UK) and one middle income country (China) were also reviewed. We searched publications in English on 'Pubmed' and Google Scholars. We extracted information related to COVID-19 transmission dynamics, clinical presentations and exposures that may facilitate the transmission and compared and contrasted these findings with the recommended IPC measures. RESULTS: The review findings showed nosocomial transmission of SARS-CoV-2 in health settings through droplet, aerosol and by an oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol generating procedures. However, recommendations around type of surgical masks varied. In addition, CDC recommends cloth masks when the surgical mask is totally unavailable. CONCLUSION: IPC strategies should consider all the possible routes of transmission and target all patient care activities where there may be person to person transmission risk. This review may assist international health agencies to update their guidelines.