Resilience Strategies of Tour Operators During the Uncertainty of COVID-19: Evidence from Bangladesh

Since the outbreak of COVID-19 pandemic, tour operators have been going through uncertain times as they depend directly on supply-side (e.g. airlines, hotels) and demand-side (e.g. tourists) of tourism as well as on destination management organizations. This study explores resilience strategies made by tour operators in Bangladesh that ultimately helped them survive through the COVID-19 pandemic. Drawing on qualitative semi-structured interviews with 25 tour operators, findings of the study show that resilience-building depends not only on strategies of tour operators but also on supports from external agencies. The study further shows that a multi-dimensional understanding of resilience strategies is essential in tourism research and proposes that the resilience-building of tour operators can be conceptualized as a three-dimensional mechanism including innate resilience, internally-induced resilience, and externally-induced resilience. The study would facilitate improved resilience strategy and informed policymaking to better address uncertainties during and after a major crisis for tour operators.

An integrated in-silico Pharmaco-BioInformatics approaches to identify synergistic effects of COVID-19 to HIV patients.

BACKGROUND: With high inflammatory states from both COVID-19 and HIV conditions further result in complications. The ongoing confrontation between these two viral infections can be avoided by adopting suitable management measures. PURPOSE: The aim of this study was to figure out the pharmacological mechanism behind apigenin's role in the synergetic effects of COVID-19 to the progression of HIV patients. METHOD: We employed computer-aided methods to uncover similar biological targets and signaling pathways associated with COVID-19 and HIV, along with bioinformatics and network pharmacology techniques to assess the synergetic effects of apigenin on COVID-19 to the progression of HIV, as well as pharmacokinetics analysis to examine apigenin's safety in the human body. RESULT: Stress-responsive, membrane receptor, and induction pathways were mostly involved in gene ontology (GO) pathways, whereas apoptosis and inflammatory pathways were significantly associated in the Kyoto encyclopedia of genes and genomes (KEGG). The top 20 hub genes were detected utilizing the shortest path ranked by degree method and protein-protein interaction (PPI), as well as molecular docking and molecular dynamics simulation were performed, revealing apigenin's strong interaction with hub proteins (MAPK3, RELA, MAPK1, EP300, and AKT1). Moreover, the pharmacokinetic features of apigenin revealed that it is an effective therapeutic agent with minimal adverse effects, for instance, hepatoxicity. CONCLUSION: Synergetic effects of COVID-19 on the progression of HIV may still be a danger to global public health. Consequently, advanced solutions are required to give valid information regarding apigenin as a suitable therapeutic agent for the management of COVID-19 and HIV synergetic effects. However, the findings have yet to be confirmed in patients, suggesting more in vitro and in vivo studies.

Sero-surveillance of SARS-CoV-2 specific antibody (IgG) among garment workers in Bangladesh (preprint)

Background Since the detection of first corona virus infection in Bangladesh on 8th March, 2020, it has been spread to the whole country quickly. Though there is lack of proper treatment facility, diagnostic facility, lack of awareness, unwillingness of people to follow the social distance guideline and lack of other containment strategies, the prevalence of COVID-19 infection especially severe and symptomatic infection among people of Bangladesh specially among working people like garment workers, people living in slum areas and rural areas are low.Objectives The purpose of this research was to determine the sero-prevalence of SARS-CoV-2-specific antibody (IgG) among Bangladeshi garment workers.Methods A cross-sectional and observational research was conducted on 402 garment workers. (69.4% female; mean age = 28.9 ± 6.9 years) in Dhaka city. A semi-structured questionnaire including informed consent as well as, socio-demographics and COVID-19 infection related information, was used to conduct the survey. Blood samples of all participants were also collected to measure the SARS-CoV-2 specific antibody (IgG). Serum level of SARS-CoV-2 specific antibody (IgG) was assessed by Chemiluminescent immunoassay technique as per instruction of manufacturer.Results The prevalence of sero-prevalence of SARS-CoV-2 specific antibody (IgG) was 80.8% which was slightly higher among females compared to male but not significant (82.1% vs. 78.0%, p > 0.05). It was notable that no significant differences were obtained in other socio-demographic information (e.g., age, education, marital status, residence, and economic status).Conclusions The findings reflect that the SARS-CoV-2 specific antibody (IgG) was prevalent among garment workers in Bangladesh. It may be due to the virus itself, genetic factor of virus, people and presence of preexisting immunity specially SARS-CoV-2 specific antibody due to previous cross infections with other corona viruses in Bangladesh.

A comprehensive design for prevention and management of COVID-19 in a tertiary medical institution in Bangladesh.

INTRODUCTION: Containment of the further spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and reducing fatality due to coronavirus disease 19 (COVID-19) represent a pressing challenge to global health services. Here, we present a management blueprint for both the containment of SARS-CoV-2 and treatment of COVID-19 through a comprehensive approach. METHODOLOGY: A cohort of 130 consecutive patients identified as positive for SARS-CoV-2 by testing of nasal swab by polymerase chain reaction were managed at a peripheral city of Bangladesh between 1 April and 31 May, 2020. Based on their clinical status, 64 of them were initially selected for isolation (Isolation Group) and 66 recommended for hospitalization (Hospital Group) as per the direction of the "Central COVID-19 Control" Center. Both groups of patients were allocated to receive standard of care management and oxygen inhalation, and intensive care unit management as and when necessary. Based on the conditions of the COVID-19 patients, there was an active system of patients being transferred from the "Isolation Group" to "Hospital Group" and vice versa. RESULTS: Twelve patients of the "Isolation Group" were transferred to the hospital, as they exhibited symptoms of deterioration. Four patients of the "Hospital Group" died during the observation period of two months in the intensive care unit. However, there has been no fatality among the patients of the "Isolation Group". CONCLUSIONS: The concept of "Isolation" and "Hospital Management" with the participation of the community seems to be an effective management strategy for COVID-19 in developing countries.

A study protocol for a double-blind randomised placebo-controlled trial evaluating the efficacy of carrageenan nasal and throat spray for COVID-19 prophylaxis – ICE COVID (preprint)

Introduction: At present, vaccines form the only mode of prophylaxis against COVID-19. The time needed to achieve mass global vaccination and the emergence of new variants warrants continued research into other COVID-19 prevention strategies. The severity of COVID-19 infection is thought to be associated with the initial viral load and for infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus and attach to the host cell surface receptors. Carrageenan, a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a wide range of viruses in clinical trials through prevention of viral entry into respiratory host cells. Carrageenan has also demonstrated in-vitro activity against SARS-CoV-2. This clinical trial was designed to investigate the efficacy of carrageenan nasal and throat sprays in reducing the rate and severity of COVID-19 infection. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population. Methods: and analysis: A single centre, randomised, double-blinded, placebo-controlled phase III trial was designed. Participants randomised in a 1:1 allocation to either the treatment arm, verum Coldamaris plus (1.2 mg iota-carrageenan (Carragelose®), 0.4 mg kappa-carrageenan, 0.5% sodium chloride and purified water) or placebo arm, Coldamaris sine (0.5% sodium chloride) spray applied daily to their nose and throat for 8 weeks, while completing a daily symptom tracker questionnaire for a total of 10 weeks.Primary outcome: Acquisition of COVID-19 infection as confirmed by positive PCR swab taken at symptom onset or seroconversion during the study. Secondary outcomes include symptom type, severity and duration, subsequent familial/household COVID-19 infection and infection with non-COVID-19 upper respiratory tract infections. A within-trial economic evaluation will be undertaken, with effects expressed as quality-adjusted life years. Hypothesis: That carrageenan spray will reduce SARS-CoV-2 attachment to the naso- and oropharyngeal mucosal epithelial cells thus reducing the effective viral infective dose preventing COVID19 infection and reducing disease severity where infection is not prevented. Ethics and dissemination : Ethics approval was obtained from Research Ethics Committee 6 South Wales (REC Reference 20/WA/0298; IRAS 283187) on the 18 th November 2020. The results will be submitted for publication in a peer-reviewed journal. Trial registration number: NCT04590365; registered on ClinicalTrials.gov (NCT04590365) on the 19 th October 2020.

The psychometric properties of the Bangla Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): preliminary reports from a large-scale validation study

Background The Posttraumatic Stress Disorder Checklist (PCL-5) is the most widely used screening tool in assessing posttraumatic stress disorder symptoms, based on the Diagnostic and Statistical Manual of Mental disorders (DSM-5) criteria. This study aimed to evaluate the psychometric properties of the newly translated Bangla PCL-5. Methods A cross-sectional survey was carried out among 10,605 individuals (61.0% male;mean age: 23.6 ± 5.5 [13–71 years]) during May and June 2020, several months after the onset of the COVID-19 outbreak in Bangladesh. The survey included the Bangla PCL-5 and the PHQ-9 depression scale. We used confirmatory factor analysis to test the four-factor DSM-5 model, the six-factor Anhedonia model, and the seven-factor hybrid model. Results The Bangla PCL-5 displayed adequate internal consistency (Cronbach’s alpha = 0.90). The Bangla PCL-5 score was significantly correlated with scores of the PHQ-9 depression scale, confirming strong convergent validity. Confirmatory factor analyses indicated the models had a good fit to the data, including the four-factor DSM-5 model, the six-factor Anhedonia model, and the seven-factor hybrid model. Overall, the seven-factor hybrid model exhibited the best fit to the data. Conclusions The Bangla PCL-5 appears to be a valid and reliable psychometric screening tool that may be employed in the prospective evaluation of posttraumatic stress disorder in Bangladesh.

Self-medication practices and associated factors among COVID-19 recovered patients to prevent future infections: A web-based survey in Bangladesh (preprint)

Background Human health is largely affected by self-medication in both ways, adversely and favorably, as evidenced by the COVID-19 pandemic. The fear of spreading COVID-19 among health workers and hospital environments has led many Bangladeshi people to practice self-medicate for as a preventive strategy against this disease. Consequently, this practice entails an improper and injudicious use of medicine to cure self-recognized symptoms. To date, the COVID-19 has no effective treatment. The lack of a cure for COVID-19 and the continual progression of the diseases in educational settings induce a substantial population to practice self-medication. Therefore a study of self-medication practices is necessary for the framework of the pandemic. This study aimed to estimate the prevalence and factors associated with self-medication to prevent or manage future COVID-19 infections among recovered COVID-19 patients. Methods This cross-sectional study was conducted from September 2020 to February 2021 using an e-survey along with 360 participants. Data were collected using a pre-tested self-reported questionnaire. Descriptive statistics and correlations analysis were performed in the study. Results Among 360 participants, males were 69.7%, and females 30.3%. The prevalence of self-medication is 11%, and monthly family income, residence, education, occupation, and previous history of SM are the associated factors. Among the participants, 29.7% use antibiotics, and 30% use herbal products or drugs as medication. Conclusion The present study found SMP is moderately prevalent among COVID-19 recovered patients. To minimize the rate of SMP, adequate health care access systems and public education should be introduced, and media & community should be engaged in rational use of medication.

Face Masks to Combat Coronavirus (COVID-19)-Processing, Roles, Requirements, Efficacy, Risk and Sustainability.

Increasingly prevalent respiratory infectious diseases (e.g., COVID-19) have posed severe threats to public health. Viruses including coronavirus, influenza, and so on can cause respiratory infections. A pandemic may potentially emerge owing to the worldwide spread of the virus through persistent human-to-human transmission. However, transmission pathways may vary; respiratory droplets or airborne virus-carrying particles can have a key role in transmitting infections to humans. In conjunction with social distancing, hand cleanliness, and other preventative measures, the use of face masks is considered to be another scientific approach to combat ubiquitous coronavirus. Different types of face masks are produced using a range of materials (e.g., polypropylene, polyacrylonitrile, polycarbonate, polyurethane, polystyrene, polyester and polyethylene) and manufacturing techniques (woven, knitted, and non-woven) that provide different levels of protection to the users. However, the efficacy and proper disposal/management of the used face masks, particularly the ones made of non-biodegradable polymers, pose great environmental concerns. This review compiles the recent advancements of face masks, covering their requirements, materials and techniques used, efficacy, challenges, risks, and sustainability towards further enhancement of the quality and performance of face masks.

Sero-prevalence of anti-SARS-CoV-2 antibodies in Chattogram Metropolitan Area, Bangladesh (preprint)

Background Seroprevalence studies of coronavirus disease 2019 (COVID-19) assess the degree of undetected transmission in the community. Different groups, such as healthcare workers (HCWs), garment workers, and others, are deemed vulnerable due to their workplace hazards and immense responsibility. Purpose The present study was conducted to estimate the seroprevalence of anti-SARS-CoV-2 antibody (IgG) and its association with different explanatory variables. Further, the antibody was quantified to assess the increasing or decreasing trend over different intervention periods and according to other factors. Methodology This cross-sectional study observed health workers - doctor, nurse, hospital staff, etc. in and outpatients (non-COVID-19) and garments workers of Chattogram metropolitan area (CMA, N=748) from randomly selected six government and private hospitals and two garment factories. Study subjects were included upon written consent, fulfilling specific inclusion criteria. Venous blood was collected following standard aseptic methods. Qualitative and quantitative ELISA was used to identify and quantify antibodies (IgG) in serum samples. Descriptive, univariable, and multivariable statistical analysis was performed. Results Overall seroprevalence was estimated as 66.99% (95% CI: 63.40%-70.40%). Seroprevalence among HCWs, in and outpatients, and garments workers were 68.99 % (95% CI: 63.8%-73.7%), 81.37 % (95% CI: 74.7%-86.7%), and 50.56 % (95% CI: 43.5%-57.5%), respectively. Seroprevalence was 44.47 % (95% CI: 38.6%-50.4%) in the non-vaccinated population while it was significantly ( p <0.001) higher in the population receiving the first dose (61.66 %, 95% CI: 54.8%-68.0%) and both (first and second) doses of vaccine (100%, 95% CI: 98.4%-100%). The mean titer of the antibody was estimated as 255.46 DU/ml and 159.08 DU/ml in the population with both doses and one dose of vaccine, respectively, compared to 53.71 DU/ml of the unvaccinated population. A decreasing trend in the titer of antibodies with increasing time after vaccination was observed. Conclusions Seroprevalence and mean antibody titer varied according to different factors in this study. The second dose of vaccine significantly increased the seroprevalence and titer, which decreased to a certain level over time. Although antibody was produced following natural infection, the mean titer was relatively low compared to antibody after vaccination. This study emphasizes the role of the vaccine in antibody production. Based on the findings, interventions like continuing extensive mass vaccination of the leftover unvaccinated population and bringing the mass population with a second dose under a third dose campaign might be planned.

DeepHealth: A secure framework to manage health certificates through medical IoT, blockchain and deep learning

In order to flatten the curve and lower human-to-human transmission of COVID-19 pathogen, one of the critical suggestions by health professionals is to monitor COVID-19 virus status of each human dynamically which is not a pragmatic solution unless the COVID-19 positive, negative, or symptomatic subjects are identified and have a secure health certificate generated based on daily health status. In this paper, we have developed a Blockchain and off-chain based secure health status and user biometric storage system. The health status is being visualized through a distributed QR code app. We have also incorporated deep learning-based face recognition and QR code recognition system in which the facial features are mapped to the QR code of a subject. We have developed three distributed apps (dApps): for the citizens, hospital authorities, and COVID-19 status checking entities. The system allows, for example, supermarkets, malls, and airports, to inquire about the health status of any subject through our developed application using already installed cameras. Our system will allow full life-cycle of the health certificate and biometric user management: creation through dApps, secure storage at Blockchain and off-chain, privacy-preserving sharing with the community of interest, and dynamic visualization. © 2021 IEEE.

Computational screening of 645 antiviral peptides against the receptor-binding domain of the spike protein in SARS-CoV-2.

The receptor-binding domain (RBD) of SARS-CoV-2 spike (S) protein plays a vital role in binding and internalization through the alpha-helix (AH) of human angiotensin-converting enzyme 2 (hACE2). Thus, it is a potential target for designing and developing antiviral agents. Inhibition of RBD activity of the S protein may be achieved by blocking RBD interaction with hACE2. In this context, inhibitors with large contact surface area are preferable as they can form a potentially stable complex with RBD of S protein and would not allow RBD to come in contact with hACE2. Peptides represent excellent features as potential anti-RBD agents due to better efficacy, safety, and tolerability in humans compared to that of small molecules. The present study has selected 645 antiviral peptides known to inhibit various viruses and computationally screened them against the RBD of SARS-CoV-2 S protein. In primary screening, 27 out of 645 peptides exhibited higher affinity for the RBD of S protein compared to that of AH of the hACE2 receptor. Subsequently, AVP1795 appeared as the most promising candidate that could inhibit hACE2 recognition by SARS-CoV 2 as was predicted by the molecular dynamics simulation. The critical residues in RBD found for protein-peptide interactions are TYR 489, GLY 485, TYR 505, and GLU 484. Peptide-protein interactions were substantially influenced by hydrogen bonding and hydrophobic interactions. This comprehensive computational screening may provide a guideline to design the most effective peptides targeting the spike protein, which could be studied further in vitro and in vivo for assessing their anti-SARS CoV-2 activity.

Self-Isolation Negatively Impacts Self-Management of Diabetes During the Coronavirus (COVID-19) Pandemic (preprint)

Background/Aim: People with diabetes are at a greater risk of serious complications from Coronavirus disease (COVID-19). Self-management of diabetes is therefore of paramount importance. The purpose of this study is to compare self-management of diabetes pre-COVID-19 and during COVID-19 pandemic. Methods: 679 participants with diabetes completed an online structured questionnaire. Outcome variables that were analysed were: (i) fluctuation of blood glucose levels, (ii) access to diabetes medicine, (iii) access to healthy diet, and (iv) physical activity. Adjusted multiple regression analysis ascertained significant associations for each outcome variable against exposure variables such as demographics (age/gender), history of diabetes (duration, treatment, and complications) and the need for self-isolation. Results:  Multiple regression analysis showed that self-isolation was significantly associated with greater fluctuation in blood glucose levels (OR=1.8, 95% CI=1.2-2.6, p=0.005), worsened access to diabetes medicine (OR=1.9, 95% CI=1.1-3.1, p=0.02) and reduced access to healthy diet (OR=3.0, 95% CI= 2.0-4.6, p<0.001). Fluctuating blood glucose was also significantly associated with having at least one complication of diabetes (OR=2.2, 95 % CI=1.2-3.9, p=0.008) and worsened access to diabetes medicine was significantly higher in people who were on insulin (OR=2.1, 95% CI=1.3-3.3, p=0.001).   Conclusions: Self-isolation impacted various factors that influence self-management of diabetes. A targeted approach to improved access to diabetes medicine and healthy diet for people needing to self-isolate is vital in order to ensure that they are able to self-manage their diabetes effectively.  

Clinicopathological features and outcome of COVID-19- early experiences from three covid hospitals, Chittagong, Bangladesh (preprint)

Introduction: COVID 19 is an unknown virus affecting mankind creating a deadly experience to all. It is true for Bangladesh also. So the objectives of the present study is to find the clinicopathological features and outcome of COVID patients admitted in three COVID dedicated hospitals of Chittagong, Bnagladesh. Methods: This was an observational study where a total of 209 patients admitted in three COVID dedicated hospital were recruited. Clinicopathological data were recorded and patients were under observation till discharge and thus outcome were recorded. Prior consent was taken from the patients and ethical clearance was also taken. Data was compiled and analyzed by SPSS-20. Results: Among 209 patients most of them were male 139(66.5%) and male to female ratio was 1.98:1. Age group distribution revealed more were aggregated in age group 41-50 years 36(17.2%), 51-60 years 54(25.8%) and 61-70 years 57(27.3%). Among all 92(44%) patients were RT-PCR positive and 117(56%) were probable cases. Fever was present in 195(93.3%) cases, cough in 180(86.1%), respiratory distress in 105(50.2%) anosmia in 123(58.8% ), aguesea in 112 (53.58%) and lethargy was present in 143( 68.42%). Chest X-ray findings revealed 73(34.9%) had bilateral patchy opacities, 20(9.6%) had unilateral opacities 65(31.1%) had consolidations, 6(2.9%) had ground glass opacities and 2(1.0%) had pleural effusion. Supplemental O2 was given in 173(82.8%) patients, Favipiravir in 59(28.2%), Remdisivir in 111(53.1%), Methylprednisolone in 87(41.6%), Dexamethasone in 93(44.5%), Antibiotics in 204(97.60%), Toccilizumab in 34(16.3%), plasma in 18(8.6%) and LMWH in 200(95.7%) patients. Regarding outcome of the COVID patients admitted, 85(92.4%) patients improved, 6(6.5%) died who were RT-PCR positive and 107(91.15%) improved, 9(7.7%) died who were probable cases. Total death rate was 7.1%. Conclusion: Present study findings were some early activities among COVID patients in the years 2020. Male were more affected and middle age group people were the most victims.

Surging COVID-19 in Bangladesh driven by B.1.351 variant (preprint)

A dramatic resurgence of COVID-19 cases and deaths in Bangladesh in March 2021 coincided with the SARS-CoV-2 B.1.351 (501Y.V2) variant of concern rapidly becoming the dominant circulating variant. Concurrently, increasing numbers of reinfections have been detected and the effective Reproductive number, Rt, has doubled, despite high levels of prior infection in Dhaka city. These data support the prediction that acquired immunity from past infection provides reduced protection against B.1.351, and highlights the major public health concern posed by immune escape variants, especially in populations where vaccination coverage remains low.

Knowledge, attitudes and perceptions towards COVID-19 vaccinations: a cross-sectional community survey in Bangladesh (preprint)

BackgroundSeveral vaccines have been approved against coronavirus disease (COVID-19) and distributed globally in different regions. However, general community knowledge, attitudes and perceptions towards COVID-19 vaccinations are poorly understood. Thus, the study aimed to investigate community knowledge, attitudes and perceptions towards COVID-19 vaccinations in Bangladesh. MethodsAn exploratory and anonymous population-based e-survey was conducted among 1658 general individuals (55.6% male; mean age=23.17{+/-}6.05 years; age range=18-65 years). The survey was conducted using a semi-structured and self-reported questionnaire containing informed consent along with four sections (i.e., socio-demographics, knowledge, attitudes, and perceptions). Multiple linear regression was performed to determine the variables predicting knowledge, and attitudes towards COVID-19 vaccinations. ResultsThe mean scores of knowledge and attitudes were 2.83{+/-}1.48 (out of 5) and 9.34{+/-}2.39 (out of 12) respectively. About a quarter of participants thought that the COVID-19 vaccination available in Bangladesh is safe, only 60% will have the vaccination and about two-thirds will recommend it to family and friends. In the multiple regression model, higher SES, having university/ higher levels of education, holding nuclear families and having previous history of essential vaccines uptake were associated with knowledge; whilst attitudes were significantly associated with being female and having previous history of essential vaccines uptake. Just over half of the participants thought that everyone should be vaccinated and 61% responded that health workers should be vaccinated first on priority basis. 95% vaccine should be administered free of charge in Bangladesh and almost 90% believed that the COVID-19 vaccine used in Bangladesh may have side effects. ConclusionsThe findings reflect inadequate knowledge but more positive attitudes towards COVID-19 vaccine among the general population in Bangladesh. In order to improve knowledge, immediate health education programs need to be initiated before mass vaccination schedule.