Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study.

IMPORTANCE: Knowledge and attitude influence compliance and individuals' practices. The risk and protective factors associated with high compliance to these preventive measures are critical to enhancing pandemic preparedness. OBJECTIVE: This survey aims to assess differences in mental health, knowledge, attitudes, and practices (KAP) of preventive measures for COVID-19 amongst healthcare professionals (HCP) and non-healthcare professionals. DESIGN: Multi-national cross-sectional study was carried out using electronic surveys between May-June 2020. SETTING: Multi-national survey was distributed across 36 countries through social media, word-of-mouth, and electronic mail. PARTICIPANTS: Participants ≥21 years working in healthcare and non-healthcare related professions. MAIN OUTCOME: Risk factors determining the difference in KAP towards personal hygiene and social distancing measures during COVID-19 amongst HCP and non-HCP. RESULTS: HCP were significantly more knowledgeable on personal hygiene (AdjOR 1.45, 95% CI -1.14 to 1.83) and social distancing (AdjOR 1.31, 95% CI -1.06 to 1.61) compared to non-HCP. They were more likely to have a positive attitude towards personal hygiene and 1.5 times more willing to participate in the contact tracing app. There was high compliance towards personal hygiene and social distancing measures amongst HCP. HCP with high compliance were 1.8 times more likely to flourish and more likely to have a high sense of emotional (AdjOR 1.94, 95% CI (1.44 to 2.61), social (AdjOR 2.07, 95% CI -1.55 to 2.78), and psychological (AdjOR 2.13, 95% CI (1.59-2.85) well-being. CONCLUSION AND RELEVANCE: While healthcare professionals were more knowledgeable, had more positive attitudes, their higher sense of total well-being was seen to be more critical to enhance compliance. Therefore, focusing on the well-being of the general population would help to enhance their compliance towards the preventive measures for COVID-19.

Bioinformatic analyses hinted at augmented T helper 17 cell differentiation and cytokine response as the central mechanism of COVID‐19–associated Guillain‐Barré syndrome

ObjectivesGuillain‐Barré syndrome (GBS) results from autoimmune attack on the peripheral nerves, causing sensory, motor and autonomic abnormalities. Emerging evidence suggests that there might be an association between COVID‐19 and GBS. Nevertheless, the underlying pathophysiological mechanism remains unclear.Materials and MethodsWe performed bioinformatic analyses to delineate the potential genetic crosstalk between COVID‐19 and GBS.ResultsCOVID‐19 and GBS were associated with a similar subset of immune/inflammation regulatory genes, including TNF, CSF2, IL2RA, IL1B, IL4, IL6 and IL10. Protein‐protein interaction network analysis revealed that the combined gene set showed an increased connectivity as compared to COVID‐19 or GBS alone, particularly the potentiated interactions with CD86, IL23A, IL27, ISG20, PTGS2, HLA‐DRB1, HLA‐DQB1 and ITGAM, and these genes are related to Th17 cell differentiation. Transcriptome analysis of peripheral blood mononuclear cells from patients with COVID‐19 and GBS further demonstrated the activation of interleukin‐17 signalling in both conditions.ConclusionsAugmented Th17 cell differentiation and cytokine response was identified in both COVID‐19 and GBS. PBMC transcriptome analysis also suggested the pivotal involvement of Th17 signalling pathway. In conclusion, our data suggested aberrant Th17 cell differentiation as a possible mechanism by which COVID‐19 can increase the risk of GBS.

Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome.

BACKGROUND AND AIM: Gastrointestinal manifestations of the coronavirus disease 2019 (COVID-19) pandemic may mimic irritable bowel syndrome (IBS), and social distancing measures may affect IBS patients negatively. We aimed to study the impact of COVID-19 on respondents with self-reported IBS. METHODS: We conducted an anonymized survey from May to June 2020 in 33 countries. Knowledge, attitudes, and practices on personal hygiene and social distancing as well as psychological impact of COVID-19 were assessed. Statistical analysis was performed to determine differences in well-being and compliance to social distancing measures between respondents with and without self-reported IBS. Factors associated with improvement or worsening of IBS symptoms were evaluated. RESULTS: Out of 2704 respondents, 2024 (74.9%) did not have IBS, 305 (11.3%) had self-reported IBS, and 374 (13.8%) did not know what IBS was. Self-reported IBS respondents reported significantly worse emotional, social, and psychological well-being compared with non-IBS respondents and were less compliant to social distancing measures (28.2% vs 35.3%, P = 0.029); 61.6% reported no change, 26.6% reported improvement, and 11.8% reported worsening IBS symptoms. Higher proportion of respondents with no change in IBS symptoms were willing to practice social distancing indefinitely versus those who deteriorated (74.9% vs 51.4%, P = 0.016). In multivariate analysis, willingness to continue social distancing for another 2-3 weeks (vs longer period) was significantly associated with higher odds of worsening IBS. CONCLUSION: Our study showed that self-reported IBS respondents had worse well-being and compliance to social distancing measures than non-IBS respondents. Future research will focus on occupational stress and dietary changes during COVID-19 that may influence IBS.

The potential effectiveness of the WHO International Health Regulations capacity requirements on control of the COVID-19 pandemic: a cross-sectional study of 114 countries.

OBJECTIVES: We examined if the WHO International Health Regulations (IHR) capacities were associated with better COVID-19 pandemic control. DESIGN: Observational study. SETTING: Population-based study of 114 countries. PARTICIPANTS: General population. MAIN OUTCOME MEASURES: For each country, we extracted: (1) the maximum rate of COVID-19 incidence increase per 100,000 population over any 5-day moving average period since the first 100 confirmed cases; (2) the maximum 14-day cumulative incidence rate since the first case; (3) the incidence and mortality within 30 days since the first case and first COVID-19-related death, respectively. We retrieved the 13 country-specific International Health Regulations capacities and constructed linear regression models to examine whether these capacities were associated with COVID-19 incidence and mortality, controlling for the Human Development Index, Gross Domestic Product, the population density, the Global Health Security index, prior exposure to SARS/MERS and Stringency Index. RESULTS: Countries with higher International Health Regulations score were significantly more likely to have lower incidence (ß coefficient -24, 95% CI -35 to -13) and mortality (ß coefficient -1.7, 95% CI -2.5 to -1.0) per 100,000 population within 30 days since the first COVID-19 diagnosis. A similar association was found for the other incidence outcomes. Analysis using different regression models controlling for various confounders showed a similarly significant association. CONCLUSIONS: The International Health Regulations score was significantly associated with reduction in rate of incidence and mortality of COVID-19. These findings inform design of pandemic control strategies, and validated the International Health Regulations capacities as important metrics for countries that warrant evaluation and improvement of their health security capabilities.

IDDF2020-ABS-0205 The impact of the COVID-19 pandemic on irritable bowel syndrome

IDDF2020-ABS-0205 Table 1Comparison of demographic variables between respondents with and without IBS Non-IBS (n = 2024) IBS (n = 305) p Age 39.7 ± 12.9 40.1 ± 13.0 1.0 Gender 0.6 Male 727 (35.9) 119 (39.0) Female 1297 (64.1) 186 (61.0) Race 0.2 Bengali 31 (1.5) 2 (0.7) Caucasian 24 (1.2) 6 (2.0) Chinese 1148 (56.7) 188 (61.6) Filipino 45 (2.2) 2 (0.7) Indian 154 (7.6) 20 (6.6) Japanese 5 (0.2) 0 (0.0) Korean 131 (6.5) 28 (9.2) Malay 328 (16.2) 39 (12.8) Others 158 (7.8) 20 (6.6) Economic region 0.3 High 1156 (57.1) 183 (60.0) Upper-middle 457 (22.6) 74 (24.3) Middle/Low 411 (20.3) 48 (15.7) What is your highest education level? 0.8 No formal education/Primary school 9 (0.4) 0 (0.0) Secondary school 164 (8.1) 29 (9.5) Pre-university 258 (12.7) 44 (14.4) Tertiary – undergraduate/postgraduate degree 1593 (78.7) 232 (76.1) Employment 0.4 Full-time 1497 (74.0) 213 (69.8) Part-time 125 (6.2) 18 (5.9) Not working 402 (19.9) 74 (24.3) Housing 1.0 Dormitory 61 (3.0) 13 (4.3) Government housing with 2 or 3 rooms 306 (15.1) 37 (12.1) Government housing with more than 3 rooms 376 (18.6) 62 (20.3) Private apartment or condominium 601 (29.7) 89 (29.2) Private landed property 680 (33.6) 104 (34.1) Annual household Income per capita in USD (total household income/number of people in the household) 1.0 Less than $1000 259 (12.8) 37 (12.1) $1000 - $2000 274 (13.5) 46 (15.1) $2000 - $4000 375 (18.5) 49 (16.1) $4000 - $6000 211 (10.4) 29 (9.5) $6000 - $8000 138 (6.8) 24 (7.9) $8000 - $10000 173 (8.5) 23 (7.5) More than $10000 594 (29.3) 97 (31.8) Have you been diagnosed with COVID-19? 1.0 Yes 32 (1.6) 4 (1.3) No 1992 (98.4) 301 (98.7) Compliance 0.029 Yes 715 (35.3) 86 (28.2) No 1309 (64.7) 219 (71.8) Not flourishing 1025 (50.6) 207 (67.9) <0.01 Flourishing 999 (49.4) 98 (32.1) Well-being total scores 45.8 ± 14.6 40.5 ± 14.8 <0.01 Emotional well-being 10.3 ± 3.5 9.4 ± 3.6 <0.01 Social well-being 15.0 ± 6.1 12.8 ± 6.1 <0.01 Psychological well-being 20.4 ± 6.6 18.3 ± 6.7 <0.01 Abstract IDDF2020-ABS-0205 Table 2Comparison of demographic variables between respondents who reported no change and worsening in severity of IBSQuestion No change (n = 183) Worsen (n = 35) p Age 38.8 ± 12.2 40.1 ± 14.3 1.0 Gender 1.0 Male 71 (38.8) 14 (40.0) Female 112 (61.2) 21 (60.0) Economic region 0.1 High 110 (60.1) 28 (80.0) Upper-middle 44 (24.0) 6 (17.1) Middle/Low 29 (15.8) 1 (2.9) What is your highest education level? 1.0 Secondary school 18 (9.8) 4 (11.4) Pre-university 22 (12.0) 5 (14.3) Tertiary – undergraduate/postgraduate degree 143 (78.1) 26 (74.3) Employment 0.2 Full-time 132 (72.1) 26 (74.3) Part-time 7 (3.8) 4 (11.4) Not working 44 (24.0) 5 (14.3) Work from home 1.0 Yes 45 (32.1) 8 (26.7) No 95 (67.9) 22 (73.3) Compliance 1.0 Yes 54 (29.5) 10 (28.6) No 129 (70.5) 25 (71.4) Which of the following would you consider as main reason for compliance with social distancing measures? 0.034 Fear of getting COVID 19 90 (49.2) 11 (31.4) Fear of family members getting COVID 19 86 (47.0) 19 (54.3) Fear of fines/punitive measures 7 (3.8) 5 (14.3) Would you willingly participate in the contact tracing app? 1.0 Yes 143 (78.1) 27 (77.1) No 40 (21.9) 8 (22.9) For how long are you willing to practice social distancing behaviour to keep yourself and others safe? 0.016 As long as it takes 137 (74.9) 18 (51.4) For another 2–3 weeks 4 (2.2) 4 (11.4) For another 1 month 12 (6.6) 6 (17.1) For another 3 months 14 (7.7) 5 (14.3) For another 6 months 13 (7.1) 1 (2.9) I want social distancing to stop now 3 (1.6) 1 (2.9) Flourishing <0.01 Yes 64 (35.0) 3 (8.6) No 119 (65.0) 32 (91.4) Well-being total scores 40.5 ± 15.0 35.4 ± 13.3 0.1 Emotional well-being 9.5 ± 3.5 7.7 ± 3.6 0.014 Social well-being 12.7 ± 6.3 11.7 ± 4.7 0.8 Psychological well-being 18.3 ± 6.9 15.9 ± 6.5 0.1 Abstract IDDF2020-ABS-0205 Table 3Univariable and multivariable regression of factors associated with worsening in severity of IBS (with no change in severity of IBS group as reference)Question OR (95% CI) p AdjOR(95%CI) p Do you wash your hands before and after handing food?* Never (ref) 1.00 - - Seldom 0.0 (0.0) 1.0 - - 50% of the time 0.0 (0.0) 1.0 - - Most of the time 0.0 (0.0) 1.0 - - Always 0.0 (0.0) 1.0 - - Do you cover your mouth when you sneeze or cough?* Never (ref) 1.00 - - Seldom 0.0 (0.0) 1.0 - - 50% of the time 0.0 (0.0) 1.0 - - Most of the time 0.0 (0.0) 1.0 - - Always 0.0 (0.0) 1.0 - - Which of the following would you consider as main reason for compliance with social distancing measures? Fear of getting COVID 19 (ref) 1.00 1.00 Fear of family members getting COVID 19 1.8 (0.8 – 4.0) 0.1 2.0 (0.9 – 4.7) 0.1 Fear of fines/punitive measures 5.8 (1.6 – 21.6) <0.01 5.9 (1.4 – 25.6) 0.017 For how long are you willing to practice social distancing behaviour to keep yourself and others safe? As long as it takes (ref) 1.00 1.00 For another 2–3 weeks 7.6 (1.7 – 33.1) <0.01 6.0 (1.2 – 28.8) 0.026 For another 1 month 3.8 (1.3 – 11.4) 0.017 2.9 (0.9 – 9.0) 0.1 For another 3 months 2.7 (0.9 – 8.4) 0.1 3.1 (0.9 – 10.2) 0.1 For another 6 months 0.6 (0.1 – 4.7) 0.6 0.6 (0.1 – 4.7) 0.6 I want social distancing to stop now 2.5 (0.3 – 25.7) 0.4 1.3 (0.1 – 22.3) 0.9 Emotional well-being 0.9 (0.8 – 1.0) <0.01 0.9 (0.8 – 1.0) 0.042 Flourishing was excluded from analysis due to overlap with emotional well-being.*Excluded from multivariable analysis due to 0 respondents in reference categories for respondents with no change in control IBSConclusionsOur study showed differences in well-being and compliance to social distancing between IBS and non-IBS respondents, and these factors influence the worsening in severity of IBS. Further research will focus on how occupational stress and dietary changes may influence IBS symptoms

The potential impact of previous exposure to SARS or MERS on control of the COVID-19 pandemic.

The Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) is believed to share similar characteristics with SARS in 2003 and Mediterranean East Respiratory Syndrome (MERS) in 2012. We hypothesized that countries with previous exposure to SARS and MERS were significantly more likely to have fewer cases and deaths from coronavirus disease 2019 (COVID-19). We retrieved the incidence of COVID-19 per 100,000 population within 30 days since the first confirmed case was reported from the 2019 Novel COVID-19 data repository by the Johns Hopkins Centre for Systems Science and Engineering for 94 countries. The association between previous exposure to SARS and/or MERS and the 30-day COVID-19 incidence rate was examined by multivariable linear regression analysis, whilst controlling for potential confounders including the INFORM COVID-19 Risk Index, Testing Policies, Democracy Index, Scientific Citation Index, Gross Domestic Product (GDP), Human Development Index (HDI) and the population density of each country. We found that countries with previous exposure to SARS and/or MERS epidemics were significantly more likely to have lower incidence of COVID-19 (ß coefficient - 225.6, 95% C.I. - 415.8,- 35.4, p = 0.021). However, countries being classified as having "full democracy" using Democracy Index had higher incidence of COVID-19 (reference: authoritarian regime; ß coefficient 425.0, 95% C.I. 98.0, 752.0, p = 0.011). This implies that previous exposure to global epidemics and Democracy Index for a country are associated its performance in response to COVID-19. We recommend future studies should evaluate the impact of various pandemic control strategies at individual, community, and policy levels on mitigation of the disease.

Overview of guidance for endoscopy during the coronavirus disease 2019 pandemic.

From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol-generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal-oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.

Covid-19 and the digestive system.

The novel coronavirus disease is currently causing a major pandemic. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the Betacoronavirus genus that also includes the SARS-CoV and Middle East respiratory syndrome coronavirus. While patients typically present with fever and a respiratory illness, some patients also report gastrointestinal symptoms such as diarrhea, vomiting, and abdominal pain. Studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin converting enzyme 2 was found to be highly expressed in gastrointestinal epithelial cells. These suggest that SARS-CoV-2 can actively infect and replicate in the gastrointestinal tract. This has important implications to the disease management, transmission, and infection control. In this article, we review the important gastrointestinal aspects of the disease.