Life in a New Normal with a Self-Care Routine: A Cross-Sectional Study of Older Adults' Daily Health Behaviors (DHB) Performance during the Initial Outbreak of COVID-19 in China.

For older adults, self-care begins with daily health behaviors (DHB), which refers to a series of basic behaviors beneficial to health in daily life; it is the foundation for promoting health, preventing disease, and maintaining health with or without the support of a healthcare provider. Thus, this study aimed to observe the changes in DHB among older adults when the COVID-19 pan-demic first erupted in China (at the beginning of 2020) and explore the impact factors on self-care routines in daily life. We applied a cross-sectional study among 1256 (83.7%) valid older Chinese from 19 February 2020 to 19 March 2020, the score of DHB changes (mean ± SD, 14.70 ± 2.140; range, 8-18) presented a significant growth (t1256 = 44.636, p < 0.001) during COVID-19. From 3 hierarchical linear regression models, the older Chinese who received a higher education include high school (ß = 0.403, 95% CI [0.009, 0.797], p = 0.045) and college degree and above (ß = 0.488, 95% CI [0.034, 0.943], p = 0.035), and lived in the eastern China (ß = 0.771, 95% CI [0.392, 1.151], p < 0.001) took DHB more frequently. However, the high-risk infection (ß = -0.740, 95% CI [-1.248, -0.231], p = 0.004), overweight/obese character (ß = -0.265, 95% CI [-0.526, -0.004], p = 0.047), and alcohol consumption (ß = -0.350, 95% CI [-0.634, -0.065], p = 0.016) are significant factors in decreasing a senior's DHB performance. For China, self-care offers a straightforward strategy among the range of measures required to combat COVID-19 and future health threats. In summary, findings in this study can build a foundation for developing healthcare policy and services for the relevant government and departments on prompting DHB and the importance of self-care among the older population.

Moderating Effect of a Cross-Level Social Distancing Policy on the Disparity of COVID-19 Transmission in the United States

Currently, coronavirus disease 2019 (COVID-19) remains a global pandemic, but the prevention and control of the disease in various countries have also entered the normalization stage. To achieve economic recovery and avoid a waste of resources, different regions have developed prevention and control strategies according to their social, economic, and medical conditions and culture. COVID-19 disparities under the interaction of various factors, including interventions, need to be analyzed in advance for effective and precise prevention and control. Considering the United States as the study case, we investigated statistical and spatial disparities based on the impact of the county-level social vulnerability index (SVI) on the COVID-19 infection rate. The county-level COVID-19 infection rate showed very significant heterogeneity between states, where 67% of county-level disparities in COVID-19 infection rates come from differences between states. A hierarchical linear model (HLM) was adopted to examine the moderating effects of state-level social distancing policies on the influence of the county-level SVI on COVID-19 infection rates, considering the variation in data at a unified level and the interaction of various data at different levels. Although previous studies have shown that various social distancing policies inhibit COVID-19 transmission to varying degrees, this study explored the reasons for the disparities in COVID-19 transmission under various policies. For example, we revealed that the state-level restrictions on the internal movement policy significantly attenuate the positive effect of county-level economic vulnerability indicators on COVID-19 infection rates, indirectly inhibiting COVID-19 transmission. We also found that not all regions are suitable for the strictest social distancing policies. We considered the moderating effect of multilevel covariates on the results, allowing us to identify the causes of significant group differences across regions and to tailor measures of varying intensity more easily. This study is also necessary to accomplish targeted preventative measures and to allocate resources.

Spatial Patterns of the Spread of COVID-19 in Singapore and the Influencing Factors

Exploring the spatial patterns of COVID-19 transmission and its key determinants could provide a deeper understanding of the evolution of the COVID-19 pandemic. The goal of this study is to investigate the spatial patterns of COVID-19 transmission in different periods in Singapore, as well as their relationship with demographic and built-environment factors. Based on reported cases from 23 January to 30 September 2020, we divided the research time into six phases and used spatial autocorrelation analysis, the ordinary least squares (OLS) model, the multiscale geographically weighted regression (MGWR) model, and dominance analysis to explore the spatial patterns and influencing factors in each phase. The results showed that the spatial patterns of COVID-19 cases differed across time, and imported cases presented a random pattern, whereas local cases presented a clustered pattern. Among the selected variables, the supermarket density, elderly population density, hotel density, business land proportion, and park density may be particular fitting indicators explaining the different phases of pandemic development in Singapore. Furthermore, the associations between determinants and COVID-19 transmission changed dynamically over time. This study provides policymakers with valuable information for developing targeted interventions for certain areas and periods.

Mental Health Status of the Elderly Chinese Population During COVID-19: An Online Cross-Sectional Study.

Background: COVID-19 not only threatened the public's physical health but also brought unbearable psychological pressure, especially for those vulnerable groups like the elderly. However, studies on the psychological status of older adults during this public health emergency remained scant. This study aims to investigate the mental health status among the elderly Chinese population during COVID-19 pandemic and determine the influencing factors of psychological symptoms. Methods: From February 19 to March 19, 2020, an online survey was administered to Chinese older adults using a convenience sampling method. Information on demographic data, health status and other epidemic related factors were collected. Specifically, the study defined the psychological status as five primary disorder-depression, neurasthenia, fear, anxiety, and hypochondria-which were assessed by the Psychological Questionnaire for Emergent Event of Public Health (PQEEPH). Standard descriptive statistics and multiple logistic regression analyses were conducted to analyze the data. Results: Of 1,501 participants recruited from 31 provinces in China, 1,278 were valid for further analysis. Participants' scores on each sub-scale were described in median and interquartile [M(Q)]: depression [0.00 (0.33)], neurasthenia [0.00 (0.40)], fear [1.00 (0.83)], anxiety [0.00 (0.17)], hypochondria [0.00 (0.50)]. Chronic diseases (depression p = 0.001; neurasthenia p < 0.001; fear p = 0.023; anxiety p < 0.001; hypochondria p = 0.001) and the BMI index (depression p = 0.015; neurasthenia p = 0.046; fear p = 0.016; anxiety p = 0.015; hypochondria p = 0.013) had significant impacts on all of the five sub-scales. Specifically, the rural dwellers had a higher level of neurasthenia, fear, and hypochondria. Besides, education level (p = 0.035) and outbreak risk level (p = 0.004) had significant impacts on the depression. Higher household monthly income per capita (p = 0.031), and the community-level entry/exit control (p = 0.011) are factors against anxiety. Conclusions: Most elderly residents reported mild negative emotions during COVID-19 and more attention should be paid to the recognition and alleviation of fear. Our findings also identified factors associated with the mental health status of the elderly, which is of practical significance in the design and implementation of psychological interventions for this vulnerable population during COVID-19 and future emerging diseases.

Impact of antitumor regimens on the outcomes of cancer patients with COVID-19: a pooled analysis.

Since the outbreak of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) discovered in December 2019, the disease has emerged as a global pandemic (Shi et al., 2020; World Health Organization, 2020). Several studies have shown a higher incidence of COVID-19, as well as related poor outcomes in patients with malignancies as compared with those without them (Liang et al., 2020; Tian et al., 2020). The impact of cancer on COVID-19 may be attri­buted to the use of antitumor treatments that may disturb the host response to SARS-CoV-2 infection (Wang et al., 2020), while the current studies on this topic have drawn controversial conclusions. Some implied that anticancer treatments might elevate the risk of death (García-Suárez et al., 2020; Liu et al., 2020). On the contrary, others pointed out that this association is not significant (Brar et al., 2020; Lee et al., 2020a). Although previous systematic reviews have investigated this important issue (Wang and Huang, 2020), the heterogeneity of findings is obvious and the general conclusion has remained unclear. Considering this ambiguity, it is difficult for clinicians to make therapeutic decisions when facing patients with both cancer and COVID-19; therefore, a high-quality and accurate evaluation of the impact of anticancer treatments on COVID-19 patients is necessary. Accordingly, we conducted a pooled analysis with the original data of each patient for the first time to provide a comprehensive perspective into the association between anticancer regimens and the outcomes of cancer patients with COVID-19.

Effect of ORF7 of SARS-CoV-2 on the Chemotaxis of Monocytes and Neutrophils In Vitro.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the most significant public health threat worldwide. Patients with severe COVID-19 usually have pneumonia concomitant with local inflammation and sometimes a cytokine storm. Specific components of the SARS-CoV-2 virus trigger lung inflammation, and recruitment of immune cells to the lungs exacerbates this process, although much remains unknown about the pathogenesis of COVID-19. Our study of lung type II pneumocyte cells (A549) demonstrated that ORF7, an open reading frame (ORF) in the genome of SARS-CoV-2, induced the production of CCL2, a chemokine that promotes the chemotaxis of monocytes, and decreased the expression of IL-8, a chemokine that recruits neutrophils. A549 cells also had an increased level of IL-6. The results of our chemotaxis Transwell assay suggested that ORF7 augmented monocyte infiltration and reduced the number of neutrophils. We conclude that the ORF7 of SARS-CoV-2 may have specific effects on the immunological changes in tissues after infection. These results suggest that the functions of other ORFs of SARS-CoV-2 should also be comprehensively examined.

Abnormal Indexes of Liver and Kidney Injury Markers Predict Severity in COVID-19 Patients.

BACKGROUND: SARS-CoV-2 can damage not only the lungs but also the liver and kidney. Most critically ill patients with coronavirus disease 2019 (COVID-19) have liver and kidney dysfunction. We aim to investigate the levels of liver and kidney function indexes in mild and severe COVID-19 patients and their capability to predict the severity of the disease. METHODS: The characteristics and laboratory indexes were compared between patients with different conditions. We applied binary logistic regression to find the independent risk factors of severe patients. Receiver operating characteristic (ROC) analysis was used to predict the severity of COVID-19 using the liver and kidney function indexes. RESULTS: This study enrolled 266 COVID-19 patients, including 235 mild patients and 31 severe patients. Compared with mild patients, severe patients had lower albumin (ALB) and higher alanine aminotransferase (ALT), aspartate aminotransferase (AST), and urea nitrogen (BUN) (all p<0.001). Binary logistic regression analysis also identified ALB [OR=0.273 (0.079-0.947), p=0.041] and ALT [OR=2.680 (1.036-6.934), p=0.042] as independent factors of severe COVID-19 patients. Combining ALB, ALT, BUN, and LDH exhibited the area under ROC at 0.914, with a sensitivity of 86.7% and specificity of 83.0%. CONCLUSION: COVID-19 patients, especially severe patients, have damage to liver and kidney function. ALT, AST, LDH, and BUN could be independent factors for predicting the severity of COVID-19. Combining the ALB, ALT, BUN, and LDH could predict the transition from mild to severe in COVID-19 patients.

An overview of COVID-19

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection emerged in Wuhan City, Hubei Province, China in December 2019. By Feb. 11, 2020, the World Health Organization (WHO) officially named the disease resulting from infection with SARS-CoV-2 as coronavirus disease 2019 (COVID-19). COVID-19 represents a spectrum of clinical manifestations that typically include fever, dry cough, and fatigue, often with pulmonary involvement. SARS-CoV-2 is highly contagious and most individuals within the population at large are susceptible to infection. Wild animal hosts and infected patients are currently the main sources of disease which is transmitted via respiratory droplets and direct contact. Since the outbreak, the Chinese government and scientific community have acted rapidly to identify the causative agent and promptly shared the viral gene sequence, and have carried out measures to contain the epidemic. Meanwhile, recent research has revealed critical aspects of SARS-CoV-2 biology and disease pathogenesis;other studies have focused on epidemiology, clinical features, diagnosis, management, as well as drug and vaccine development. This review aims to summarize the latest research findings and to provide expert consensus. We will also share ongoing efforts and experience in China, which may provide insight on how to contain the epidemic and improve our understanding of this emerging infectious disease, together with updated guidance for prevention, control, and critical management of this pandemic.

Knowledge, Perceived Beliefs, and Preventive Behaviors Related to COVID-19 Among Chinese Older Adults: Cross-Sectional Web-Based Survey.

BACKGROUND: The COVID-19 pandemic continues to pose an international public health threat. Prevention is of paramount importance to protect the high-risk group of older adults until specific treatments for COVID-19 become available; however, little work has been done to explore factors that promote preventive behaviors among this population. OBJECTIVE: This study aims to investigate the knowledge, perceived beliefs, and preventive behaviors towards COVID-19 of older adults in China and determine the factors that influence their practice of preventive behaviors. METHODS: From February 19 to March 19, 2020, a cross-sectional, web-based survey was administered to Chinese older adults in all 31 provinces of mainland China using a convenience sampling method to assess the respondents' knowledge, perceived beliefs, and preventive behaviors towards COVID-19. Standard descriptive statistics and hierarchical linear regression analyses were conducted to analyze the data. RESULTS: A total of 1501 participants responded to the survey, and 1263 valid responses (84.1%) were obtained for further analysis. The overall correct rate on the knowledge questionnaire was 87%, overall positive beliefs regarding COVID-19 were found, and the mean behavior score was 13.73/15 (SD 1.62, range 5-15). The hierarchical linear regression showed that respondents who were married or cohabitating and who lived in areas with community-level control measures were more likely to practice preventive behaviors (P<.01). Knowledge (ß=0.198, P<.001), perceived susceptibility (ß=0.263, P=.03), perceived benefits (ß=0.643, P<.001), and self-efficacy in preventing COVID-19 (ß=0.468, P<.001) were also found to be significantly associated with preventive behaviors. CONCLUSIONS: Most older residents had adequate knowledge and positive beliefs regarding COVID-19 and engaged in proactive behaviors to prevent the disease. Knowledge and beliefs were confirmed to be significantly associated with behavior responses. Our findings have significant implications in enhancing the effectiveness of COVID-19 prevention programs targeting the older population; these programs must be continued and strengthened as the epidemic continues.