Ways to promote intra-regional trade and investment in Central Asia to boost the green recovery

The economic recession caused by the restrictions on the spread of the Coronavirus disrupted the economic life of many countries. The primary purpose of the paper is to measure the impacts of intra-regional trade and investment on the green recovery of five Central Asian economies over 2010–2021 through employing annual data and the panel co-integration approach. The results confirmed that the degree of green trade openness positively and significantly affects the green recovery. The estimated coefficient of direct foreign investment is negative. The patent coefficient is not statistically significant, and the official exchange rate has a positive effect. Financial development has a positive and significant coefficient. The paper has several policy implications, such as enhancing green FDI (Foreign Direct Investment), supporting green innovation, and promoting green trade liberalism for scholars and policymakers. © 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Cities of Central Asia: New hotspots of air pollution in the world

Central Asian cities are one of the hotspots for air pollution worldwide. There are limited studies and knowledge regarding air quality variation in this region. This study investigated PM2.5 temporal variations and the influence of meteorological parameters on PM2.5 concentrations for six major cities in Central Asia: Almaty and Astana (Kazakhstan), Ashgabat (Turkmenistan), Bishkek (Kyrgyzstan), Dushanbe (Tajikistan), and Tashkent (Uzbekistan). The results show severe air quality deterioration in the cities with annual PM2.5 concentrations up to ten-fold higher than the limits. A clear seasonal pattern with winter peaks was observed in Almaty, Bishkek, and Astana, whereas winter and summer were highly polluted in Tashkent and Dushanbe. Based on the pollution profiles, cities were classified into several clusters. Episodes with high PM2.5 concentrations were evaluated for regional pollutant transportation using the HYSPLIT model. The results of this investigation highlight a significant discrepancy in official emissions inventory studies. While previous studies have suggested that transportation is the primary source of air pollution, the approach to estimate the share of emission sources was based on an outdated methodology that obscures information on the most hazardous pollutants, including PM2.5. This study shows that coal combustion is the primary source of PM2.5 pollution in most cities, offering policymakers critical insights into the sources of air pollution in the region. These findings demonstrate the need for policymakers to take swift action to address coal use and adopt effective measures to mitigate PM2.5 pollution, thereby improving the health and well-being of the population.

Characteristics of COVID-19 patients and risk factors of mortality in the early times of pandemic, Herat-Afghanistan

Objective: Coronaviruses are a large family of viruses that cause different types of diseases. This study aims to evaluate the risk factors for mortality based on comorbidity and sociodemographic characteristics among COVID-19 patients. Methods: This cross-sectional study conducted in Herat, Afghanistan, from February 24 to July 5, 2020, used data provided by the public health department, including sociodemographics, symptoms, comorbidities, hospitalization, contact history, and COVID-19 test type. The Chi-square test was used to observe differences between categorical variables. In bivariate analysis, all independent variables with a significant p-value were put into the model. Odds ratios and 95% confidence intervals were calculated, and a p-value less than 0.05 was considered statistically significant. Results: The study analyzed 11,183 COVID-19 cases, with a 53.5% positivity rate. Recovery rates in the city and Herat province districts were 96.2% and 94.7%, respectively. Case-fatality rates varied with age, with 0.4% for those aged 1-29 and 33% for those aged 80-105. Mortality rates were highest for those with COPD and cancer, at 12.5% and 18.2%, respectively. In the logistic regression results, age, gender, and COPD were significant variables for COVID-19 mortality. Conclusion: By providing more health service facilities to people in risk groups, especially in rural areas, the mortality rate of COVID-19 and other diseases can be decreased.

Attitude and acceptance toward COVID-19 vaccines among Kabul city's residents: a cross sectional study

Objective: The present study aimed to assess the attitude and perception of Kabul city's residents toward COVID-19 vaccines hesitancy and acceptance. Methods: Applying a cross-sectional study design, the data was collected from 665 participants in Kabul city using a predesigned validated questionnaire. For statistical analysis, Spearman correlation, chi-square, and logistic regression techniques were used. Results: Although the vaccine availability was limited for the public during the survey period, 70.5% of the participants were willing to receive COVID-19 vaccines. Meanwhile, 49.2% participants were concerned about the COVID-19 vaccines side effects. The presence of positive COVID-19 cases among family members and friends (OR: 2.7), presence of fears during COVID-19 pandemic (OR: 4.4) and beliefs that vaccine has important and vital role in people's protection against COVID-19 (OR: 5.3), increase the likelihood of vaccine acceptance among the participants. On the other hand, participant's mistrust of the safety of COVID-19 vaccines (OR: 0.21) and disbelief on ministry of public health "MoPH" advice about COVID-19 vaccine safety and efficiency (OR: 0.27) decrease the odds of COVID-19 vaccine acceptance among the respondents. In addition, a strong correlation was found between vaccine attitude and vaccine acceptance scales (Spearman p=0.52, p<0.001). Conclusion: Although majority of the participants were willing to receive the COVID-19 vaccines, due to high level of participant's concerns about COVID-19 vaccines-related side effects, a great proportion of the respondents were hesitate to receive the COVID-19 vaccines. Accordingly, public awareness about COVID-19 vaccines must be increased to counteract incorrect and misleading propaganda about vaccination and immunization.

Perceived Attitudes Toward Vaccines, Trust and Vaccination Behaviors

Objectives: The decision-making process for taking vaccination is influenced by a multitude of factors such as individual beliefs concerning vaccinations, trust in contextual forces, and sociodemographic. This study established a model to understand the relationship between people's beliefs in the safety, importance and effectiveness of vaccines, their trust in the medical advice from the government and doctors and their behaviors of having their children vaccinated from infectious diseases in low-and-middle-income countries (LMIC). Method(s): We structured a structural equation model with two latent variables, Motivation and Trust, and their relationships with the vaccination taking behavior. Motivation is constructed by people's beliefs in the safety, importance and effectiveness of vaccines and trust is constructed by people's trust in government, medical providers and scientists. This study used the 2018 Wellcome Global Monitor dataset and focused on people in 80 LMIC. The countries were divided into eight geographic regions: Eastern Africa, Central & Southern Africa, Norther Africa & Middle East, Western Africa, Central Asia, Southeast Asia, South Asia and Southern& Eastern Europe. Result(s): The latent variable Motivation is significantly positively associated with parental vaccination behaviors in all geographic areas except for South Asia and Western Africa. South Asia is the only area where the trust in government and medical system, providers had a significant association with vaccination behavior and such association is positive. Conclusion(s): In most LMIC, positive attitudes about vaccines are associated with an improved vaccine rate. Increasing people's belief in vaccines' importance, safety and effectiveness will be essential both for boosting vaccination rates and scaling up a vaccine for COVID-19. In South Asia, trust in the government and the public health system are important in deciding taking vaccines. In these countries, policymakers need to think of ways to improve people's trust in the public health system and further effectively communicate important health messages.Copyright © 2023

The influence of post-COVID syndrome on cognitive functions of students

A survey of senior students of the Faculty of General Medicine of the NAO MUK who had recovered from Covid-19 was conducted. The disease in all respondents proceeded in a mild form or moderate severity. Post-covid syndrome developed in students who had a coronavirus infection in the form of moderate severity. The most frequent complications were loss of smell and taste, cough and shortness of breath, as well as cognitive dysfunction in the form of impaired attention, memory and thinking. The decline in performance is associated with the above violations of the central nervous system.

The impact of COVID-19 on the indicators of the oncological service for breast cancer in Kazakhstan

Introduction. According to International Agency for Research on Cancer in 2040, about 3 million new cases of breast cancer (BC) are predicted and about 1 million women are expected to die from this pathology. The aim of the study to assess the impact of COVID-19 on the indicators of the oncological service for breast cancer in Kazakhstan. Material and research methods. The main method was a retrospective study using descriptive, analytical methods of biomedical statistics and data of the Ministry of Health of the Republic of Kazakhstan - form No.7 and 35 regarding BC (ICD 10 - C50) for 2011-2020. Results. For 2011-2020 42,376 new cases of BC and 12,914 deaths from this pathology were registered. The average annual crude incidence rate was 46.4+or-1.10/0000 (95%CI=44.3-48.5), and increased from 40.8+or-0.70/0000 (2011) to 51 .3+or-0.70/0000 in 2019 and then decrease to 44.2+or-0.70/0000 in 2020 (p<0.001). In dynamics, mortality rates tended to (p<0.001) decrease from 16.1+or-0.40/0000 (2009) to 11.9+or-0.40/0000 in 2019 and 11.5+or- 0.40/0000 in 2020, and the average annual crude mortality rate was 14.2+or-0.60/0000 (95%CI=13.1-15.3). Indicators of early diagnosis (stage I-II) improved from 73.4% (2011) to 86.9% in 2019, and decreased to 84.2% in 2020. Proportion of patients with stage III decreased (from 20.9% in 2011 to 8.4% in 2019 and to 10.0% in 2020) and stage IV (from 5.6% to 4.2% and 5.0%, respectively), i.e. neglect rates are declining. The indicators of morphological verification improved from 95.7% to 99.4% over the years. Conclusions. As a result of the analysis, an improvement in the indicators of morphological verification, early diagnosis, a decrease in the neglect and mortality rates were established. The trends in 2011-2019 differed significantly from the period from 2011-2020, which is due to the COVID-19 pandemic on the registration of BC.

COVID-19 Policy in Uzbekistan: Slipping Back Toward Authoritarianism?

Since the death of Islom Karimov in September 2016, the government of Uzbekistan has witnessed almost 4 years of slow but steady political reform. President Shavkat Mirzayoyev initiated restructuring in the law enforcement agencies, intelligence service and military, all that moved the country away from the police state that Karimov constructed in his 25-year reign. In particular, Mirzayoyev restricted the power of the criminal police and the traffic police, the latter a particularly despised organization because of their corruption and abuse of power. Beginning in March 2020, the Uzbek government began extending the powers of law enforcement, including reopening the interregional traffic police checkpoints which had been closed in 2017. The country implemented a strict quarantine, confining people to their homes except for trips for food, medical treatment and a handful of other "essential” activities. Other authoritarian measures, with little if any connection to controlling the spread of infection, have also been imposed in the political, religious and media spheres. This chapter explores the political changes COVID-19 has wrought in Uzbekistan, especially in the context of ongoing reforms directed toward fighting corruption and increasing political freedom. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Competition and firm recovery post-COVID-19

Plain English SummaryThe COVID-19 crisis had a profound impact on firms. Firms which were more productive pre-crisis fared relatively better, particularly in countries with a more competitive business environment. Using survey data for about 8000 firms, including both small and large firms, in 23 emerging and developing countries in Europe and Central Asia, the paper finds that during the COVID-19 crisis, smaller firms were hit harder, and economic activity was reallocated toward firms with higher pre-crisis labor productivity. Countries with a strong competition environment experienced more reallocation from less productive to more productive firms than countries with a weak competition environment. The evidence also suggests that reallocation from low- to high-productivity firms during the COVID-19 crisis was stronger compared with pre-crisis times. Finally, the analysis shows that government support measures implemented in response to the crisis went to less productive and larger firms, regardless of their pre-crisis innovation. Thus, government support measures during the COVID-19 crisis may have had adverse effects on competition and productivity growth. As economies enter the economic recovery phase, it will be important for policymakers to phase out support measures as soon as appropriate and focus on fostering a competitive business environment. This paper examines the impact of the COVID-19 crisis on the reallocation of economic activity across firms and whether this reallocation depends on the competition environment. The paper uses the World Bank's Enterprise Surveys COVID-19 Follow-up Surveys for about 8000 firms, including both small and large firms, in 23 emerging and developing countries in Europe and Central Asia, matched with 2019 Enterprise Surveys data. It finds that during the COVID-19 crisis, smaller firms were hit harder, and economic activity was reallocated toward firms with higher pre-crisis labor productivity. Countries with a strong competition environment experienced more reallocation from less productive to more productive firms than countries with a weak competition environment. The evidence also suggests that reallocation from low- to high-productivity firms during the COVID-19 crisis was stronger compared with pre-crisis times. Finally, the analysis shows that government support measures implemented in response to the crisis may have adverse effects on competition and productivity growth since support went to less productive and larger firms, regardless of their pre-crisis innovation.

Assessment of risk factors for thrombosis in ICU patients with COVID-19

Introduction: According to scientific studies, a high incidence of thrombotic events is known in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Background: To identify significant risk factors for thrombosis thrombosis (DVT) in intensive care patients with COVID-19. Materials and methods: We conducted a prospective cross-sectional study that included 465 adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. All patients underwent computer tomography of the chest organs, ultrasound angioscanning of lower extremities, body mass index was calculated, the presence of comorbotity diseases and indicators of volumetric blood saturation were considered. The level of D-dimer in blood plasma, coagulation parameters (fibrinogen, factor VIII) were taken from laboratory parameters in calculations. For subgroups with 5 or fewer people, the chi-square test and Fisher's exact test were used. For quantitative variables, analysis of variance (ANOVA) and the Pearson and Spearman correlation coefficient were used. For multiple variables, ordered logistic regression models were built, with likelihood ratio tests performed to compare the models. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%) had at least one comorbidity. The most common was arterial hypertension - 370 (79.57%), followed by chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases -25 (5.38%). The average body mass index was 29.7 kg/m2. In patients with DVT and venostasis, the body mass index (BMI) was more than 30 kg/m2 than without DVT (32.57+or-10.92 kg/m2, and 30.24+or-6.85 kg/m2, versus 29.22+or-6.46 kg/m2, respectively). Ultrasound angioscanning (USAS) confirmed deep vein thrombosis in 60 patients (13.8%) and was associated with older age (71.12+or-13.98 versus 67.20+or-11.16, p < 0.006), venous stasis was detected in 56 patients (12%) no DVT was detected in the rest of the studied patients. In the majority of cases, DVT was detected in the tibial segment -26 (43.33%), in 18 (30%) patients it was diagnosed in the popliteal veins and in 14 (23.33%) cases in the femoral segment. Diabetes mellitus (p=0.041), obesity (p=0.01) and CRF (p=0.028) were also significant risk factors for DVT. Conclusions: Significant risk factors for deep vein thrombosis in intensive care patients with COVID-19 are high levels of D-dimer (>=2.33 g/ml) and comorbidities such as obesity, chronic kidney failure, and diabetes mellitus.

Analysis of epidemiological features of COVID-19 in Pavlodar region

Introduction: Coronavirus infection (COVID-19), first reported at the end of 2019, which has spilled over into a worldwide pandemic and has affected all aspects of our modern lives. The aim is to study and analyze the epidemiological features of COVID-19 in the Pavlodar region. Materials and methods: Study design is a descriptive retrospective study analysis. The data were obtained from official sources of the Republican Center for e-Health of the Ministry of Health of the Republic of Kazakhstan. The study includes patients from June 30, 2020 to October 31, 2021 who received outpatient and inpatient treatment for coronavirus infection in medical institutions of the Pavlodar region. Study materials - uploading reports from the Republican Center for e-Health of the Ministry of Health of the Republic of Kazakhstan. Results: This article presents epidemiological data on the incidence of coronavirus infection in the population of Pavlodar region. The number of detected cases of COVID-19 from June 30, 2020 to October 31, 2021 was 29,443. Distribution of patients by sex predominated women - 17,831 (60.56%), than men - 11,612 (39.44%). The majority of cases were in the age group from 61 to 70 years old, with a male to female ratio of 1:1.54. Statistical significance was found between duration of stay and type of inpatient care (p < 0.001, VS-MPR*=2.135 x 10+22). Conclusion: The study showed that the number of women who fell ill prevailed over the number of men who fell ill, although the number of deaths among men prevailed over the number of deaths among women. In the study, there was no significant difference in the duration of stay for men and women in home care, compared to patients under 24-hour observation.

Recalibrating EU Foreign Policy Vis-à-vis Central Asia: Towards Principled Pragmatism and Resilience

With China and Russia acting more assertively vis-à-vis Central Asia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan have gradually moved to the core of contemporary Eurasian geopolitics – albeit to varying degrees. The European Union (EU) has purposefully sought to promote its norms and values in the region for quite some time in the past. However, considering the ongoing Western "polycrisis" exacerbated by the Covid-19 pandemic most recently, our paper investigates how the EU has been recalibrating its relationship towards Central Asia – within the timespan of its two EU Central Asia Strategies, dating from 2007 and 2019, respectively. We argue that the reformulation of EU policy towards Central Asia is pragmatically taking its lead from the growing constraints of EU foreign policy as well as Chinese and Russian intervention in the region;it is, in the end, geographical proximity that continues to shape geopolitics in Central Asia. [ FROM AUTHOR] Copyright of Geopolitics is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Countering violent extremism in central Asia and South Asia: Islamophobia and cyber-radicalization in the digital era

Widespread political and economic uncertainty following the COVID-19 pandemic, paired with increased access to digital messaging and online social media platforms, has rendered vulnerable populations in Central Asia and South Asia (CASA) even more susceptible to misinformation, radical propaganda, and population targeting by violent extremists. More, studies show that violent extremism is inextricably linked with Islamophobia. Violent extremist recruiters frequently capitalize on publicized Islamophobic events to spread digital misinformation and lure disenfranchised recruits, particularly among youth populations. A debilitated Afghanistan only compounds these issues in CASA. The growing humanitarian crisis in the wake of U.S. military withdrawal, leaves this impoverished nation ripe for the proliferation of violent extremist activity that will reach far beyond its borders. Weaponized cyber-misinformation is a moving target that threatens even rural populations. Effective deterrence calls for novel multilateral efforts between great and local powers, both on and offline, to dispel skewed narratives and reinforce positive counter-narratives. While expanding access to digital communications in CASA presents obvious challenges for countering violent extremism, it likewise affords vital new opportunities for cooperation between global and regional powers to reach previously unreachable, vulnerable populations. © The Author(s), 2022. All rights reserved.

Schistosomiasis and soil-transmitted helminthiases: progress report, 2021

In 2021, the number of children who required PC for STH decreased for pre-SAC from 291.2 million to 260.6 million and for SAC from 732.3 million to 653.7 million (Figure 2). This change was mainly due to revision of the numbers of children who require PC for STH in India, which decreased from 103.5 to 80.7 million for pre-SAC and from 332.1 to 259.1 million for SAC. The decreases were based on impact assessment surveys conducted in the past few years, which changed the endemicity status of some districts. Globally, PC coverage of SAC increased from 47% in 2020 to 62.9% in 2021.The number of SAC reached with deworming increased almost to that before the COVID-19 pandemic (411 million in 2021, 344 million in 2020, 455.9 million in 2019), indicating that countries are recovering.

Study of the problems and prospects of small tourism business development in the city of Almaty

This study is based on an understanding of the state of development of small tourism businesses in Almaty, one of the oldest settlements located along the Great Silk Road. The aim of the study was to obtain accurate data on the current state of development of small tourism businesses in Almaty and to identify problems and prospects. In the course of the research, 655 questionnaire responses from business owners and managers meeting the selection criteria were selected and rigorously monitored over a period of 3 months. As a result of the study, the most important problems of small tourism businesses in Almaty were identified, which include: 75.7% of respondents lacked knowledge about tourism activities;53.6% of entrepreneurs do not conclude contracts with employees;82% of business representatives do not have marketing plans;and, as a consequence, inability to obtain loans from banks;and the consequences of the war in Ukraine. However, we also saw some positive trends in the survey: the willingness of respondents to overcome the consequences and the crisis of the covid pandemic-19;motivation to develop their own business;28.7% of young entrepreneurs;74.7% of individual entrepreneurs invest in small tourism businesses. Thus, this study is an auxiliary tool for solving the problem of sustainable development of tourism infrastructure of Almaty, service activities, problems arising in small tourism business.

The Great Power Competition Volume 2: Contagion Effect: Strategic Competition in the COVID-19 Era

Even before the outbreak of the COVID-19 pandemic, the Central Region faced numerous obstacles to building a stable and prosperous future. The region, which encompasses the Middle East, the Horn of Africa, Central Asia, and South Asia, has been plagued by economic and political uncertainty amidst dramatic shifts in the global power structure. With the pandemic now exacerbating the volatility in this already fragile region, the U.S.‘s strategic objectives are rife for re-examination. A complicated stew of factors such as weakening of established governance systems, the emboldening of extremist individuals and groups through advances in digital technology, the humanitarian crises in Afghanistan and Syria, and the intensification of the great power competition with China and Russia are creating a fertile environment for the growth of violent extremist organizations (VEOs). Such organizations take advantage of vulnerable, aggrieved, and traumatized populations to fuel radicalization, recruitment, and unrest, which further undermine stability and the potential for peace and prosperity. While it is still early to fully understand how the ongoing response to the COVID-19 pandemic will impact U.S. policy, this book provides a timely analysis of relevant dynamics such as popular radicalization, digital information ecosystems, networks of influence, and new capabilities to recognize and prepare for other such black swan events in the region. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Building Trust and Advancing U.S. Geoeconomic Strength Through Public-Private Partnership Stakeholder Capitalism

The United States and China are currently engaged in a struggle for global influence and critical resources known as the Great Power Competition (GPC). Strategic access to key populations, geographies and supply chains, largely built on trust, will be the deciding factor in determining a competitive advantage. The global devastation of the COVID-19 pandemic has demonstrated that no one wins in a power struggle that overlooks human security for shareholder interests. This chapter explores a new way for the U.S. to engage within the modern GPC that increases competitiveness while better supporting the dignity of human constituents: specifically, to employ stakeholder capitalism rather than shareholder capitalism to win the hearts and minds of global citizens. This chapter will demonstrate that traditional national security policies, based primarily on the state, are less effective geopolitically and should no longer drive foreign policy or U.S. industrial policy. In order for the U.S. to compete in the current global arena, its policy must prioritize human and business security. Additionally, the chapter will explore the interdependent and complex relationship between the U.S. and China within the context of the modern GPC and the effects of this relationship on U.S. economy and industry. Finally, the chapter prescribes Public-Private Partnerships (PPPs), both at home and abroad, as an effective means to bolster U.S. and foreign institutions. Such a strategy will better serve all stakeholders in a post-COVID-19 global society while positioning U.S. security interests uniquely within the modern GPC. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

From the Great Power Competition to Great Power Cooperation: Strategic Lessons from a Pandemic

A swiftly changing geopolitical and geoeconomic landscape in Central Asia-Southeast Asia (CASA) resulting from the COVID-19 pandemic coupled with the modern Great Power Competition (GPC)-calls for a timely shift in U.S. foreign diplomacy to "soft power” facilitation and cooperation in this fragile region. The COVID-19 pandemic has revealed that isolationism and/or the over-reliance on militaristic might are ineffective strategies for maintaining long-term U.S. national interests. As China rapidly expands its "soft power” influence in the Central Region through its Belt and Road Initiative (BRI), the U.S. must enact similar strategic undertakings to remain competitive. To that end, the New Silk Road Initiative (NSRI) is the United States' best option to compete and/or cooperate with China's BRI. Strategic implementation of the NSRI is critical, not only for gaining traction in the modern GPC, but ultimately for expediting a successful recovery from the pandemic, through increased regional trade and economic development. The NSRI can facilitate the commercialization of Afghanistan's vast wealth of natural resources, especially its rare earth and critical minerals, ensuring continued U.S. strategic influence in the CASA region. The NSRI can also be instrumental in affording new opportunities for interstate cooperation within the scientific and technological communities during this crucial time of global recovery. The COVID-19 pandemic has highlighted not only our global interconnectedness and interdependence, but also the prospect of great power cooperation in the service of global healing. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Exploiting Seams and Gaps in the Central Asia and South Asia Region: A Framework for Analysis

This chapter analyzes the implications of the maritime strategic environment for the Central Asia and South Asia (CASA) region and considers the strategic vulnerabilities-seams and gaps-in the region. The six seams and gaps discussed are environmental, geographic, political, diplomatic, institutional, and cognitive. The argument in this chapter starts with a cognitive seam: focusing on the maritime rather than solely continental perspectives, changing maps to place India at the center of the strategic dialogue, and changing perspectives to consider the opportunities for the U.S. as a challenger to networks of trade and interests that Russia, China, and other states have already built in the region. By inverting the conventional analytical framework with the U.S. as the hegemon, and thus viewing the U.S. and its allies as part of a disruptive capability, the Seams and Gaps framework also provides new policy options for challenging Russian, Chinese, and other competing narratives in the region. Moreover, by linking the CASA to the Greater Indian Ocean region and considering China's opportunities and risks from its Belt and Road Initiative, the chapter also highlights opportunities for the U.S. and its allies to change narratives and build a robust multi-polar strategy to support U.S. interests in the region and beyond. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Characterization of viral pathogens associated with symptomatic upper respiratory tract infection in adults during a low COVID-19 transmission period.

Background: The epidemiology of respiratory tract infections (RTI) has dramatically changed over the course of the COVID-19 pandemic. A major effort in the clinical management of RTI has been directed toward diagnosing COVID-19, while the causes of other, common community RTI often remain enigmatic. To shed light on the etiological causes of RTI during a low COVID-19 transmission period in 2021, we did a pilot study using molecular testing for virologic causes of upper RTI among adults with respiratory symptoms from Almaty, Kazakhstan. Methods: Adults presenting at two public hospitals with respiratory symptoms were screened using SARS-CoV-2 PCR on nasopharyngeal swabs. A subset of RTI+, COVID-19-negative adults (n = 50) was then tested for the presence of common RTI viruses and influenza A virus (IAV). Next generation virome sequencing was used to further characterize the PCR-detected RTI pathogens. Results: Of 1,812 symptomatic adults, 21 (1.2%) tested SARS-CoV-2-positive. Within the COVID-19 negative outpatient subset, 33/50 subjects (66%) had a positive PCR result for a common community RTI virus, consisting of human parainfluenza virus 3-4 (hPIV 3-4) in 25/50 (50%), rhinovirus (hRV) in 2 (4%), hPIV4-hRV co-infection in four (8%) and adenovirus or the OCR43/HKU-1 coronavirus in two (4%) cases; no IAV was detected. Virome sequencing allowed to reconstruct sequences of most PCR-identified rhinoviruses and hPIV-3/human respirovirus-3. Conclusions: COVID-19 was cause to a low proportion of symptomatic RTI among adults. Among COVID-negative participants, symptomatic RTI was predominantly associated with hPIV and hRV. Therefore, respiratory viruses other than SARS-CoV-2 should be considered in the clinical management and prevention of adult RTI in the post-pandemic era.