Anxiety and depression among epilepsy patients in low-risk areas for COVID-19 in the northern part of Guizhou Province, China, during the COVID-19 pandemic

BackgroundThis study was aimed to investigate whether patients with epilepsy (PWE) have higher depression and anxiety levels than the normal population in low-risk areas for coronavirus disease 2019 (COVID-19) in the northern part of Guizhou Province, China, during the COVID-19 epidemic, to evaluate their knowledge on COVID-19, and to analyze related factors for the psychological distress of PWE at this special time.MethodsThe survey was conducted online from February 28, 2020 to March 7, 2020 via a questionnaire. PWE from the outpatient clinic of epilepsy of the Affiliated Hospital of Zunyi Medical University, and healthy people matched for age and sex, participated in this study. Mental health was assessed via a generalized anxiety self-rating scale (GAD-7) and the self-rating depression scale (PHQ-9). The knowledge of COVID-19 in both groups was investigated.ResultsThere were no significant differences in the general demographics between the PWE and healthy control groups. The scores of PHQ-9 (P < 0.01) and GAD-7 (P < 0.001) were higher in the PWE group than in the healthy group. There was a significant difference in the proportions of respondents with different severities of depression and anxiety, between the two groups, which revealed significantly higher degree of depression and anxiety in PWE than in healthy people (P = 0, P = 0). Overwhelming awareness and stressful concerns for the pandemic and female patients with epilepsy were key factors that affect the level of anxiety and depression in PWE. Further, the PWE had less accurate knowledge of COVID-19 than healthy people (P < 0.001). There was no statistically significant difference between the two groups in the knowledge of virus transmission route, incubation period, susceptible population, transmission speed, clinical characteristics, and isolation measures on COVID-19 (P > 0.05). PWE knew less about some of the prevention and control measures of COVID-19 than healthy people.ConclusionsDuring the COVID-19 epidemic, excessive attention to the epidemic and the female sex are factors associated with anxiety and depression in PWE, even in low-risk areas.

Limits of science-based approaches in global health: Sociocultural and moral lessons from Ebola and COVID-19

This chapter explores the significance of sociocultural and ethical limitations of non-science-based approaches toward effectively containing, managing, and ending global health emergencies. It refers to the 2013-2016 Ebola epidemic in West Africa and the current COVID-19 global pandemic to underscore the limits of science-based approaches in tackling infectious disease outbreaks. Against this background, it points to the significance of measures rooted in the humanities that have been (or are being) used to demonstrate the values of social, cultural, and ethical approaches in addressing global health emergencies. This chapter shows that while science-based approaches are essential, they are not sufficient toward addressing the varied challenges of global health emergencies. The experiences of Ebola epidemics in Africa and the COVID-19 global pandemic have shown that science-based approaches need to be buttressed by sociocultural and ethical measures to be successful. It has become self-evident that global health emergencies can be addressed sooner if non-science-based approaches are incorporated into the core responses. The successful approaches toward addressing global health emergencies will be ones that adequately harmonized science-based approaches with sociocultural and ethical measures. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023. All rights reserved.

Public agencies tweeting the COVID-19 pandemic: cross-country comparison of must have and forgotten communication topics

IntroductionDespite the importance of national-level public health agencies in times of a pandemic, there is limited comparative understanding of their must-have and forgotten pandemic-related communication topics. MethodsTo fill this gap in the literature, this article presents an analysis of COVID-related communication topics by national-level health agencies in Italy, Sweden, and the United States using the IDEA (Internalization, Distribution, Explanation, Action) model on crisis message framing. The public health agencies included in the study are the Italian National Institute of Health (Istituto Superiore di Sanita;ISS), the Public Health Agency of Sweden (Folkhalsomyndigheten), and the Center for Disease Control and Prevention (CDC) in the US. ResultsBased on these agencies' Twitter posts (n = 856) in the first 3 months of the pandemic, the article reveals a greater attention paid to action oriented (e.g., disease prevention) and explanatory messages (e.g., disease trends) than to distribution (e.g., transmission) and internalizing messages (e.g., risk factors) in all three countries. The study also highlights differences in terms of referrals to other communication channels and communication topics, especially in terms of these agencies' emphasis on individual risk factors (related to the risk of a person suffering from serious COVID-19-related health consequences) and social risk factors (related to the chance of an individual to become infected with COVID-19 because of the social context). DiscussionThe study's findings call for better incorporation of information that is directly relevant to the receivers (internalizing messages) by public health agencies.

Emerging and Miscellaneous Viral Infections

• The infectious diseases described in this chapter are either: (1) diseases of humans or other animals generally transmitted through contact with the secretions or excretions of rodents (hantaviruses, arenaviruses, and encephalomyocarditis virus), swine (hepatitis E virus), monkeys (Ebola virus), or bats (systemic coronaviruses);(2) common diseases of humans where the role of companion animals in transmission has been investigated (enteroviruses, SARS-CoV-2);(3) diseases of significant importance to the agricultural industry (foot-and-mouth disease virus, vesicular exanthema, encephalomyocarditis virus);or (4) significant diseases of potential prey of dogs and cats (rabbit hemorrhagic disease virus). • Clinical illness has not always been confirmed in dogs and cats with these infections, but evidence of seroconversion to these viruses exists. • In some cases, concern has been raised in the possible role of dogs and cats in zoonotic transmission;this has been heightened by the COVID-19 pandemic. • In general, research suggests that dogs and cats do not play a major role in transmission of these viruses, but the potential exists should new viral variants emerge. © 2021 Elsevier Inc. All rights reserved.

Disease discourses, African knowledge systems, and COVID-19 in Senegal

Too often African knowledge systems are excluded from formal discussions surrounding public health, as they are often perceived traditional mechanisms that operate outside the sphere of mainstream science and medicine. Yet with the diffusion of COVID-19 across the globe, new conversations have emerged in relation to Africa's community-based successes in responding to the virus and its impacts. This chapter employs a geographical analysis of Senegal in order to highlight the ways in which Senegalese have approached the diffusion of COVID-19 and successfully controlled its spread. Using maps and qualitative data, this chapter underscores the ways in which global public health experts can draw from the expertise of African nations given the complex ways they have responded to both this pandemic and previous health emergencies. Findings indicate that science and community-based response systems are the key to Senegal's management of coronavirus. This chapter aims to subvert dominant discourses, which suggest that African states somehow stumbled upon their pandemic-related successes. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023. All rights reserved.

The outbreak of Ebola virus disease in 2022: A spotlight on a re-emerging global health menace

Ebola virus disease (EVD) is a rare but highly contagious and lethal disease that occurs predominantly in African countries, with a case-fatality rate of 30–90%. The causative viral pathogens of EVD are within the genus Ebolavirus in the family Filoviridae. The primary route of human-to-human transmission is through direct contact with blood, bodily fluids and secretions from infected individuals. Direct contact with virally contaminated objects and sexual transmission have also been reported. Management of EVD is aggressive supportive care with possibly new therapeutic options. On 20 September 2022, an EVD outbreak was declared in Uganda, caused by Sudan ebolavirus. As of 7 November 2022, a total of 136 confirmed cases, 53 confirmed deaths have been reported, including 18 cases with seven deaths among healthcare workers. In the Democratic Republic of Congo (DRC), an EVD outbreak was also declared on 22 August 2022 (which ended on 27 September 2022);with only one case, a middle-aged woman. At the time when most countries in the world have been occupied with the coronavirus disease 2019 (COVID-19) pandemic and the recent human monkeypox outbreak, these two outbreaks of EVD have the potential to significantly add to the burden on global health. Authorities need to augment their multi-faceted response, including stringent contact tracing and border control, to avoid the catastrophe of the 2014–2016 EVD epidemic. © 2022, School of Medicine, Universitas Syiah Kuala. All rights reserved.

Nigeria's new president ‘must walk the talk on health'

Speed read Nigeria's president-elect eyes 40 per cent health insurance coverage in two years Ambitious target needs funding, human resources Over 75,000 nurses and midwives left Nigeria in five years [LAGOS] Health experts in Nigeria say the country's president-elect who will be inaugurated on 29 May must prioritise health care and refrain from politicising it. While Nigeria committed to achieving universal health coverage (UHC) by 2030, its National Health Insurance Scheme (NHIS) established in 2005 makes health insurance coverage voluntary. [...]in May 2022, after two decades of sustained calls by health professionals, a new Act was passed which aimed to provide health insurance for all Nigerians, through a mandatory mechanism and in collaboration with state health insurance agencies.

Special Issue: Honor of Dr. Mike Bray on his retirement as the editor-in-chief of antiviral research. (Special Issue: Honor of Dr. Mike Bray on his retirement as the editor-in-chief of antiviral research.)

This special issue contains 23 articles that discuss various aspects of antiviral research, focusing on the contributions and legacy of Dr. Mike Bray, the retiring Editor-in-Chief of Antiviral Research. The articles cover a range of topics, including the underappreciated mouse model for Ebola virus disease, the history and impact of the mouse-adapted Ebola virus model, and the characterisation of CD-1 mice infected with different strains of Ebola virus. Other articles delve into transplacental vertical transmission of flaviviruses, the development of reverse genetic systems for SARS-CoV-2, and the mechanisms of action and drug resistance of nucleotide analogues against the virus. The special issue also explores therapeutics for flaviviral infections, alternative splicing in RNA virus infections, and targeted protein degradation as an antiviral approach.

A comprehensive insight on the challenges for COVID-19 vaccine: A lesson learnt from other viral vaccines.

The aim of this study is to comprehensively analyze previous viral vaccine programs and identify potential challenges and effective measures for the COVID-19 vaccine program. Previous viral vaccine programs, such as those for HIV, Zika, Influenza, Ebola, Dengue, SARS, and MERS, were evaluated. Paramount challenges were identified, including quasi-species, cross-reactivity, duration of immunity, revaccination, mutation, immunosenescence, and adverse events related to viral vaccines. Although a large population has been vaccinated, mutations in SARS-CoV-2 and adverse events related to vaccines pose significant challenges. Previous vaccine programs have taught us that predicting the final outcome of the current vaccine program for COVID-19 cannot be determined at a given state. Long-term follow-up studies are essential. Validated preclinical studies, long-term follow-up studies, alternative therapeutic approaches, and alternative vaccines are necessary.

COVID-19 Vaccine Perceptions among Ebola-Affected Communities in North Kivu, Democratic Republic of the Congo, 2021.

Populations affected by humanitarian crises and emerging infectious disease outbreaks may have unique concerns and experiences that influence their perceptions toward vaccines. In March 2021, we conducted a survey to examine the perceptions toward COVID-19 vaccines and identify the factors associated with vaccine intention among 631 community members (CMs) and 438 healthcare workers (HCWs) affected by the 2018-2020 Ebola Virus Disease outbreak in North Kivu, Democratic Republic of the Congo. A multivariable logistic regression was used to identify correlates of vaccine intention. Most HCWs (81.7%) and 53.6% of CMs felt at risk of contracting COVID-19; however, vaccine intention was low (27.6% CMs; 39.7% HCWs). In both groups, the perceived risk of contracting COVID-19, general vaccine confidence, and male sex were associated with the intention to get vaccinated, with security concerns preventing vaccine access being negatively associated. Among CMs, getting the Ebola vaccine was associated with the intention to get vaccinated (RR 1.43, 95% CI 1.05-1.94). Among HCWs, concerns about new vaccines' safety and side effects (OR 0.72, 95% CI 0.57-0.91), religion's influence on health decisions (OR 0.45, 95% CI 0.34-0.61), security concerns (OR 0.52, 95% CI 0.37-0.74), and governmental distrust (OR 0.50, 95% CI 0.35-0.70) were negatively associated with vaccine perceptions. Enhanced community engagement and communication that address this population's concerns could help improve vaccine perceptions and vaccination decisions. These findings could facilitate the success of vaccine campaigns in North Kivu and similar settings.

Points of entry dynamics: understanding the cross-border threats for Ebola virus disease and COVID-19 in Ghana using a logic model approach.

Background: The influx of people across the national borders of Ghana has been of interest and concern in the public health and national security community in recent times due to the low capacity for the prevention and management of epidemics and other public health risks. Although the international health regulations (IHR) stipulate core public health capacities for designated border facilities such as international airports, seaports, and ground crossings, contextual factors that influence the attainment of effective public health measures and response capabilities remain understudied. Objective: This study aims to assess the relationship between contextual factors and COVID-19 procurement to help strengthen infrastructure resources for points of entry (PoE) public health surveillance functions, thereby eliminating gaps in the design, implementation, monitoring, and evaluation of pandemic-related interventions in Ghana. Methods: This study employed a mixed-methods design, where quantitative variables were examined for relationships and effect size interactions using multiple linear regression techniques and the wild bootstrap technique. Country-level data was sourced from multiple publicly available sources using the social-ecological framework, logic model, and IHR capacity monitoring framework. The qualitative portion included triangulation with an expert panel to determine areas of convergence and divergence. Results: The most general findings were that laboratory capacity and Kotoka International Airport testing center positively predicted COVID-19 procurement, and public health response and airline boarding rule negatively predicted COVID-19 procurement. Conclusion: Contextual understanding of the COVID-19 pandemic and Ebola epidemic is vital for strengthening PoE mitigation measures and preventing disease importation.

Reddit and Google Activity Related to Non-COVID Epidemic Diseases Surged at Start of COVID-19 Pandemic: Retrospective Study.

BACKGROUND: Resources such as Google Trends and Reddit provide opportunities to gauge real-time popular interest in public health issues. Despite the potential for these publicly available and free resources to help optimize public health campaigns, use for this purpose has been limited. OBJECTIVE: The purpose of this study is to determine whether early public awareness of COVID-19 correlated with elevated public interest in other infectious diseases of public health importance. METHODS: Google Trends search data and Reddit comment data were analyzed from 2018 through 2020 for the frequency of keywords "chikungunya," "Ebola," "H1N1," "MERS," "SARS," and "Zika," 6 highly publicized epidemic diseases in recent decades. After collecting Google Trends relative popularity scores for each of these 6 terms, unpaired 2-tailed t tests were used to compare the 2020 weekly scores for each term to their average level over the 3-year study period. The number of Reddit comments per month with each of these 6 terms was collected and then adjusted for the total estimated Reddit monthly comment volume to derive a measure of relative use, analogous to the Google Trends popularity score. The relative monthly incidence of comments with each search term was then compared to the corresponding search term's pre-COVID monthly comment data, again using unpaired 2-tailed t tests. P value cutoffs for statistical significance were determined a priori with a Bonferroni correction. RESULTS: Google Trends and Reddit data both demonstrate large and statistically significant increases in the usage of each evaluated disease term through at least the initial months of the pandemic. Google searches and Reddit comments that included any of the evaluated infectious disease search terms rose significantly in the first months of 2020 above their baseline usage, peaking in March 2020. Google searches for "SARS" and "MERS" remained elevated for the entirety of the 2020 calendar year, as did Reddit comments with the words "Ebola," "H1N1," "MERS," and "SARS" (P<.001, for each weekly or monthly comparison, respectively). CONCLUSIONS: Google Trends and Reddit can readily be used to evaluate real-time general interest levels in public health-related topics, providing a tool to better time and direct public health initiatives that require a receptive target audience. The start of the COVID-19 pandemic correlated with increased public interest in other epidemic infectious diseases. We have demonstrated that for 6 distinct infectious causes of epidemics over the last 2 decades, public interest rose substantially and rapidly with the outbreak of COVID-19. Our data suggests that for at least several months after the initial outbreak, the public may have been particularly receptive to dialogue on these topics. Public health officials should consider using Google Trends and social media data to identify patterns of engagement with public health topics in real time and to optimize the timing of public health campaigns.

Negative and positive antecedents of intention to resume hotel consumption in new normal settings in Malaysia: insight from three psychological theories

PurposeApplying three psychological theories, this study aims to attempt to investigate the role of consumer psychology, specifically the factors of trust in vaccination, threat severity, fear, anxiety, risk and hygiene, and safety, on intention to resume hotel consumption. The authors also tested the mediation effect of anxiety among psychological constructs: perceived threat, fear and risk with the intention to resume hotel consumption.Design/methodology/approachUsing purposive sampling, data were collected from 470 respondents from four cities in Malaysia and analysed by applying analysis of moment structures (AMOS) structural equation model technique. The respondents for this study were frequent travellers meaning the leisure tourists who at least travel twice a year or travel when getting the occasion to explore new things. In this study, an online survey was employed to ensure easy accessibility and to enhance the number of replies.FindingsThe results of this study confirmed that perceived severity, risk and fear influence travellers' anxiety. This study further confirms that trust in vaccination and hygiene & safety provided by the hotelier reduces anxiety levels. Anxiety is found one of the most important predictors of intention to resume hotel consumption, which further mediates the relationship between other psychological variables: perceived severity, risk, fear and intention to resume hotel consumption. Anxiety mediates the relationship between perceived severity, fear and intention to resume hotel consumption and partially mediates the association between risk and intention to resume hotel consumption.Originality/valueThis study examined three psychological theories and extended them by including the trust in vaccination and the hygiene and safety constructs. Anxiety was investigated as a mediator.

Blaming Others: Stigmas Related to COVID-19 Pandemic in Indonesia and Malaysia

High stigma toward COVID-19 sufferers was observed in Indonesia's and Malaysia's social media spheres, especially at the beginning of the pandemic in 2020. This study compared individual and interpersonal stigmas through analysis of online conversations and established government protocols in handling COVID-19 in Malaysia and Indonesia. The critical narrative found was 'blaming others,' pointing fingers toward other actors, such as certain ethnic and religious groups, for the continuous spread of the virus. We found that stigmatisation of COVID-19 in Indonesia and Malaysia pointed out jarring concerns, 1) lack of knowledge on COVID-19, 2) the need for effective and efficient dissemination of information to avoid victim blaming, and 3) politicisation of COVID-19 for one's benefit. In times of public health crises such as COVID-19, governments should not only be responsive in formulating just policies that could help to control the spread of the virus but also mitigate stigmatization towards certain members of society. For Indonesian and Malaysian governments, while there were attempts to address COVID-19 stigma through various online and offline campaigns, observers expressed concern over the lack of recognition of the effects of stigma in COVID-19 official protocols. We discovered that COVID-19 protocols did not provide sufficient information on how to develop a safe environment for COVID-19 sufferers, thus preventing people from getting health treatment and other public services during the pandemic. Also, the protocols were found to have strengthened existing negative stereotypes toward marginalised groups.

Peacekeeping Operations: Challenges and Opportunities in the Midst of Health Crises

The COVID-19 crisis has brought about significant challenges to international organizations operating in fragile contexts. Among others, the case of United Nations (UN) and its peacekeeping operations (PKOs) counting more than 80, 000 personnel from 121 countries is certainly prominent. Not only do PKOs rely on international personnel's frequent rotations, but they also rely on freedom of movement to carry out their mandate. How have PKOs adapted and responded to the crisis? How do PKOs balance the need to protect vulnerable civilians with support to governments' responses to the crisis and safeguard legitimacy? This chapter explores the impact of the health crisis due to the COVID-19 pandemic on PKOs by focusing on two key aspects. First, it evaluates the current PKO efforts in managing the crisis in light of two previous health emergencies occurring in the midst of PKOs, namely Ebola in Western Africa and cholera in Haiti. It will reflect on the legitimacy costs associated with the risk of UN personnel being seen as vector of the disease. Second, it identifies challenges and opportunities created by the emergency. The key challenges stem from the inevitable delay or interruption of ongoing negotiation processes, and the associated risks of armed groups taking advantage of the uncertain situation. But there are some opportunities to consider. Operational adaptation becomes a need as missions have to prioritize civilians' protection without violating governments' policies on movement. Furthermore, halting frequent personnel rotations has likely increased cohesion within missions among soldiers but also between soldiers and missions' leaders. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Emerging Pandemic Infectious Disease Threats

Pandemic infectious diseases are caused by pathogens that have adapted well to growth and reproduction within the human host and that through unique environmental, socioeconomic, and cultural circumstances are able to rapidly spread across national boundaries and even globally. Although uncommon and caused by relatively few pathogens, the extraordinary human, economic, and societal losses caused by pandemic diseases as exemplified by coronavirus disease 2019 (COVID-19) make pandemic diseases of unique importance to clinicians, immunologists, and many other scientists and healthcare professionals. The pathogenesis of pandemic diseases is complex and unique to each pathogen, but common to all is widespread immunologic naïveté within the host population. In this chapter, we consider the pathogens of greatest concern for their pandemic potential. Most of these organisms are viruses, including betacoronaviruses, alpha influenza virus, Ebola virus, and the flaviviruses, but numerous bacteria are also emerging with pandemic disease potential. For each organism, we consider the factors, especially immunologic, that lead to pandemic spread and prospects for effective therapy and prevention. © 2023 Elsevier Ltd. All rights reserved.

Role of AI and ML in Epidemics and Pandemics

The healthcare industry, as well as business and society, have been revolutionized by Artificial Intelligence (AI) and Machine Learning (ML). Currently, microbiology, biochemistry, genetics, structural biology, and immunological concepts have all seen significant advances. In contrast, the fields of bioinformatics have seen considerable expansion in order to handle this massive data influx. The field of bioinformatics, which tries to use computational methods for a better understanding of biological sciences, sits at the crossroads of data science and wet lab. Several innovative databases and computational techniques have been proposed in this sector to advance immunology research, with many of them relying on artificial intelligence and machine learning to anticipate complicated immune system activities, such as epitope identification for lymphocytes. Models based on machine learning skilled on specific proteins have provided inexpensive and quick-to-implement strategies for the discovery of effective viral treatments in the recent decade. Given a target biomolecule, these models can predict inhibitor candidates using structural data. The emergence of the coronavirus COVID-19 has resulted in significant network data traffic and resource optimization demands, rendering standard network designs incapable of dealing calmly with COVID-19's consequences. Researchers are encouraged by the use of Machine Learning (ML) and Artificial Intelligence (AI) in previous epidemics, which offers a novel strategy to combating the latest COVID-19 pandemic. © 2023 Scrivener Publishing LLC.

Systemic Viral Infections and the Eye

Ocular manifestations of systemic viral infections are common. Because viral infection syndromes may be nonspecific, diagnosis of a particular viral infection often requires understanding of the risk factors and transmission modes of viral pathogens. Careful review of both history of the disease and the ocular exam findings can be helpful in narrowing down the differential diagnosis for the systemic condition and vice versa. A history of exposures, including animal exposures, sexual exposures, and travel, as well as the vaccination history and general medical history helps guide the workup and treatment of viral infections. Diagnostic testing for viral infections may include blood testing for serologic studies and viral detection, samples from involved extraocular organs, as well as ocular samples that can confirm a diagnosis and facilitate initiation of optimal therapy while minimizing side effects from exposure to unnecessary antiviral agents. Importantly, patients with HIV or other immunocompromising conditions may simultaneously have more than one active infection and also may manifest with syndromes that are atypical and have serologic testing that is less accurate. Careful and aggressive diagnostic evaluation of ocular symptoms is especially important in these patients, as are efforts to improve immune function while monitoring for the possible impact of immune reconstitution on the clinical course. © Springer Nature Switzerland AG 2022.

Émergence des vulnérabilités de soignants en première ligne au cours des urgences sanitaires. De l'épidémie d'Ebola à la COVID-19 au Sénégal

Based on results of ethnographic study about social construction of trust, this article describes experiences of the Ebola Virus Disease epidemic. The author describes how, on the front line of the disease, response to an unpredictable epidemic in a country with limited resources such as Senegal, relies on the capacities of health workers not very visible, who have a precarious status, and who are not considered to be health personnel but who provide essential "ordinary" care on a daily basis through "tasks delegation". The article describes the patient's care itinerary, contact case identification modalities and the profile of the caregivers considered as "contacts". The author describes their experiences, the social and financial effects of home assignment, which reinforces their double professional and social vulnerability as well as their suffering. Locked in a "health subsystem" at the entrance of the health pyramid, these invisible caregivers are the most exposed, the least protected or supported. In context of a country with a fragile health system, this analysis should contribute to a sociological understanding of the usual role of caregivers in the public health system and in epidemic situations, but also to understand contours of an "organized" and institutionalized invisibility that compromises epidemic responses.Alternate :Basado en los resultados de un estudio etnográfico sobre la construcción social de la confianza, este artículo describe las experiencias vividas durante la epidemia de la enfermedad viral del Ébola. Muestra cómo, en primera línea ante los enfermos, los dispositivos para responder a una epidemia imprevisible en Senegal dependen de las capacidades de los agentes sanitarios poco visibles, con estatus precario, que no son considerados como miembros del personal de salud pero que aseguran de manera cotidiana lo esencial de la asistencia sanitaria «rutinaria». El artículo presenta el itinerario de la atención del paciente, las modalidades de identificación y el perfil del personal sanitario considerados como «contactos». La autora describe su vivencia, los efectos sociales y financieros de la asignación en domicilio, la cual refuerza la doble vulnerabilidad profesional y social, así como sus padecimientos. Confinados en un «subsistema de salud» en la base de la pirámide sanitaria, ese personal sanitario invisible es el más expuesto, el menos protegido o apoyado. Este análisis contribuirá al conocimiento sociológico del rol habitual y en situación de epidemia del personal sanitario en el sistema de salud pública, y por otra parte permitirá comprender los contornos de una invisibilidad «organizada» e institucionalizada que compromete la respuesta a las epidemias.Alternate :Basé sur les résultats d'une étude ethnographique sur la construction sociale de la confiance, cet article décrit les expériences vécues lors de l'épidémie de la maladie à virus Ebola. Il montre comment, en première ligne face aux malades, les dispositifs de réponse à une épidémie imprévisible au Sénégal reposent sur les capacités des agents de santé peu visibles, au statut précaire, qui ne sont pas considérés comme faisant partie des membres du personnel de santé, qui assurent au quotidien l'essentiel des soins « ordinaires ». L'article décrit l'itinéraire de soins du patient, les modalités d'identification et le profil des soignants considérés comme des « contacts ». L'auteure décrit leur vécu, les effets sociaux, et financiers de l'assignation à domicile qui renforce la double vulnérabilité professionnelle et sociale ainsi que leurs souffrances. Enfermés dans un « sous‑système de santé » à l'entrée de la pyramide sanitaire, ces soignants invisibles sont les plus exposés, les moins protégés ou soutenus. Cette analyse devrait permettre, d'une part, de contribuer à une connaissance sociologique du rôle habituel et en situation d'épidémie de ces soignants dans le système de soins publics, et, d'autre part, d'appréhender des cont ur d'une invisibilité « organisée » et institutionnalisée qui compromet les ripostes épidémiques.

Impact of health systems reform on COVID-19 control in Sierra Leone: a case study.

BACKGROUND: There are various impacts of COVID-19 on health systems of the world. The health systems of low- and middle-income countries are less developed. Therefore, they have greater tendencies to experience challenges and vulnerabilities in COVID-19 control compared to high-income countries. It is important to contain the spread of the virus, and likewise strengthen the capacity of health systems in order for the response to be effective and swift. The experience from 2014 to 2016 Ebola outbreak in Sierra Leone served as preparation for COVID-19 outbreak. The aim of this study is to determine how control of COVID-19 outbreak in Sierra Leone was enhanced by the lessons learned from 2014 to 2016 Ebola outbreak, and health systems reform. METHODS: We used data from a qualitative case study conducted in four districts in Sierra Leone through key informant interviews, focus group discussions, document, and archive record reviews. A total of 32 key informant interviews and 14 focus group discussions were conducted. A thematic analysis was used to analyze the data, and all transcripts were coded and analyzed with the aid of ATLAS.ti 9 software program. RESULTS: The six themes obtained were composed of categories that connect with each other and with codes to form networks. The analysis of the responses demonstrated that "Multisectoral Leadership and Cooperation", "Government Collaboration among International Partners", and "Awareness in the Community" were among the key interventions used during the control of 2014-2016 Ebola virus disease outbreak, which were applied in the control of COVID-19. An infectious disease outbreak control model was proposed based on the results obtained from the analysis of the lessons learned during the Ebola virus disease outbreak, and health systems reform. CONCLUSIONS: "Multisectoral Leadership and Cooperation", "Government Collaboration among International Partners" and "Awareness in the Community" are key strategies that enhanced the control of the COVID-19 outbreak in Sierra Leone. It is recommended that they are implemented in controlling COVID-19 pandemic or any other infectious disease outbreak. The proposed model can be used in controlling infectious disease outbreaks, especially in low- and middle-income countries. Further research is needed to validate the usefulness of these interventions in overcoming an infectious disease outbreak.