Tomato Flu in the Time of COVID-19: Another Challenge for the Indian Health System

Just as the country has recently dealt with the increase in COVID-19 and monkey pox cases, another dark cloud of "Tomato flu/ Tomato fever " loomed the skies of the nation. As of 24 august, 2022, 100 kids mainly below the age of 5 have been reported showing symptoms of the flu. Another state of Odisha, suspected similar infectious etiology in 36 cases out of which 26 Children were below the age of 10. This endemic viral illness has triggered an alert to the neighboring states of Tamil Nadu and Karnataka, along with the entire nation at large. The wrath of this disease is not just restricted to India but crossing borders. Tang, et al reported a case of a 13-month-old female child and her 5-year old brother based in United kingdom with similar etiology. Through this report, we aim to alert the frontline pediatricians, who are most likely to come across and manage such daunting cases with these non-specific clinical features in their routine clinical practice across the globe. Early and extreme preventive and surveillance measures must be undertaken to prevent substantial loss in public and private sector Mehta et al.

For COVID-19, what are the priorities of normalized prevention and control strategies?

The COVID-19 pandemic has ravaged the world for three years. Most countries have adjusted policies and strategies in response to the burden of COVID-19. The severity of COVID-19 seems to be diminishing as the case fatality rate has declined and the number of vaccinated people has increased markedly. Given the large population worldwide, we need to pay attention to the continuing COVID-19 burden. Globally, the number of cases remains at a certain level, and the number of cases is still increasing in China. We also need to deal with shortages of medical resources, antipyretics, and home nursing facilities. SARS-CoV-2 will coexist with humans for a long time, and predicting viral mutations and pandemic trends will be difficult. The reform of the whole public health system is imperative. A comprehensive surveillance system should be created to determine the proportion of various pathogens and to guard against mixed infections of respiratory infectious diseases. A comprehensive response mechanism, including preventive measures and medical treatments, should be created as soon as possible to monitor the status of the epidemic and to deal with the long-term health burden of SARS-CoV-2.

Assessing the impact of mental health capacity building of Primary Health Care (PHC) personnel

Introduction: COVID-19 poses an immense challenge to health systems and societies, associated with a burden of mental health in the population. The pandemic is uncovering treatment gaps in mental health systems, especially in Low and Middle-Resource Countries, as Georgia. The high burden calls for renewed efforts to integrate mental health into Primary Health Care (PHC) to address increased mental health needs of the population. The capacity building of PHC personnel is ongoing since October 2020, according to mhGAP algorithm. Family doctors (FD) are trained in identification and management in priority mental conditions. Objective(s): The overall aim of the study was to assess the impact of capacity building of PHC personnel. This was an implementation research seeking to understand how effective was the offered capacity building process and what could be lessons learnt. Method(s): We employed a mixed-methods process evaluation design utilising a series of instruments specifically designed to provide data for the domains as training/capacity building, service delivery and user satisfaction. Result(s): FD were able to identify the most prevalent conditions - Anxiety (74%) and Depression (39%);in 22.8% the comorbidity was recognized. The psychoeducation was the most common method of management used by 72%. In 39.4% FD were able to recommend at least one medicine to their patients. 83.3% of patients reported improved conditions. Conclusion(s): The family doctors are able to identify and manage certain mental health conditions after proper trainings and regular supervision. This study has simultaneously identified targets for change within the broader mental health system.

Holistic strategies to mitigate the economic, societal, and health burden of the Coronavirus disease-2019 pandemic

Pandemics are not the unique features of modern civilization;epidemics/pandemics can be traced back to ancient civilization. History is replete with such pandemics. Coronavirus first originated in Hubei province, China, in November 2019 and then manifested in Wuhan but within a very short span of time it has spread like wildfire all over the world and its impact has been multifaceted. It is indeed an indication of the fact that we live in a truly globalized world. Due to the outbreak of Coronavirus disease-2019 (COVID-19), people lost their lives but due to the consequent lockdown, people lost their livelihood, and the economy is shattered. Global GDP and trade experienced a huge contraction during the period of pandemic and the improvements to date are not worth mentioning. Actually, pandemic acts like a serial killer and its aftermath is devastating on human lives and the global economy. © 2022 Elsevier Inc. All rights reserved.

Role of Neuroimmune Interactions in COVID-19-related Cardiovascular Damage.

Coronavirus disease 2019 (COVID-19) has caused a global pandemic impacting over 200 countries/regions and more than 200 million patients worldwide. Among the infected patients, there is a high prevalence of COVID-19-related cardiovascular injuries. However, the specific mechanisms linking cardiovascular damage and COVID-19 remain unclear. The COVID-19 pandemic also has exacerbated the mental health burden of humans. Considering the close association between neuroimmune interactions and cardiovascular disease, this review assessed the complex pathophysiological mechanisms connecting neuroimmune interactions and cardiovascular disease. It was revealed that the mental health burden might be a pivotal accomplice causing COVID-19-associated cardiovascular damage. Specifically, the proinflammatory status of patients with a terrible mood state is closely related to overdrive of the hypothalamus-pituitary-adrenal (HPA) axis, sympathovagal imbalance, and endothelial dysfunction, which lead to an increased risk of developing cardiovascular injury during COVID-19. Therefore, during the prevention and treatment of cardiovascular complications in COVID-19 patients, particular attention should be given to relieve the mental health burden of these patients.

Increased Safety Behavior and COVID-19-Related Fear in Adults with Cystic Fibrosis during the Pandemic.

People with cystic fibrosis (pwCF) face great challenges during the ongoing COVID-19 pandemic. Recent research found equal levels of distress in pwCF and healthy controls (HC). The current study aimed to investigate the mental health burden and safety behavior in pwCF. Sixty-nine adult pwCF and sixty-nine propensity-score-matched HC participated in this study. Participants completed an anonymous online questionnaire assessing distress, generalized anxiety, depressive symptoms, COVID-19-related variables, self-reported adherent safety behavior (ASB), and dysfunctional safety behavior (DSB). PwCF showed equal amounts of distress (W = 2481.0, p = 0.669), depressive symptoms (W = 2632.5, p = 0.268), and generalized anxiety symptoms (W = 2515.5, p = 0.565) compared to the HC. COVID-19-related fear (W = 1872.0, p = 0.028), ASB (W = 1630.0, p = 0.001), and DSB (W = 1498.5, p < 0.001) were significantly elevated in pwCF. The pwCF estimated that the probability of suffering from symptoms (W = 954.5, p < 0.001), experiencing a severe course (W = 806.5, p < 0.001), or dying (W = 1079.0, p < 0.001) from COVID-19 is significantly higher than that of the HC. ASB was associated with a CF diagnosis, COVID-19-related fear, and a subjective level of information (R2 = 0.414, F(13, 124) = 6.936, p ≤ 0.001). DSB was associated with a diagnosis of CF and COVID-19-related fear (R2 = 0.196, F(13, 124) = 3.169, p ≤ 0.001). The data suggest that pwCF show functional and adequate behaviors towards the risk caused by the pandemic. Therefore, functional coping behaviors may provide advantages in addressing pandemic challenges.

Mental Health Symptoms among General Practitioners Facing the Acute Phase of the COVID-19 Pandemic: Detecting Different Reaction Groups.

During the 2020 first wave of the COVID-19 pandemic, general practitioners (GPs) represented the first line of primary care and were highly exposed to the pandemic risks, with a consequent risk of developing a wide range of mental health symptoms. However, scant data are still available on factors associated with a worse outcome. The aim of the present study was to investigate mental health symptoms in 139 GPs in the aftermath of the first COVID-19 national lockdown in Italy, detecting groups of subjects with different depressive, anxiety, and post-traumatic stress symptom severity. The impact of the mental health symptoms on quality of life and individual functioning were also evaluated. A cluster analysis identified three groups with mild (44.6%), moderate (35.3%), and severe psychopathological burden (20.1%). Higher symptom severity was related to younger age, fewer years in service as GPs, working in a high incidence area for the pandemic, having a relative at risk of medical complications due to COVID-19, besides more severe global functioning impairment, burnout, and secondary traumatic stress. The present findings showed that GPs, forced to perform their professional activity in extremely stressful conditions during the COVID-19 pandemic, were at high risk of developing mental health problems and a worse quality of life.

Optimal timing and effectiveness of COVID-19 outbreak responses in China: a modelling study.

BACKGROUND: In January 2020, an outbreak of atypical pneumonia caused by a novel coronavirus, SARS-CoV-2, was reported in Wuhan, China. On Jan 23, 2020, the Chinese government instituted mitigation strategies to control spread. Most modeling studies have focused on projecting epidemiological outcomes throughout the pandemic. However, the impact and optimal timing of different mitigation approaches have not been well-studied. METHODS: We developed a mathematical model reflecting SARS-CoV-2 transmission dynamics in an age-stratified population. The model simulates health and economic outcomes from Dec 1, 2019 through Mar 31, 2020 for cities including Wuhan, Chongqing, Beijing, and Shanghai in China. We considered differences in timing and duration of three mitigation strategies in the early phase of the epidemic: city-wide quarantine on Wuhan, travel history screening and isolation of travelers from Wuhan to other Chinese cities, and general social distancing. RESULTS: Our model estimated that implementing all three mitigation strategies one week earlier would have averted 35% of deaths in Wuhan (50% in other cities) with a 7% increase in economic impacts (16-18% in other cities). One week's delay in mitigation strategy initiation was estimated to decrease economic cost by the same amount, but with 35% more deaths in Wuhan and more than 80% more deaths in the other cities. Of the three mitigation approaches, infections and deaths increased most rapidly if initiation of social distancing was delayed. Furthermore, social distancing of working-age adults was most critical to reducing COVID-19 outcomes versus social distancing among children and/or the elderly. CONCLUSIONS: Optimizing the timing of epidemic mitigation strategies is paramount and involves weighing trade-offs between preventing infections and deaths and incurring immense economic impacts. City-wide quarantine was not as effective as city-wide social distancing due to its much higher daily cost than social distancing. Under typical economic evaluation standards, the optimal timing for the full set of control measures would have been much later than Jan 23, 2020 (status quo).

Mental Health Burden of the COVID-19 Pandemic in Healthcare Workers in Four Latin American Countries.

The aim of the study was to assess the mental health burden of the COVID-19 pandemic in healthcare workers in four Latin American countries in 2020.An online survey was carried out with 1721 participants from Argentina, Chile, Colombia and Mexico in 2020. A non-probabilistic convenience sampling method was used to recruit voluntary participants. Post-traumatic stress symptoms were assessed with the SPRINT-E scale, Perceived Discrimination was assessed with a Spanish version of the scale developed by Molero, and anxiety toward death was assessed with the Spanish version of the Templer scale. All instruments were assessed for internal consistency.The overall frequency of post-traumatic stress symptoms was 23.9%. The frequency by countries was 26.4% in Argentina, 29.8% in Chile, 19.9 in Colombia, and 23.8% in Mexico. Post-traumatic stress symptoms were associated with individual subtle discrimination, anxiety toward the death of the elderly, lack of Personal Protective Equipment, and exposition to the death.The COVID-19 pandemic has imposed a mental health burden on health workers in the countries included in the study, not only due to the implications of the disease in the face of exposure to death, but also due to institutional conditions and in which they carry out their work.

Health and related economic benefits associated with reduction in air pollution during COVID-19 outbreak in 367 cities in China.

Due to the COVID-19 outbreak, the Chinese government implemented nationwide traffic restrictions and self-quarantine measures from January 23 to April 8 (in Wuhan), 2020. We estimated how these measures impacted ambient air pollution and the subsequent consequences on health and the health-related economy in 367 Chinese cities. A random forests modeling was used to predict the business-as-usual air pollution concentrations in 2020, after adjusting for the impact of long-term trend and weather conditions. We calculated changes in mortality attributable to reductions in air pollution in early 2020 and health-related economic benefits based on the value of statistical life (VSL). Compared with the business-as-usual scenario, we estimated 1239 (95% CI: 844-1578) PM2.5-related deaths were avoided, as were 2777 (95% CI: 1565-3995) PM10-related deaths, 1587 (95% CI: 98-3104) CO-related deaths, 4711 (95% CI: 3649-5781) NO2-related deaths, 215 (95% CI: 116-314) O3-related deaths, and 1088 (95% CI: 774-1421) SO2-related deaths. Based on the reduction in deaths, economic benefits for in PM2.5, PM10, CO, NO2, O3, and SO2 were 1.22, 2.60, 1.36, 4.05, 0.20, and 0.95 billion USD, respectively. Our findings demonstrate the substantial benefits in human health and health-related costs due to improved urban air quality during the COVID lockdown period in China in early 2020.

The Impact of COVID-19 and Quarantine on Suicidality in Geriatric Inpatients-A Case Report.

The mental health burden of COVID-19 and associated quarantine can be enormous for the elderly. Being at higher risk for serious illnesses results in them being further isolated at a time of prolonged social distancing. In the following suicide-attempt cases, we examine the effects of quarantine and a global pandemic that expose the elderly to increased risk for negative mental health outcomes. Examining defense mechanisms and the effects of quarantine may help healthcare professionals better identify individuals at higher risk during times of crises that warrant isolation and quarantine, and provide appropriate interventions.

Excess of all-cause mortality is only partially explained by COVID-19 in Veneto (Italy) during spring outbreak.

BACKGROUND: Italy has been the first European country to be affected by the COVID-19 epidemic which started out at the end of February. In this report, we focus our attention on the Veneto Region, in the North-East of Italy, which is one of the areas that were first affected by the rapid spread of SARS-CoV-2. We aim to evaluate the trend of all-cause mortality and to give a description of the characteristics of the studied population. METHODS: Data used in the analyses were released by the majority of municipalities and cover the 93% of the total population living in the Veneto Region. We evaluated the trend of overall mortality from Jan.01 to Jun.30. 2020. Moreover we compared the COVID-19-related deaths to the overall deaths. RESULTS: From March 2020, the overall mortality rate increased exponentially, affecting males and people aged > 76 the most. The confirmed COVID-19-related death rate in the Veneto region between Mar.01 and Apr.302020 is 30 per 100,000 inhabitants. In contrast, the all-cause mortality increase registered in the same months in the municipalities included in the study is 219 per 100,000 inhabitants. CONCLUSIONS: COVID-19 has a primary role in the increase in mortality but does not entirely explain such a high number of deaths. Strategies need to be developed to reduce this gap in case of future waves of the pandemic.

Temporary reduction in fine particulate matter due to 'anthropogenic emissions switch-off' during COVID-19 lockdown in Indian cities.

The COVID-19 pandemic elicited a global response to limit associated mortality, with social distancing and lockdowns being imposed. In India, human activities were restricted from late March 2020. This 'anthropogenic emissions switch-off' presented an opportunity to investigate impacts of COVID-19 mitigation measures on ambient air quality in five Indian cities (Chennai, Delhi, Hyderabad, Kolkata, and Mumbai), using in-situ measurements from 2015 to 2020. For each year, we isolated, analysed and compared fine particulate matter (PM2.5) concentration data from 25 March to 11 May, to elucidate the effects of the lockdown. Like other global cities, we observed substantial reductions in PM2.5 concentrations, from 19 to 43% (Chennai), 41-53% (Delhi), 26-54% (Hyderabad), 24-36% (Kolkata), and 10-39% (Mumbai). Generally, cities with larger traffic volumes showed greater reductions. Aerosol loading decreased by 29% (Chennai), 11% (Delhi), 4% (Kolkata), and 1% (Mumbai) against 2019 data. Health and related economic impact assessments indicated 630 prevented premature deaths during lockdown across all five cities, valued at 0.69 billion USD. Improvements in air quality may be considered a temporary lockdown benefit as revitalising the economy could reverse this trend. Regulatory bodies must closely monitor air quality levels, which currently offer a baseline for future mitigation plans.

Decrease in Ambient Fine Particulate Matter during COVID-19 Crisis and Corresponding Health Benefits in Seoul, Korea.

Both domestic emissions and transported pollutants from neighboring countries affect the ambient fine particulate matter (PM2.5) concentration of Seoul, Korea. Diverse measures to control the coronavirus disease 2019 (COVID-19), such as social distancing and increased telecommuting in Korea and the stringent lockdown measures of China, may reduce domestic emissions and levels of transported pollutants, respectively. In addition, wearing a particulate-filtering respirator may have decreased the absolute PM2.5 exposure level for individuals. Therefore, this study estimated the acute health benefits of PM2.5 reduction and changes in public behavior during the COVID-19 crisis in Seoul, Korea. To calculate the mortality burden attributable to PM2.5, we obtained residents' registration data, mortality data, and air pollution monitoring data for Seoul from publicly available databases. Relative risks were derived from previous time-series studies. We used the attributable fraction to estimate the number of excessive deaths attributable to acute PM2.5 exposure during January to April, yearly, from 2016 to 2020, and the number of mortalities avoided from PM2.5 reduction and respirator use observed in 2020. The average PM2.5 concentration from January to April in 2020 (25.6 µg/m3) was the lowest in the last 5 years. At least -4.1 µg/m3 (95% CI: -7.2, -0.9) change in ambient PM2.5 in Seoul was observed in 2020 compared to the previous 4 years. Overall, 37.6 (95% CI: 32.6, 42.5) non-accidental; 7.0 (95% CI: 5.7, 8.4) cardiovascular; and 4.7 (95% CI: 3.4, 6.1) respiratory mortalities were avoided due to PM2.5 reduction in 2020. By considering the effects of particulate respirator, decreases of 102.5 (95% CI: 89.0, 115.9) non-accidental; 19.1 (95% CI: 15.6, 22.9) cardiovascular; and 12.9 (95% CI: 9.2, 16.5) respiratory mortalities were estimated. We estimated that 37 lives were saved due to the PM2.5 reduction related to COVID-19 in Seoul, Korea. The health benefit may be greater due to the popular use of particulate-filtering respirators during the COVID-19 crisis. Future studies with daily mortality data are needed to verify our study estimates.

The mortality and psychological burden caused by response to COVID-19 outbreak.

The world is experiencing a severe COVID-19 outbreak. To control this outbreak, many governments in the world have imposed lockdown or quarantine measures. We hypothesize that these measures may cause additional mortality and morbidity in the (near) future due to delay in diagnosing diseases and other indirect effect on health (such as economic crisis). To support this hypothesis and to estimate the additional mortality that may linked to the COVID-19 controlling policy, we performed a step-by-step pragmatical approach. First, we chose a country (The Netherlands), and looked at the most common causes of mortality in this country. Then, we performed a literature study on the additional mortality when these causes were diagnosed late, and selected a paper with the most severe scenario. We also performed a literature study on the effect of economic crisis on additional mortality. The mortality data were then extrapolated to the demography of The Netherlands, and the results were compared with the present data on deaths directly due to COVID-19. Roughly, we forecast 388 additional deaths a week in The Netherlands in 5 years due to the direct and indirect effects of the lockdown measures. The most important implications of this hypothesis is that the additional mortality and increased mental health problem should be considered in evaluating the necessity of lock down and quarantine policy.

COVID-19 pandemic: A global health burden.

Coronavirus disease 2019 (COVID-19) pandemic began in China with a group of severe pneumonia cases, later identified to be caused by the severe acute respiratory syndrome coronavirus 2 in December 2019. Thailand reported the first COVID-19 case outside of China on 13th January 2020, Africa reported its first case in Egypt on 14th February 2020 and Nigeria reported its index case of COVID-19 on 27th February 2020. Virtually, all countries in the world are affected, with over 5 million cases reported globally. A literature search was conducted using publications from academic databases and websites of relevant organisations. The disease is associated with typical and atypical signs and symptoms, mimicking other common illnesses. Nigeria is now in the phase of widespread community transmission as almost all the states have reported confirmed cases. The pandemic has shown a wide range of case-fatality rate (CFR) globally; this is postulated to be related to the demographics, existing health systems and probably other unidentified factors. There has been a steady increase in the burden caused by the disease in Nigeria with a relatively stable CFR, which is lower than the global CFR. Health systems have responded with the guidelines for prevention, management, and surveillance of the disease, while effort is being put in place to find a vaccine and a specific therapy for the cure of the disease. The pandemic has had a severe effect on health systems globally, including an unintended disruption in the service delivery of other diseases. It has the potential to disrupt the weak health system in Nigeria significantly. As such, a combination of non-pharmaceutical preventive measures that are cost-effective needs to be scaled up to prevent it from further weakening the existing health system.