Varying numbers of acute wheezing cases presenting to paediatric emergency during the COVID-19 pandemic

Acute wheezing in children due to underlying asthma or airways hypersensitivity (including allergic rhinitis) can be exacerbated by infectious and non-infectious causes. Of the infectious causes, seasonal rhinoviruses are the most common. Particulate airborne pollutants (PM2.5, PM10) can also play a role. During the COVID-19 pandemic, we observed changes in the pattern of paediatric emergency department (PED) presentations for acute wheezing. In this retrospective observational cohort study, data was extracted for children (0-18 years) presenting to the PED during 2018-2021, whose illness episodes were coded as 'asthma' or 'viral induced wheeze', along with their age, ethnicity, gender, and clinical outcomes, from hospital databases. The Figure shows the number of PED presentations for acute wheezing during 2018-2021, with annotations to explain the changing patterns. The number of cases presenting during the pandemic years 2020-2021 were similar to those in 2018-2019 in the same months, except for April-June 2020, July-August 2020, November 2020 and January-March 2021. Decreases in PED presentations coincided with periods of enforced national and local lockdowns, likely due to parental reluctance to expose their children to SARS-CoV-2 in a hospital setting. In addition, fluctuations in the incidence of rhinovirus infections, as shown by national sentinel surveillance data, likely contributed to changes in case numbers. Higher and lower incidence of rhinovirus infections tended to increase and decrease the number of presentations, respectively. Surprisingly, the level of airborne particulates (PM2.5, PM10) showed no correlation with these PED presentations for acute wheezing.

The Prevalence and Clinical Characteristics of Multidrug-resistant Hospital-acquired Staphylococcus aureus in Medina, Saudi Arabia

Hospital acquired-Staphylococcus aureus (HA-Staphylococcus aureus), particularly methicillin-resistant Staphylococcus aureus (MRSA), are an important source of nosocomial infections with high morbidity and mortality rates. Few reports showed that infections due to HA-Staphylococcus aureus in Saudi Arabia is increasing, particularly infections attributed to HA-MRSA. The study aimed to explore the prevalence and clinical characteristics of HA-Staphylococcus aureus for the first time in Medina, Saudi Arabia. A total of 1262 clinical samples of hospitalized patients were examined for the presence of Staphylococcus aureus through selective culturing on mannitol salt agar. Vitek Compact System and conventional methods were followed to confirm the isolates. Vitek Compact System tested the antimicrobial susceptibility of isolates whereas the standard PCR was employed to detect the genes encoding antimicrobial resistance (mecA and vanA) and virulence factors (tst, et, and LukS-PV). The overall HA-Staphylococcus aureus prevalence was low (6.58%, n = 1262) of which 84.34% (n = 83) were MRSA. Approximately, 57 samples of the 70 MRSA (81.5%) exhibited a multidrug-resistance (MDR) pattern. All the 83 HA-Staphylococcus aureus isolates were negative for the genes encoding toxic shock syndrome toxin, exfoliative toxin, and Panton-Valentine leukocidin. The study was conducted during the Covid-19 pandemic under partial lockdown, restricted hospitalization, and increased disinfection and infection control measures. Therefore, the low prevalence of HA-Staphylococcus aureus should be carefully interpreted and further multicenter investigations could reveal its true incidence in the city. The high prevalence of MDR HA-MRSA is alarming as it highlights inappropriate antibiotic prescriptions to counter staphylococcal infections. HA-Staphylococcus aureus investigated in this study might lack certain virulence factors. However, their MDR traits and invasive nature could worsen the situation if not properly handled. Copyright © 2023 The Author(s).

The Impact of Public Activity Restriction during COVID-19 to Air Quality in Urban Area of Bandung Measured Using Mobile Monitoring

The COVID-19 outbreak impacted the people's lives in the world. Lockdown is one way of controlling the spread of the virus. In Indonesia, the government would rather implement public activity restriction than lockdown. The detailed comprehension of the effect of lockdown or similar policies on air pollution is valuable for making future policies about the control of pandemics as well as its effect on air quality. To understand the effect of public activity restriction (PAR) and its correlation with air pollution, mobile monitoring (MM) of particulate matter (PM2.5) was performed in the urban area of Bandung, Indonesia, in July 2021. Based on MM using a bicycle, we found that a PAR had an impact on air pollution. Our result showed that there was a decrease between 20% and 30% in 3 of 6 sub-districts. The advantage of MM was highlighted by the prominent visualization of the concentration of PM2.5 MM data at the level of the road. Localization of polluted roads could be seen clearly through the MM method. The uncovering effect of PAR on air pollution using the MM method will provide important insights for government and policymakers to develop future policy that controls air pollution for better citizen health. © 2023, AAGR Aerosol and Air Quality Research. All rights reserved.

Effect of restricted emissions during COVID-19 on atmospheric aerosol chemistry in a Greater Cairo suburb: Characterization and enhancement of secondary inorganic aerosol production.

To prevent the rapid spreading of the COVID-19 pandemic, the Egyptian government had imposed partial lockdown restrictions which led emissions reduction. This served as ideal conditions for a natural experiment, for study the effect of partial lockdown on the atmospheric aerosol chemistry and the enhanced secondary inorganic aerosol production in a semi-desert climate area like Egypt. To achieve this objective, SO2, NO2, and PM2.5 and their chemical compositions were measured during the pre-COVID, COVID partial lockdown, and post-COVID periods in 2020 in a suburb of Greater Cairo, Egypt. Our results show that the SO2, NO2, PM2.5 and anthropogenic elements concentrations follow the pattern pre-COVID > post-COVID > COVID partial lockdown. SO2 and NO2 reductions were high compared with their secondary products during the COVID partial lockdown compared with pre-COVID. Although, PM2.5, anthropogenic elements, NO2, SO2, SO4 2-, NO3 -, and NH4 + decreased by 39%, 38-55%, 38%, 32.9%. 9%, 14%, and 4.3%, respectively, during the COVID partial lockdown compared with pre-COVID, with the secondary inorganic ions (SO4 2-, NO3 -, and NH4 +) being the dominant components in PM2.5 during the COVID partial lockdown. Moreover, the enhancement of NO3 - and SO4 2- formation during the COVID partial lockdown was high compared with pre-COVID. SO4 2- and NO3 - formation enhancements were significantly positive correlated with PM2.5 concentration. Chemical forms of SO4 2- and NO3 - were identified in PM2.5 based on their NH4 +/SO4 2- molar ratio and correlation between NH4 + and both NO3 - and SO4 2-. The particles during the COVID partial lockdown were more acidic than those in pre-COVID.

British Society of Paediatric Endocrinology and Diabetes

Aims To review the glycaemic control of type 1 diabetic patients attending the paediatric and transition adolescent diabetes clinic within NHS Lanarkshire during the coronavirus pandemic. Methods A quantitative analysis of 348 patients attending the paediatric and transition adolescent diabetes clinics within NHS Lanarkshire was carried out. Data collected included age, sex, date of diagnosis and insulin delivery device. Comparing these measures to the Scottish Index of Multiple Deprivation (SIMD) of the patient. Patient data was anonymised within a single data collection sheet. Results 94% of patients across both clinics (n=298) attended a consultation during lockdown, before returning to school in August. Within the paediatric diabetes clinic, results from 199 patients were analysed. 30.65% (n=61) patients experienced a rise in their HbA1c over lockdown whilst 65.32% (n=130) of patients reduced their HbA1c. In this cohort, the mean HbA1c before lockdown compared to after lockdown was 3.77mmol/mol (95% CI 1.93, 5.61;P=0.000). 90 sets of patient data were analysed from the transition adolescent diabetes clinic. 27.78% (n=25) of patients had a rise in their HbA1c and whilst patients from this clinic gained tighter glycaemic control over lockdown. The mean HbA1c pre-lockdown compared to post-lockdown in this clinic reduced by 4.67mmol/mol (CI: +1.35, +7.99, P= 0.006). Patients residing in SIMD quintiles 3-5 had the greatest improvement in HbA1c over lockdown. Conclusion Glycaemic control of patients within the NHS Lanarkshire paediatric diabetes clinics improved over lockdown. There was a mean reduction in HbA1c over the lockdown period. Repeating this audit in a year would be beneficial to see how returning to school and further local lockdowns affected the glycaemic control of paediatric patients.

Visual hallucinations caused by Charles Bonnet Syndrome are not impacted by the psychosocial factors resulting from COVID19 restrictions

Purpose : Charles Bonnet Syndrome (CBS) is a poorly understood, debilitating phenomenon following vision loss from common diseases such as age-related macular degeneration and currently has no treatment. Individuals with CBS often experience visual hallucinations in the form of images such as people, landscapes, or patterns that do not exist. This experience is the result of an imbalance between the loss of vision and the active visual brain but is often misdiagnosed as dementia or a mental health condition. Psychosocial factors have been suggested to exacerbate CBS visual hallucinations. The ongoing COVID-19 pandemic has resulted in the implementation of public health safety measures including extended periods of total or partial lockdowns to reduce virus transmission. To date, Canadians have undergone several waves of restrictions that may increase the risk of pervasive psychosocial issues from social isolation. The goal of this research is to assess how the social constraints of the current COVID-19 pandemic may affect CBS visual hallucinations. Methods : We surveyed 39 individuals (M: 69 years, SD: 16 years) with CBS from the CNIB Foundation. Visual hallucinations, anxiety, social isolation, loneliness, and QoL were assessed using: The Specific Psychotic Experiences Questionnaire and modified versions of the Generalized Anxiety Disorder 7 scale, Steptoe Social Isolation Index, DeJong Gierveld Loneliness scale, and the World Health Organization QoL scale, respectively. Results : 90.6% of patients reported no change (increase: 6.3%;decrease: 3.1%) in average duration and 62.2% reported no change (increase: 21.6%;decrease: 16.2%) in frequency of CBS hallucinations. No significant differences were observed in anxiety (p= 0.514);QoL (p= 0.155);social isolation (p= 0.835);and loneliness (p= 0.296) between participants who reported experiencing a change compared no change in hallucinations. Conclusions : The social constraints of the current COVID-19 pandemic measured through anxiety, social isolation, loneliness, and QoL do not affect visual hallucinations caused by CBS. This is consistent with the notion that CBS hallucinations are associated with an active visual cortex following vision loss.

Assessment of the dynamics of urban surface temperatures and air pollution related to COVID-19 in a densely populated City environment in East Java.

The COVID-19 pandemic that has hit the whole world has caused losses in various aspects. Several countries have implemented lockdowns to curb the spread of the SARS-CoV-2 virus that caused death. However, for developing countries such as Indonesia, it is not suitable for lockdown because it considers the economic recession. Instead, the Large-scale Social Restrictions (LSSR) regulation is applied, the same as the partial lockdown. Thus, it is hypothesized that implementing LSSR that limits anthropogenic activities can reduce heat emissions and air pollution. Utilization of remote sensing data such as Terra-MODIS LST and Sentinel-5P images to investigate short-term trends (i.e., comparison between baseline year and COVID-19 year) in surface temperature, Surface Urban Heat Islands Intensity (SUHII), and air pollution such as NO2, CO, and O3 in Malang City and Surabaya City, East Java Province. Spatial downscaling of LST using the Random Forest Regression technique was also carried out to transform the spatial resolution of the Terra-MODIS LST image to make it feasible on a city scale. Raster re-gridding was also implemented to refine the Sentinel-5P spatial resolution. The accuracy of LST spatial downscaling results is quite satisfactory in both cities. Surface temperatures in both cities slightly decreased (below 1 °C) during LSSR was applied (P < 0.05). SUHII in both cities experienced a slight increase in both cities during LSSR. NO2 gas was reduced significantly (P < 0.05) in Malang City (∼38%) and Surabaya City (∼28%) during LSSR phase due to reduced vehicle traffic and restrictions on anthropogenic activities. However, CO and O3 gases did not indicate anomaly during LSSR. Moreover, this study provides insight into the correlation between SUHII change and the distribution of air pollution in both cities during the pandemic year. Air temperature and wind speed are also added as meteorological factors to examine their effect on air pollution. The proposed models of spatial downscaling LST and re-gridding satellite-based air pollution can help decision-makers control local air quality in the long and short term in the future. In addition, this model can also be applied to other ecological research, especially the input variables for ecological spatial modeling.

IMPACT OF THE COVID-19 PANDEMIC ON FECAL IMMUNOCHEMICAL TESTING, COLONOSCOPY SERVICES, AND COLORECTAL NEOPLASIA DETECTION IN A LARGE UNITED STATES COMMUNITY-BASED POPULATION

Background and Aims: The COVID-19 pandemic profoundly impacted clinical services globally, including colorectal cancer (CRC) testing such as fecal immunochemical test (FIT) screening and colonoscopy. We investigated the impact of the pandemic on FIT and colonoscopy utilization, and colorectal neoplasia detection in a large community-based population in the United States. Methods: We performed a retrospective cohort study of patients ages 18-89 years undergoing FIT screening or colonoscopy in 2019 and 2020 within Kaiser Permanente Northern California (KPNC), a large integrated healthcare organization. We calculated percentage changes in FIT kits mailed, FITs completed, positive FITs, colonoscopies performed overall and by indication, and colorectal neoplasia detection (advanced adenoma and CRC) in 2020 compared to 2019. Results: FIT kit mailings ceased in mid- March through April 2020 but rebounded thereafter leading to an 8.7% increase in total FIT kits mailed in 2020 compared to 2019. However, with the later mailing of FIT kits, there were 9.0% fewer FITs completed and 10.1% fewer positive tests in 2020 compared to 2019. Colonoscopy volumes nadired in April 2020, with a 79.4% reduction compared with April 2019, but recovered to near pre-pandemic monthly volumes in September through December 2020. However, overall, there was a 26.9% decline in colonoscopies performed in 2020 compared to 2019. Declines of 41.5%, 38,3%, 19.9%, and 20.0% were seen for screening, surveillance, diagnostic, and FIT positive colonoscopies, respectively, in 2020 compared to 2019. With the gradual recovery of colonoscopy volumes after the initial pandemic lockdown, by November and December 2020 the numbers of patients with advanced adenomas or CRC detected by colonoscopy were comparable to those same months in 2019. However, the total number of patients with advanced adenomas or CRC detected by colonoscopy declined by 26.9% and 8.7%, respectively, in 2020 compared to 2019. Conclusions: The COVID-19 pandemic led to fewer FIT screenings and colonoscopies performed in 2020 compared with 2019. However, after the lifting of regional lockdowns, FIT screenings exceeded, and colonoscopy volumes nearly reached numbers from those same months in 2019. Overall, the pandemic led to 27% and 9% reductions in advanced adenoma and CRC detection, respectively, in 2020 compared to 2019, validating concerns about the potential for stage progression for cancers that went undetected due to the pandemic. Strategies to identify high-risk patients for expedited colonoscopy procedure scheduling and resolve remaining colonoscopy procedure backlogs are needed to mitigate this risk.(Figure Presented)Figure 1. Number of FIT kits mailed, completed, and positive in 2019 and 2020(Figure Presented)Figure 2. Number of colonoscopies and advanced adenomas and colorectal cancers detected by colonoscopy in 2019 and 2020

COVID-19 DID NOT RESULT IN INCREASED HOSPITALIZATION FOR STROKE AND TRANSIENT ISCHEMIC ATTACK: A NATIONWIDE STUDY

Background: The risk of thrombosis increases in infectious diseases, yet observational studies from single centers have shown a decrease in admission of acute ischemic stroke patients during the COVID-19 pandemic. To investigate unselected stroke admission rates, we performed a nationwide study in Denmark. Methods: We extracted information from Danish national health registries. The following mutually exclusive time periods were compared to the year before the lockdown: 1) 1st national lockdown, 2) gradual reopening, 3) few restrictions, 4) regional lockdown, 5) 2nd national lockdown. Results: Generally, admission rates were unchanged during the pandemic. In the unadjusted data, we observed a small decrease in the admission rate for all strokes under the first lockdown (incidence rate ratio: 0.93, confidence interval [CI]: 0.87-0.99) and a slight increase during the periods with gradual reopening, few restrictions, and the regional lockdown driven by ischemic strokes. We found no change in the rate of severe strokes, mild strokes, or 30-day mortality. An exception was the higher mortality for all stroke during the 1st lockdown (risk ratio: crude 1.30 [CI: 1.03-1.59];adjusted 1.17 [CI: 0.93-1.47]). The quality of care remained unchanged. Discussion: In Denmark, stroke admission rates remained largely unchanged during the pandemic. The increased short-term mortality rate in patients admitted with stroke observed during the 1st lockdown probably reflects that the frailest patients were more prone to die in the beginning of the pandemic. It seems unlikely that patients avoided admission, since admission rates for mild strokes and transient ischemic attacks were unchanged.

Relationship between the COVID-19 Pandemic and the Well-Being of Adolescents and Their Parents in Switzerland.

This study is based on two waves of data collected by the Swiss Household panel, the first one in 2019, before the beginning of the COVID-19 pandemic, and the second one in May-June 2020, just after the end of the partial lockdown that was decided by the Swiss government. We considered "couples" of adolescents (age 14-24, mean = 18.82, 51.96% female) and their parents living together (n = 431). Our main goal was to determine whether the evolution of the well-being among adolescents was similar to the evolution of the well-being among parents. Ten indicators of well-being were measured identically in both waves and for both adolescents and their parents. Results indicate that while almost all indicators of well-being decreased during partial lockdown for both adolescents and their parents, adolescents were more strongly impacted than their parents. Furthermore, the change observed in adolescents was virtually unaffected by the change observed in their parents, and vice versa. This research is a reminder that while different population groups may be affected differently by a sudden and extreme event, it is not only older people who will be most affected. Here, adolescents appear to have been more adversely affected than adults.

Thrombosis of Mechanical Mitral Valve Prosthesis Treated With Fibrinolysis

Background: Mechanical prosthetic valve thrombosis is an uncommon but serious complication associated with high mortality and morbidity. Conventionally, prosthetic valve thrombosis is treated with surgical intervention, but recent literature has shown that slow-infusion of low-dose fibrinolytic therapy could be of equal efficacy. Case: A 27-year-old lady presented to the emergency department with a three-week history of worsening shortness of breath on background of mechanical mitral valve replacement for rheumatic mitral stenosis. She had recently been non-compliant with international normalised ratio (INR) checks for warfarin dosing in the setting of local lockdown for the COVID-19 pandemic. Transthoracic echocardiography revealed mechanical mitral valve thrombosis resulting in an immobile medial disc and severely restricted lateral disc, associated with severely elevated mitral inflow gradient (mean 42mmHg at 98 beats per minute) and severe pulmonary hypertension (right ventricular systolic pressure of 92mmHg). After discussion in a multidisciplinary cardiology and cardiothoracic surgical conference, the patient was treated with three daily doses of slow-infusion low-dose fibrinolytic therapy (25mg alteplase over six hours). On day three, there was complete resolution of symptoms, associated with resolution of valve thrombosis on repeat echocardiography. There were no bleeding or embolic complications, and the patient was discharged home three days later. Conclusions: This case highlights the utility of slow-infusion low-dose fibrinolytic therapy in the management of mechanical prosthetic valve thrombosis. This conservative approach may be a useful alternative in patients with high pre-operative surgical risk.

ASSESSING the IMPACT of COVID-19 on PEOPLE with HEMOPHILIA (PWH) AGED ≥40 YEARS and the HTCS THAT CARE for THEM: AN OBSERVATIONAL COHORT STUDY from the ADVANCE WORKING GROUP

Introduction: ADVANCE provides a unique opportunity to compare the rates of infection and outcomes in PWH with the corresponding non-hemophilia populations, to identify any specific issues relating to COVID-19 infection in older PWH and provide guidance on the management of COVID-19 for the broader hemophilia community. Methods: A retrospective and prospective observational cohort study of 3,851 PWH (A/B aged ≥ 40 years registered at 18 ADVANCE Hemophilia Treatment Centers (HTCs) comprising a snapshot (Survey 1A) and a detailed follow-up (Survey 1B) to provide information on patients confirmed with COVID-19 infection from March to November 2020. Results: At the time of data submission, 5 HTCs reported being in their second wave, 12 in national/regional lockdown during a second wave and one center was in their third wave. In the 14 HTCs that completed Survey 1B, there were 26 confirmed COVID-19 cases in PWH aged ≥40 at 8 HTCs, ranging from 0.1-4.3% of the total PWH population at each center: 23 with HA (19 severe) and 3 with severe HB. Diagnosis was confirmed via a PCR test in 13 patients and 13 by nasal swab alone. At diagnosis, 7 patients were aged ≥40 years;9 were ≥50 years, 7 were ≥60 years;2 were ≥70 years;and 1 was ≥80 years. Of the 26 confirmed cases, 7 were hospitalized (2 in the ICU), 1 patient died and 3 have been discharged with ongoing COVID-19-related problems. No patients reported any increase in bleed symptoms. The majority (18/26) of confirmed cases did not have a condition known to increase the risk of severe illness from COVID-19;however, 7 were obese and 4 had diabetes (1 had both). Half the patients had hypertension, which was suggested to put people at increased risk of severe illness from COVID-19. Eight centers reported a negative impact on comorbidity management due to postponement of elective surgeries and specialist appointments, and reduced physical activity leading to muscle atrophy and reduced range of motion. Discussion/Conclusion: Although direct comparisons with the general population are complex and currently unavailable for age groups, it is reassuring that the number of PWH with confirmed COVID-19 is lower or similar to that of the general population (ranging from 5% in Germany to 14% in Slovenia). Further data from this ongoing study will add to our understanding of the impact of COVID-19 in older PWH.

Targeting the Endothelium in the Treatment of COVID-19 Early Clinical Stages: Results of a Randomized Placebo-Controlled Trial

Background: SARS-CoV-2 can induce several vascular endothelial-dependent systemic complications and treatment targeting endothelial cells has been suggested. Sulodexide is a heparin and glycosaminoglycan compound that has pleiotropic properties within the vascular endothelium that can prove beneficial in COVID-19 patients. Aims: We aimed to evaluate the effect of sulodexide when used in the early clinical stages of COVID-19. Methods: In an outpatient setting, we conducted a randomized placebo-controlled trial. Key inclusion criteria were patients within three days of COVID-19 clinical onset and being deemed at high risk (> 50%) of severe clinical disease progression. The risk was assessed using the COVID-19 Health Complication (C19HC) calculator, which clusters the importance of various chronic comorbidities into a percentage value. After inclusion, patients were randomly assigned to receive an oral dose of sulodexide (500 LRU twice a day) or a placebo for 21 days. We performed follow-ups to assess the study endpoints via remote communication with participants or household members every seven days or as deemed necessary. Participants continued the standard of care under the supervision of their healthcare provider's primary physician. The need for hospital care was the primary outcome. Also evaluated, were the need for supplemental oxygen support, D-dimer and C reactive protein (CRP) serum levels, thromboembolic events, and mortality. Physicians responsible to determine the need for hospital care or supplemental oxygen at home were blinded to group allocation. This trial was conducted throughout the regional lockdown caused by the first wave of COVID-19 which caused some unforeseen limitations during the trial. Differences in means were calculated using the Student's t-test, while differences in percentages were assessed using the χ 2 test. Before and after serum levels in the same patients were analyzed using two paired t-tests. If the data were not normally distributed, a Wilcoxon test was used. A Kaplan-Meier curve was used to graphically compare time-to-endpoint for hospital admission and mortality. Results: 312 patients were included in the intent to treat analysis. At 21 days follow-up, 23 of 155 patients required hospitalization in the sulodexide group compared to 38 of 157 in the placebo group [relative risk (RR), 0.6;95% confidence interval (CI), 0.38-0.97;p=0.037]. The benefit persisted with a per-protocol analysis (RR 0.6, p=0.031). Fewer patients required oxygen support in the sulodexide group [39 of 155 vs. 56 of 157;RR, 0.61;95% CI, 0.38 to 0.9;p=0.04], and for fewer days (9 ± 7.2 in the sulodexide group vs. 11.5 ± 9.6 in the placebo group;p=0.02). Mean D-dimer levels at week 2 were significantly higher in the placebo group than in the sulodexide group (p < 0.01). 28 of the 155 patients (18%) in the sulodexide group showed a D-dimer value > 500 ng/dl, compared to 59 out of 157 (37.5%) in the placebo group (RR of 0.48;95% CI of 0.31 to 0.67;p > 0.01). Mean C-reactive protein levels at week 2 were lower in the sulodexide group than in the placebo group (p < 0.01). There was no between-group difference concerning, hospital length of stay, thromboembolic events, major bleeding, or mortality. Conclusions: Early intervention on COVID-19 patients with sulodexide resulted in a reduced need for supplemental oxygen and hospital care. The synergistic activity of sulodexide's antithrombotic and non-antithrombotic effects on different biological targets may play an essential role in limiting disease progression. Added a low risk of bleeding or significant side effects, sulodexide might be an alternative to other oral anticoagulants which makes it a valuable medication in the outpatient treatment of COVID-19. Disclosures: Gonzalez-Ochoa: Alfasigma: Consultancy, Research Funding;servier: Consultancy.

CAM use during the COVID-19 Pandemic: A Population Based International Cross-sectional Survey

Introduction: This study was initiated to determine consultations with health care providers and use of self-management strategies such as herbal remedies, dietary supplements and self-help techniques for prevention and treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic. Methods: Data were collected in April-June 2020 during the first wave of the COVID-19 pandemic. An adapted version of the I-CAM-Q was used in which the categories 'for prevention of COVID-19′ and 'to treat COVID-19-related symptoms were added as reasons for use. Data were collected among a representative sample using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%. Results: Only a very small number of people in any of the three countries consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9%). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively);most commonly used were vitamins and minerals (2.8%) for prevention of COVID-19, primarily vitamin C (1.7%), vitamin D (0.9%), and multivitamins (0.5%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19. No such associations were found for worries about loved ones or the perception that COVID-19 is more dangerous than ordinary influenza. Conclusion: The COVID-19 pandemic does not seem to have evoked a large-scale difference in behaviour related to consultations with health care providers or the use of self-management strategies such as dietary supplements and self-help techniques in any of the three countries, despite different containment and mitigation measures. Keywords: COVID-19;Consultations with health care providers;Self-management

Strategies for COVID-19 Epidemiological Surveillance in India: Overall Policies Till June 2021.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has gripped the entire world, almost paralysing the human race in its entirety. The virus rapidly transmits via human-to-human medium resulting in a massive increase of patients with COVID-19. In order to curb the spread of the disease, an immediate action of complete lockdown was implemented across the globe. India with a population of over 1.3 billion was not an exception and took the challenge to execute phase-wise lockdown, unlock and partial lockdown activities. In this study, we intend to summarise these different phases that the Government of India (GoI) imposed to fight against SARS-CoV-2 so that it can act as a reference guideline to help controlling future waves of COVID-19 and similar pandemic situations in India.

How Covid-19 pandemic and partial lockdown decisions affect air quality of a city? The case of Istanbul, Turkey.

The world is currently struggling with a new type of coronavirus (2019-nCoV) pandemic that first appeared in Wuhan, China, and then spread to almost all countries. As in other countries of the world, public authorities in Turkey are implementing many preventive and mitigating partial lockdown (PL) actions against the virus's effects. Some decisions and policies implemented before and after March 11, 2020, when the first virus case has been identified, have reduced people and traffic circulation, which has also turned into some improvements in air quality. At this point, this study aims to investigate how this pandemic affects the air quality of a metropolis. A case study of the city of Istanbul, the most affected city with more than half of Turkey's cases, is performed. In our analysis, we observe, compare, and discuss the impact of the COVID-19 pandemic and PL decisions on Istanbul city's air quality. We consider the particulate matter (PM10), sulfur dioxide (SO2), carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxide (NO), nitrogen oxides (NOx), and ozone (O3) concentrations. We used data from 19 air monitoring stations (AMSs) and obtained improvements in the air quality for the pandemic period. In summary, the concentration levels in PM10, NO2, NO, and NOx result in a clear decline in pandemic times compared to the normal times in Istanbul. On the other hand, a non-homogenous trend for SO2 and CO concentrations is observed for different AMSs. A partial increase in O2 concentration is obtained in the comparison of before and during the PL period.

COVID-19: Has social isolation reduced the emission of pollutants in the megacity of São Paulo-Brazil?

Abstract: The first case of COVID-19 in Brazil was registered in the city of São Paulo on February 26, 2020; however, restrictive measures and social distancing were only determined in the city on March 17, 2020. A partial lockdown aimed to mitigate the advance of the virus by raising the social isolation rates, by limiting the operation of several services and the mobility of the population. Thus, this study aims to analyze the relationship between the social isolation index in the city of São Paulo and the emission levels of the main air pollutants (PM10, PM2.5, NOx, NO, NO2, SO2 and CO), as well as air temperature. We analyzed the data collected from three urban air quality monitoring stations located in the city center of São Paulo from March 16, 2020 to July 20, 2020. The data for 2020 were compared with those of the previous period in 2020 and the same period in the previous 5 years (2015-2019), and also to the city's official indices of social isolation. The relationships between pollutant concentrations and the social isolation index showed that the decrease in mobility influenced the reduction in air pollution. Pollutants NO2, NOx, NO and CO had the strongest negative associations (Pearson's correlation = - 0.582; 0.481; - 0.433 and - 0.367, respectively). Our results showed that the partial lockdown (from March 17, 2020, to July 20, 2020) had a positive impact on air quality, with a reduction in the emission of pollutants NO (31.75%), NO2 (20.60%), NOx (27.21%) and CO (29.95%). The greatest reductions in the emission of pollutants were observed when the social isolation index reached an average of 52.20%. Small negative fluctuations in the social isolation index broke the most significant reductions observed at the beginning of social isolation.

Evaluating the Psychological Impacts Related to COVID-19 of Vietnamese People Under the First Nationwide Partial Lockdown in Vietnam.

This is the first time in Vietnam that people have undergone "social distancing" to minimize the spreading of infectious disease, COVID-19. These deliberate preemptive strategies may have profound impacts on the mental health of the population. Therefore, this study aimed to identify the psychological impacts of COVID-19 on Vietnamese people and associated factors. We conducted a cross-sectional study during a one-week social distancing and isolation from April 7 to 14, 2020, in Vietnam. A snowball sampling technique was carried out to recruit participants. Impact of Event Scale-Revised (IES-R) was utilized to assess the psychological impacts of the COVID-19. Of all participants, 233 (16.4%) reported low level of PTSS; 76 (5.3%) rated as moderate, and 77 (5.4%) reported extreme psychological conditions. Being female, above 44 years old, or having a higher number of children in the family were positively associated with a higher level of psychological distress. Being self-employed/unemployed/retired was associated with a higher score of intrusion and hyperarousal subscale. Individuals who have a history of touching objects with the possibility of spreading coronavirus (utensils) were related to a higher level of avoidance. There were relatively high rates of participants suffering from PTSS during the first national lockdown related to COVID-19. Comprehensive strategies for the screen of psychological problems and to support high-risk groups are critical, especially females, middle-aged adults and the elderly, affected laborers, and health care professionals.