Wastewater-based prediction of COVID-19 cases using a random forest algorithm with strain prevalence data: A case study of five municipalities in Latvia.

Wastewater-based epidemiology (WBE) is a rapid and cost-effective method that can detect SARS-CoV-2 genomic components in wastewater and can provide an early warning for possible COVID-19 outbreaks up to one or two weeks in advance. However, the quantitative relationship between the intensity of the epidemic and the possible progression of the pandemic is still unclear, necessitating further research. This study investigates the use of WBE to rapidly monitor the SARS-CoV-2 virus from five municipal wastewater treatment plants in Latvia and forecast cumulative COVID-19 cases two weeks in advance. For this purpose, a real-time quantitative PCR approach was used to monitor the SARS-CoV-2 nucleocapsid 1 (N1), nucleocapsid 2 (N2), and E genes in municipal wastewater. The RNA signals in the wastewater were compared to the reported COVID-19 cases, and the strain prevalence data of the SARS-CoV-2 virus were identified by targeted sequencing of receptor binding domain (RBD) and furin cleavage site (FCS) regions employing next-generation sequencing technology. The model methodology for a linear model and a random forest was designed and carried out to ascertain the correlation between the cumulative cases, strain prevalence data, and RNA concentration in the wastewater to predict the COVID-19 outbreak and its scale. Additionally, the factors that impact the model prediction accuracy for COVID-19 were investigated and compared between linear and random forest models. The results of cross-validated model metrics showed that the random forest model is more effective in predicting the cumulative COVID-19 cases two weeks in advance when strain prevalence data are included. The results from this research help inform WBE and public health recommendations by providing valuable insights into the impact of environmental exposures on health outcomes.

Barriers and solutions for the integrated care of diabetic patients from the point of view of general practitioners in Latvia.

INTRODUCTION: Ambulatory care sensitive indicators for chronic care patients, such as avoidable hospitalizations and preventable mortality, show worse results in Latvia in comparison with the EU average. Previous studies reveal the situation is not far behind in terms of the quantity of diagnostics and consultations, but it is possible to prevent at least 14% of hospitalizations in the chronic patient group. The aim of this study is to find out the opinions of GPs on the barriers and solutions for better care results for diabetic patients in the context of applying an integrated care approach. METHODS: A qualitative study was conducted in the form of semi-strucured in-depth interviews (5 themes, 18 questions), and analyzed using an inductive thematic analysis. The online interviews were conducted in May and April 2021. The respondents were GPs representing different rural regions (n=26). RESULTS: The results of the study reveal that the main barriers to integrated care are: the workload of GPs, especially in COVID conditions; the limited visit time; the lack of focused informational handouts; long queues for secondary care; and the lack of electronic patient health records (EHRs). GPs point to the need to set up patient EHRs, to develop diabetes training rooms in regional hospitals, and to expand GP practice with a third nurse. DISCUSSION: Special attention should be paid to developing integrated care tools at the healthcare system level and patient data digitization and care of socially isolated and sedentary patients by developing home care services, communication tools and integrating primary, secondary and social care at the regional level.

SARS-CoV-2 seroprevalence among children in Latvia: A cross-sectional study.

Coronavirus disease 2019 (COVID-19) is a major global health concern. In contrast to adults, the course of the disease has been observed to be mild or even asymptomatic in children. It is therefore both clinically and epidemiologically important to measure the seroprevalence in children and adolescents to discern the overall morbidity of the disease and to compare these findings with similar data collected globally. We conducted a cross-sectional study between March and July of 2022 at the Children Clinical University Hospital in Riga, Latvia, to evaluate the seroprevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Participants aged 0 to 18 years were enrolled during hospitalization for reasons other than COVID-19. The levels of SARS-CoV-2 spike protein and nucleocapsid antibodies were measured in blood samples. The possibility of transplacental antibody transport was evaluated by directly interviewing the mothers of participants aged 18 months and younger. Various demographic and epidemiological risk factors and their association with seroprevalence were analyzed. Positive SARS-CoV-2 nucleocapsid antibodies were designated the main criterion for seropositivity. Of 200 enrolled children, 173 were found to be seropositive, resulting in an overall seroprevalence of 86.5%. The highest seroprevalence was detected in children and adolescents aged 12 to 18 years. With the progression of the COVID-19 pandemic, the seroprevalence in children has increased significantly. We found that almost 1-third of seropositive children in our study population were unaware of being previously infected with SARS-CoV-2 due to an asymptomatic course of the disease. Our study findings pertaining to high seropositivity among children and adolescents might be beneficial for public authorities to adapt epidemiological strategies and prevention measures. The high seroprevalence rate reported here and in many other populations around the world suggests that COVID-19 will likely become one of the many seasonal viral infections.

The Course and Surgical Treatment of Acute Appendicitis during the First and Second Wave of the COVID-19 Pandemic: A Retrospective Analysis in University Affiliated Hospital in Latvia.

Background and Objectives: Acute appendicitis is the most common abdominal emergency requiring surgery and it has an estimated lifetime risk of 6.7 to 8.6%. The COVID-19 pandemic has transformed medical care worldwide, influencing diagnostic tactics, treatment modalities and outcomes. Our study aims to compare and analyze management of acute appendicitis before and during the first and second waves of the pandemic. Materials and Methods: Patients suffering acute appendicitis were enrolled retrospectively in a single-center study for a 10-month period before the pandemic (pre-COVID-19 period: 1 March to 31 December 2019) and during the pandemic (COVID-19 period: 1 March to 31 December 2020). The total number of patients, disease severity, diagnostic methods, complications, length of hospitalization and outcomes were analyzed. Results: A total number of 863 patients were included, 454 patients in the pre-COVID-19 period and 409 patients in the COVID-19 period. Compared to the pre-COVID-19 period, the number of complicated appendicitis increased in the COVID-19 period (24.4% to 37.2%; p < 0.001). The proportion of laparoscopic appendectomies increased during the COVID-19 period but did not show statistically significant differences between periods. In both time periods, we found that open technique was the chosen surgical approach more frequently in elderly patients (p < 0.001). Generalized peritonitis was significantly more common during the COVID-19 period (3.5% vs. 6.1%, p < 0.001). The postoperative course of patients was similar in the pre-COVID-19 period and during the COVID-19 period, with no significant differences in ICU admissions, overall hospital stay or morbidity. Conclusions: The COVID-19 pandemic has led to a significant increase in complicated forms of acute appendicitis; however, no significant impact was observed in terms of diagnostic or treatment approach.

Women's perspectives on the quality of maternal and newborn care in childbirth during the COVID-19 pandemic in Latvia: Results from the IMAgiNE EURO study on 40 WHO standards-based quality measures.

OBJECTIVE: To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. METHODS: Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards-based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. RESULTS: 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001). CONCLUSION: This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required. CLINICALTRIALS: gov Identifier:NCT04847336.

A mixed-method study on the provision of remote consultations for non-communicable disease patients during the first wave of the COVID-19 pandemic in Latvia: lessons for the future.

BACKGROUND: The COVID-19 pandemic has challenged the ability of healthcare systems to ensure the continuity of health services for patients with non-communicable diseases (NCDs). The issue of remote consultations has emerged. Before the COVID-19 pandemic, remote consultations were not routinely provided or covered by public health funding in Latvia. This study aimed to describe the dynamics of consultations and the volume of remote consultations provided for patients with particular NCD and explore clinicians' experiences of providing remote consultations during the first wave of the COVID-19 pandemic in Latvia. METHODS: A mixed-method study focusing on the first wave of the COVID-19 pandemic in Latvia in Spring 2020 was conducted. Quantitative data from the National Health Services were analysed to assess the dynamics of consultations for patients with selected NCDs. Qualitative data were collected through 34 semi-structured interviews with general practitioners (GPs) and specialists and were analysed using an inductive thematic analysis. Purposive maximum variation sampling was used for participant selection. RESULTS: During the period with the strongest restrictions of scheduled on-site consultations, a decrease in the total number of consultations was observed for a variety of NCDs. A significant proportion of consultations in this period were provided remotely. GPs provided approximately one-third of cancer-related consultations and almost half of consultations for the other selected conditions remotely. Among specialists, endocrinologists had the highest proportion of remote consultations (up to 72.0%), while urologists had the lowest (16.4%). Thematic analysis of the semi-structured interviews revealed five themes: 1) Adjusting in a time of confusion and fear, 2) Remote consultations: safety versus availability, 3) Sacrifice and loss of privacy, 4) Advantages and disadvantages of communication technologies, and 5) Different form of communication and a health literacy challenge. CONCLUSIONS: During the first wave of the COVID-19 pandemic in Latvia, disruptions to health care services decreased the total number of consultations for patients with NCDs provided by both GPs and specialists. In this period, remote consultations proved to be an important instrument for ensuring the continuity of health care for patients with NCDs, and the necessity to develop a well-designed system for telemedicine in Latvia was highlighted.

Determinants of Anxiety in the General Latvian Population During the COVID-19 State of Emergency.

Background: The COVID-19 pandemic and its restrictive public health measures have seriously affected mental health of society. Social, psychological, and health-related factors have been linked to anxiety in the general population. Aim: We investigate the association of various sociopsychological and health-related determinants of anxiety and identify the predicting factors for anxiety in the general population during the COVID-19 state of emergency from in Latvia. Methods: We conducted an online survey using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Anxiety symptoms were measured using the State-Trait Anxiety Inventory (STAI-S). Sociodemographic, health-related, sociopsychological characteristics and suicidality were identified using the structured questionnaire. The statistical analysis included Pearson's chi-square test, post hoc analysis, and binomial logistic regression. Results: The weighted study sample included 2,608 participants. The mean STAY-S score of the total sample was 22.88 ± 12.25. In the total sample, 15.2% (n = 398) of participants were classified as having anxiety. The odds ratio (OR) of having anxiety was higher in females (OR = 2.44; 95% CI 1.75-3.33) and people who had experienced mental health problems in the past (OR = 1.45; 95% CI 1.03-2.04), had suicide attempt in the past (OR = 1.68; 95% CI 1.08-2.59), were worried about their health status due to COVID-19 (OR = 1.64; 95% CI 1.36-1.16), were worried about stigmatization from others if infected with COVID-19 (OR = 1.18; 95% CI 1.03-1.35), were worried about information regarding COVID-19 from the Internet (OR = 1.24; 95% CI 1.08-1.43), persons who were lonely (OR = 1.90; 95% CI 1.54-2.34), and persons with negative problem orientation (OR = 1.26; 95% CI 1.06-1.51). Protective factors were identified as having good self-rated general health (OR = 0.68, 95 % CI 0.58-0.81), maintaining a daily routine (OR = 0.74, 95 % CI 0.61-0.90), having financial stability (OR = 0.66, 95 % CI 0.55-0.79), and having good psychological resilience (OR = 0.90, 95 % CI 0.87-0.94). Conclusions: This is the first study to report a prevalence of anxiety in the general population of Latvia. Certain factors that predict anxiety, as well as protective factors were identified.

Excess mortality associated with the COVID-19 pandemic in Latvia: a population-level analysis of all-cause and noncommunicable disease deaths in 2020.

BACKGROUND: Age-standardised noncommunicable disease (NCD) mortality and the proportion of the elderly population in Latvia are high, while public health and health care systems are underresourced. The emerging COVID-19 pandemic raised concerns about its detrimental impact on all-cause and noncommunicable disease mortality in Latvia. We estimated the timing and number of excess all-cause and cause-specific deaths in 2020 in Latvia due to COVID-19 and selected noncommunicable diseases. METHODS: A time series analysis of all-cause and cause-specific weekly mortality from COVID-19, circulatory diseases, malignant neoplasms, diabetes mellitus, and chronic lower respiratory diseases from the National Causes of Death Database from 2015 to 2020 was used by applying generalised additive modelling (GAM) and joinpoint regression analysis. RESULTS: Between weeks 14 and 52 (from 1 April to 29 December) of 2020, a total of 3111 excess deaths (95% PI 1339 - 4832) were estimated in Latvia, resulting in 163.77 excess deaths per 100 000. Since September 30, with the outbreak of the second COVID-19 wave, 55% of all excess deaths have occurred. Altogether, COVID-19-related deaths accounted for only 28% of the estimated all-cause excess deaths. A significant increase in excess mortality was estimated for circulatory diseases (68.91 excess deaths per 100 000). Ischemic heart disease and cerebrovascular disease were listed as the underlying cause in almost 60% of COVID-19-contributing deaths. CONCLUSIONS: All-cause mortality and mortality from circulatory diseases significantly increased in Latvia during the first pandemic year. All-cause excess mortality substantially exceeded reported COVID-19-related deaths, implying COVID-19-related mortality during was significantly underestimated. Increasing mortality from circulatory diseases suggests a negative cumulative effect of COVID-19 exposure and reduced access to healthcare services for NCD patients.

Consumption trends of pharmaceuticals and psychoactive drugs in Latvia determined by the analysis of wastewater.

Wastewater-based epidemiology (WBE) was applied to evaluate seasonal variations of the consumption of pharmaceuticals (i.e. antibiotics, NSAIDs, antiepileptics, antihypertensives and others), caffeine, alcohol and nicotine in Latvia throughout 2021. In addition, weekly variation of caffeine, nicotine and alcohol consumption was investigated. Pronounced seasonality was observed in the consumption of antibiotics and decongestants, as well as caffeine, nicotine and alcohol. Correlation with COVID-19 statistics was observed in the case of macrolide antibiotics and antiasthmatic salbutamol. Comparison of the estimated consumption values obtained using the WBE approach and the statistics revealed that the majority of compounds data are in good agreement except angiotensin II receptor blocker group antihypertensives where the most overestimated consumption values were observed.

COVID-19 Lessons and Post-pandemic Recovery: A Case of Latvia.

The decision of EU and the response of the national governments to COVID-19 crisis provide the basis for returning "back to normal". A key challenge is the transition to economic recovery in the presence of the ongoing COVID-19 risk. Adequate policy mix and forward-looking actions of the public institutions are crucial to mitigate the devastating impact of the crisis and to preserve growth. Governments need to facilitate positive changes in the labor market, adjust the macroeconomic and fiscal regimes, and mitigate the post-crisis "fatigue" of societies. The turmoil of the EU economy is symmetrical, as the pandemic has affected all EU Member States, but the impact of the pandemic varies considerably from one country to another, as does their ability to absorb the economic crisis. Also, variation in the vaccination performance is partly due to different institutional characteristics across countries. Small countries are more vulnerable to external economic shocks; however, they can increase their resilience by efficient governance and social response. Extraordinary pandemic crisis can be seen as a stress test for the small and open Latvian economy, and it is worth analyzing the lessons that Latvia had learned and its future prospects. The aim of this paper is to evaluate the economic and social consequences of the ongoing crisis in Latvia, assess the effectiveness of the response of the government to the crisis, analyse people's perceptions, and to identify the future scenarios. The authors applied a special theoretical framework for the assessment of the effectiveness of institutions. Institutional analysis of crises response by the Latvian government reveals that the government managed to avoid serious functional disruptions; however, it failed to show convincing ability to learn by doing. The authors also provide a comprehensive analysis of the macroeconomic trends of the "COVID-sick" Latvian economy and conclude that future-oriented solutions relate to international competitiveness and that the key factor of competitiveness is a productivity renaissance. The pandemic crisis has fostered the state support for healthcare, which in Latvia for decades has been underfinanced. The right choice of fiscal instruments is crucial to accelerate the economic recovery and better healthcare. Research is based on the macroeconomic assessment and survey-based analysis. The comparison of statistically justified findings with the public perception helps formulate conclusions on the future scenarios and policies.

Is It Essential for Occupational Health and Safety Experts to Know the English Language? Results From Several Studies in Latvia.

Background: Poor knowledge of the language has been identified as a barrier to up-to-date occupational safety and health information, however, this question has not been addressed in the context of occupational safety and health expert competence in providing advice for employers in a small, non-English speaking country. Objectives: To analyze the available data on the use of languages for searching professional information by occupational safety and health (OSH) experts, and the sources of information on COVID-19 during the first wave of the pandemic in Latvia, and to assess if the knowledge of the English language among these experts is sufficient to react rapidly and effectively in case of emergency. Methods: Data were compiled from several different sources: three web-based surveys of occupational safety and health experts (data from 2006, 2010, and 2018) and ten focus group discussions with employers and occupational safety and health experts (data from 2020). Results: The results of the surveys show that between 2006 and 2018, the percentage of respondents using only one language (Latvian) for searching professional information in occupational safety and health has increased from 25 to 35.3%. In 2018, the English language was mentioned by only 42.8% of respondents and Russian by 46.8%. During the focus group discussions, the use of English was mentioned for obtaining trustful information from international organizations, for analysis of information received within international companies, for searching international experience, and for finding county-specific information. Discussion: Our study shows that knowledge of the English language for occupational safety and health experts working in Latvia is not sufficient. The companies providing external occupational safety and health services should establish a well-functioning internal training system to provide their non-English speaking experts with up-to-date information. Occupational safety and health-related non-governmental institutions should strengthen their capacity in sharing information related to different occupational safety and health aspects into the national language (Latvian in this particular case).

Transition to the forced telework - a challenge for trade unions identified by the study on working life with COVID-19 in Latvia.

BACKGROUND: In general, companies with trade unions perform better in occupational health and safety, therefore, we assume that these companies should have performed better in transition to healthy and safe telework if compared with other companies. OBJECTIVE: The objective of the study was to assess the role of company trade unions on the implementation of telework arrangements in Latvia during the 1st emergency state in spring 2020 due to the COVID-19 pandemic. METHODS: A web-based survey based on snowball sampling method and social media advertisements was used to gather information from teleworkers. After data cleaning, answers from 422 teleworkers reporting having (wTU) or not having trade unions (nTU) in their companies were included in the analysis. RESULTS: There was a significantly higher percentage of workers with teleworking experience in companies with no trade unions (37.4% nTU versus 18.1% wTU). More respondents from companies with trade unions reported buying a new computer and headphones which means that more persons had to invest their finances to be able to perform their work. Workers from companies with no trade unions were more often advised on home office ergonomics (21.2% wTU versus 28.1% nTU). The odds of all analyzed health problems (pain, sore eyes, and anxiety) were increased in workers who reported having trade unions. CONCLUSION: Companies with trade unions were less ready for the forced transition to teleworking. These results contradict the traditional understanding of trade unions as a promoting factor for a healthy and safe working environment.

Indoor Air Radon Concentration in Premises of Public Companies and Workplaces in Latvia.

Considering the multitudes of people who spend their time working indoors in public premises and workplaces, it is worth knowing what their level of exposure is to natural radioactive radon gas, the second most widespread and dangerous carcinogen for lung cancer development after cigarette smoking. This state-level study covered most of the territory of Latvia and conducted 941 radon measurements with Radtrack2, placed for 4-6 months in the premises of public companies, educational institutions, medical care institutions, etc. The study found that 94.7% of samples did not exceed the national permissible limit (200 Bq/m3), the level at which preventive measures should be initiated. The median value of average specific radioactivity of radon in these premises was 48 Bq/m3 (Q1 and Q3 being 27 and 85 Bq/m3), which is below the average of the European region. Slightly higher concentrations were observed in well-insulated premises with plastic windows and poorer air exchange, mostly in schools (59 (36, 109) Bq/m3) and kindergartens (48 (32, 79) Bq/m3). Industrial workplaces had surprisingly low radon levels (28 (16, 55) Bq/m3) due to strict requirements for air quality and proper ventilation. Public premises and workplaces in Latvia mostly have low radon concentrations in the air, but more attention should be paid to adequate ventilation and air exchange.

Detection of SARS-CoV-2 RNA in wastewater and importance of population size assessment in smaller cities: An exploratory case study from two municipalities in Latvia.

Wastewater-based epidemiology (WBE) has regained global importance during the COVID-19 pandemic. The mobility of people and other factors, such as precipitation and irregular inflow of industrial wastewater, are complicating the estimation of the disease prevalence through WBE, which is crucial for proper crisis management. These estimations are particularly challenging in urban areas with moderate or low numbers of inhabitants in situations where movement restrictions are not adopted (as in the case of Latvia) because residents of smaller municipalities tend to be more mobile and less strict in following the rules and measures of disease containment. Thus, population movement can influence the outcome of WBE measurements significantly and may not reflect the actual epidemiological situation in the respective area. Here, we demonstrate that by combining the data of detected SARS-CoV-2 RNA copy number, 5-hydroxyindoleacetic acid (5-HIAA) analyses in wastewater and mobile call detail records it was possible to provide an accurate assessment of the COVID-19 epidemiological situation in towns that are small (COVID-19 28-day cumulative incidence r = 0.609 and 35-day cumulative incidence r = 0.89, p < 0.05) and medium-sized towns (COVID-19 21-day cumulative incidence r = 0.997, 28-day cumulative incidence r = 0.98 and 35-day cumulative incidence r = 0.997, p < 0.05). This is the first study demonstrating WBE for monitoring COVID-19 outbreaks in Latvia. We demonstrate that the application of population size estimation measurements such as total 5-HIAA and call detail record data improve the accuracy of the WBE approach.

Mental Health and Associated Demographic and Occupational Factors among Health Care Workers during the COVID-19 Pandemic in Latvia.

Background and Objectives: The COVID-19 pandemic has negatively impacted the health care system. Front-line health care workers (HCWs) are at a higher risk of mental health adverse outcomes. The aim of this study was to evaluate the frequency of the symptoms of depression and anxiety and associated demographic and occupational factors among front-line HCWs in Latvia. Materials and Methods: A cross-sectional quantitative study was performed in a population of HCWs during the first wave of the COVID-19 pandemic in Latvia. The participants were interviewed between 28 April 2020 and 2 June 2020. Answers from 864 HCWs were obtained. The participants reported their demographics, work-related information, contacts with COVID-19-positive patients and completed two standardised questionnaires that assessed the symptoms of anxiety (GAD-7) and depression (PHQ-9). The gathered data were analysed by a chi-squared test and binary logistic regression. The data analysis was performed using SPSS v25. Results: A total of 209 (24.8%) participants had depression symptoms and 145 (17.2%) had anxiety symptoms. Health care workers older than 50 had a lower risk of both depression (OR 0.422 (95% CI, 0.262-0.680)) and anxiety (OR 0.468 (95% CI, 0.270-0.813)). General practitioners had more frequent symptoms of depression and anxiety than participants who worked at hospitals (32.8% (n = 63) versus 19.4% (n = 73) and 27.1% (n = 52) versus 10.3% (n = 39), respectively (p = 0.037; p < 0.000)). Working more than 48 h during the week was associated with a higher risk of depression (OR 2.222 (95% CI, 1.315-3.753)) and anxiety (OR 2.416 (95% CI, 1.272-4.586)). Conclusions: The vulnerability of the health care system before the COVID-19 pandemic led to significant mental health adverse outcomes of HCWs during the COVID-19 pandemic in Latvia. A further cohort study is needed to evaluate the dynamics of mental health and other predisposing factors of HCWs.

Lessons learned from the Baltic countries' response to the first wave of COVID-19.

The Baltic countries of Estonia, Latvia, and Lithuania shared a similar response to the first wave of the COVID-19 pandemic. Using the information available on the COVID-19 Health System Response Monitor platform, this article analyzed measures taken to prevent transmission, ensure capacity, provide essential services, finance the health system, and coordinate their governance approaches. All three countries used a highly centralized approach and implemented restrictive measures relatively early, with a state of emergency declared with fewer than 30 reported cases in each country. Due to initially low COVID-19 incidence, the countries built up their capacities for testing, contact tracing, and infrastructure, without a major stress test to the health system throughout the spring and summer of 2020, yet issues with accessing routine health care services had already started manifesting themselves. The countries in the Baltic region entered the pandemic with a precarious starting point, particularly due to smaller operational budgets and health workforce shortages, which may have contributed to their escalated response aiming to prevent transmission during the first wave. Subsequent waves, however, were much more damaging. This article focuses on early responses to the pandemic in the Baltic states highlighting measures taken to prevent virus transmission in the face of major uncertainties.

Parents' Experiences Regarding School Meals during the COVID-19 Pandemic.

The onset of the COVID-19 pandemic required not only the reorientation of learning to remote form but also a change in the form of state-funded school lunches. One of the forms of school catering allowance was food packs, which obligated parents to prepare a warm lunch for the pupil from products included in food packs. As the responsibility for providing a warm lunch for the pupil was transferred to the parents, it was important to understand the parents' experience. The survey was used to gather parents' experiences of school catering allowance received during the pandemic using survey administration software-Google forms; 5166 respondents from different regions of Latvia took part in the survey. The school catering allowance in the form of food packs (83.7%) can be considered successful as over 70% of respondents rated it as positive, giving a rating of 7 (good) or above. Parents from Vidzeme and Latgale had the most positive experience with food packs. The parents appreciated the support they received, stating that it provided a certain sense of security during the crisis. Parental dissatisfaction was related to the composition of food packs, lack of local products and unacceptable products, such as canned meat and fish.

Challenges for Workplace Risk Assessment in Home Offices-Results from a Qualitative Descriptive Study on Working Life during the First Wave of the COVID-19 Pandemic in Latvia.

Epidemiological restrictions due to the COVID-19 pandemic have raised legal and practical questions related to the provision of workplace risk assessment in home offices of teleworkers. The objective of this qualitative study was to analyze practical experience of employers and occupational safety and health experts performing workplace risk assessment in Latvia during the first wave of the COVID-19 pandemic. Our findings suggest that employers have not sufficiently implemented their legal obligations related to workplace risk assessment which can result in an increased number of physical and mental health problems of teleworkers in the short term and in the future. Work from home has shown how different working conditions can be for the same type of work (office work); therefore, the promotion of personalized workplace risk assessment should be encouraged. Even if virtual workplace visits using photos and videos are not the traditional way the workplace risk assessment should be done, it is effective; workers who report that their employers assessed their working conditions report fewer health effects. The experience of workers in participation in workplace risk assessment for telework might change the level and role of worker participation in the management of health and safety hazards at work in general.

Reasons for Low Protection of Vulnerable Workers from COVID-19-Results from the Quantitative and Qualitative Study on Working Life in Latvia.

Several individual factors like older age and chronic diseases have been linked with more severe symptoms often leading to hospitalization and higher mortality from COVID-19. Part of adults with such factors is still active in the workforce. The objective of the study was to identify measures taken by the employer to protect them and to investigate reasons for low protection of vulnerable workers during the 1st wave of the COVID-19 pandemic. Answers from 1000 workers collected via web-survey and results from 10 focus group discussions were analyzed. Only 31.5% of respondents mentioned that their employer had identified existing vulnerable groups and offered specific measures to protect them. Moving vulnerable workers away from the workplace was the most frequent measure (e.g., transfer to the back-office without contact with clients, telework, paid vacations, paid downtime). Most employers do not see elderly workers and workers with chronic diseases as risk groups, thus are not specifically protecting them. Instead, several employers have included workers critical for business continuity in their risk group. Others had not taken measures because of the lack of information due to general data protection regulation. Poor communication and lack of interest of employers to ask their workers if they need special protection is the topic to be addressed at the national level.

Factors related to depression, distress, and self-reported changes in anxiety, depression, and suicidal thoughts during the COVID-19 state of emergency in Latvia.

PURPOSE: Evidence suggests that the 2020 COVID-19 pandemic might have deleterious effects on the population's mental health and psychiatric outcomes. We examined the prevalence of depression, distress, and suicidal thoughts and their association with social and economic factors during the state of emergency in a nationwide representative sample of the general population in Latvia. MATERIALS AND METHOD: An online survey was conducted using a randomized stratified sample of the general adult population in July 2020 for 3 weeks. Distress, depression, suicidal thoughts, and self-reported changes in mental health were identified using a structured questionnaire. The statistical analysis included chi-square tests, analyses of variance, and multivariate forward-stepwise linear regressions. RESULTS: The study sample included 2608 respondents. Clinical depression was present in 5.75% and distress in 7.82%. Suicidal thoughts increased in 13.30% of those with a history of clinical depression, and 27.05% of those with a history of suicidal attempts. The variables that were associated with increases in self-reported anxiety, depressive thoughts, suicidal ideation, and being currently depressed/distressed included lower general health, increased fears of contracting COVID-19 or having family members contract it and die, history of suicidality, increased family conflicts, decreased religiosity, caring for a vulnerable person. Protective factors included positive changes in family relationships and economic situation, maintaining one's basic routine, and having more people living in the household. CONCLUSIONS: Further research and interventions should focus specifically on these factors. The study's findings can help to develop future strategies for management of psychological support for different groups in general population.