Hospitalization among vaccines for SARS-CoV-2 breakthrough infection after dose sparing strategies in Libya: A cohort study.

SARS-CoV-2 infection is widely spread over people, from youth to the elderly. Vaccination against SARS-CoV-2 is an essential preventive measure to help end the SARS-CoV-2 pandemic. A multi-center retrospective cohort study was conducted on patients in Libya who had received single-dose licensed three different types of vaccines (Oxford/AstraZeneca, CoronaVac, or Sputnik-V) and were admitted to healthcare centers with SARS-CoV-2 infection from 30th April to 15th July 2021. In this study, the number of people infected with SARS-COV-2 and the mortality rate from daily reports issued by the National Centers for Disease Control of Libya (NCDC) were collected. Approximately 445000 single doses of the SARS-COV-2 vaccine were administered in Libya from April to July 2021. In corresponding, 39996 people were infected during this period. It has been found that among the people who did not receive any vaccine, the number of patients infected by SARS-COV-2 and admitted to the healthcare centers, and died was (N = 3176 patients (7.94%), and 266 (7.10%) respectively). Compared to 43 (0.10%) of those admitted to healthcare centers who had taken a single dose from one of the licensed vaccines, of which 8 patients (0.02%) died during this period. The documented 23 patients were those who admitted to healthcare centers and got vaccinated with the CoronaVac (Sinovac) vaccine. Fourteen patients received Oxford/AstraZeneca. Only 2 patients received the Sputnik V vaccine. Of the breakthrough infection cases reviewed, 8 patients died. No deaths due to breakthrough infection among Sputnik V vaccinated patients were reported. In conclusion, a single dose of the three different types of the vaccine has significantly reduced virus interpersonal transmission and also showed a decrease in the mortality rate until the tenth week in Libya. The present study demonstrates the extent of the remarkable success of the early rollout of the coronavirus national vaccination campaign.

Clinical characteristics and outcomes among patients with COVID-19: A single-center retrospective observational study from Marj, Libya.

OBJECTIVES: To describe the clinical characteristics and the contributing factors potentially associated with the poorer outcome in Libyan COVID-19 ICU patients. METHODS: The present work is a retrospective, single-center study, which included 94 COVID-19 patients admitted to the Isolation Department at Marj Hospital from August 21st, 2020 till April 30th, 2021. The patients' data, including their medical history, clinical manifestations, radiological imaging, and laboratory findings, were obtained from the hospital records. RESULTS: A higher proportion of the admitted patients were males. The patients' mean age was 68.29 ± 13.64. The patients came with varying symptoms, but most commonly they were affected by dyspnea, fever, cough, and fatigue. Diabetes was the most common underlying comorbidity; nonetheless, other chronic diseases like hypertension, cardiovascular disease, renal disease, and lung diseases individually affected a significant proportion of patients. Although there was no effect of gender on patients' outcomes, age had a significant influence on the disease consequences. CONCLUSION: There was a strong effect of age on ICU admission and patients' surviving the illness. Diabetes was the most common underlying comorbid disease in COVID-19 patients. On admission time, inflammatory markers such as CRP, D-dimer, serum ferritin, and LDH, in common, were the most important indicators of poorer prognosis. Male gender, comorbidity, and symptomology adversely affected the rate of admission but not the patient survival.

Could self-reported symptoms be predictors of RT-PCR positivity in suspected COVID-19 cases? The Libya experience.

Background: COVID-19 has symptoms similar to several other respiratory and non-respiratory diseases, which makes differentiating them a challenging task and could lead to unnecessary use of realtime reverse transcriptase polymerase chain reaction (RT-PCR) resources. Aims: The study aimed to assess self-reported symptoms as predictors for RT-PCR positivity in suspected COVID-19 cases. Methods: This was a cross-sectional study. We retrospectively reviewed the database of COVID-19 care centres in the eastern district of Tripoli, Libya, from May to December 2020. Presenting symptoms and RT-PCR test data were extracted. Results: Of the 4593 subjects, 923 (20.1%) had positive RT-PCR result. Sensitivity for COVID-19 disease diagnosis was very low (≤ 18.2%) for all symptoms, except for myalgia (82.1%). Specificity was high for all symptoms (90.7-99.8%), except for myalgia (11.0%). Loss of taste and smell had the highest positive likelihood ratio (LR) for RT-PCR positivity (LR+ = 3.59, 95% CI: 2.95-4.37). In the multiple logistic regression, three symptoms maintained significant contribution to RT-PCR positivity; these were loss of taste and smell (odds ratio (OR) = 3.90, 95% CI: 3.04-4.99), sore throat (OR = 1.50, 95% CI: 1.02-2.19), and myalgia (OR = 0.65, 95% CI: 0.49-0.85). Other significant predictors were history of contact with a COVID-19 case (OR = 0.50, 95% CI: 0.39-0.62), and being female (OR = 1.33, 95% CI: 1.15-1.55). Conclusion: The findings of this study do not support the use of self-reported symptoms for the confirmation of COVID-19 disease in suspected cases because of their poor diagnostic properties.

Assessment of the non-communicable diseases kit for humanitarian emergencies in Yemen and Libya.

Emergency health kits are a vital way of providing essential medicines and supplies to health clinics during humanitarian crises. The WHO non-communicable diseases (NDCs) kit was developed 5 years ago, recognising the increasing challenge of providing continuity of care and secondary prevention of NCDs and exacerbations, in such settings. Monitoring and evaluation of emergency health kits is an important process to ensure the contents are fit for purpose and to assess usability and utility. However, there are also challenges and limitations in collecting the relevant data to do so.This Practice paper provides a summary of the key methodologies, findings and limitations of NCD kit assessments conducted in Libya and Yemen. Methodologies included a combination of semistructured interviews, surveys with healthcare workers, NCD knowledge tests and quantifying the remaining contents.The kit was able to support the vital delivery of NCD patient care in some complex humanitarian settings and was appreciated by health facilities. However, there were also some challenges affecting kit use. Some kit contents were found to be in greater or lesser quantities than required, and medicine brands and country of origin affected acceptability. Supply chains were affected by the humanitarian situations, with some kits being held up for months prior to arrival. Furthermore, healthcare staff had received limited NCD training and were unable to dispense certain medicines, such as psychotropics, at the primary care level. Further granularity of kit modules, predeployment facility assessments, increased NCD training opportunities and a monitoring system could improve the utility of the kits.

Parents' concerns and attitudes towards school reopening during COVID-19 pandemic: a cross-sectional survey-Tripoli, Libya, 2021.

The issue of school reopening has raised several concerns; therefore, the parent's opinion is essential to consider. This study aimed to evaluate the parent's attitudes and concerns toward school reopening in the COVID-19 era. A cross-sectional survey was performed using in-person self-administered questionnaires, the data was collected in the period between January and April 2021 covering parents' concerns and attitudes toward school reopening. A total of 402 parents participated in the survey. Analysis showed that 56.7% of parents have agreed with school reopening, but 54% have raised some legitimate concerns. Importantly, there was a strong correlation between parents' opinions towards school reopening and their level of education, and their concerns about their children's safety if the school was reopened. Despite parents' concerns, it does seem that slightly over half were in favour of school reopening and would send their children to school only if the schools did apply strict precautions and restriction measures. Sharing parents' views toward school reopening with school leaders and decision-makers is important to assess the feasibility and effectiveness of return to schools and to improve existing prevention programs.

Impact of lockdown due to the COVID-19 pandemic on mental health among the Libyan population.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have a potentially serious effect on mental health and increase the risk of anxiety, depression, and post-traumatic stress disorders in people. In this study, we aimed to determine the prevalence of psychological illness and the impact of the COVID-19 pandemic on the Libyan population's mental health. METHOD: A cross-sectional survey, conducted in both online and paper modes and consisting of five sections, was completed in more than 30 cities and towns across Libya. The first section consisted of questions on basic demographic characteristics. The second section contained a survey related to the lockdown status, activities, related stress levels, and quarantine. The third section comprised the self-administered 9-item Patient Health Questionnaire (PHQ-9). The fourth section contained the 7-item Generalized Anxiety Disorder Scale (GAD-7), and the fifth section contained the Impact of Event Scale-Revised (IES-R). RESULT: Of the 31,557 respondents, 4,280 (13.6%) reported severe depressive symptoms, with a mean [standard deviation (SD)] PHQ-9 score of 8.32 (5.44); 1,767 (5.6%) reported severe anxiety symptoms, with a mean (SD) GAD-7 score of 6 (4.6); and 6,245 (19.8%) of the respondents reported post-traumatic stress disorder (PTSD), with a mean (SD) score of 15.3 (18.85). In multivariate analysis, young age, being female, unmarried, educated, or victims of domestic violence or abuse, work suspension during the pandemic, and having increased workload, financial issues, suicidal thoughts, or a family member with or hospitalized due to COVID-19 were significantly associated with a high likelihood of depressive and anxiety symptoms, as well as PTSD. Internal displacement due to civil war was also associated with PTSD. CONCLUSION: To our knowledge, this is the first study to analyze the psychological impacts of the COVID-19 pandemic and civil war in Libya. Further study on the development of strategies and interventions aimed at reducing the mental disease burden on the Libyan population is warranted.

Humanitarian development peace nexus for health profile: Libya, December 2020

The humanitarian-development-peace nexus (HDPNX) is a new way of working that offers a framework for coherent joined-up planning and implementation of shared priorities between humanitarian development and peacebuilding actors in emergency settings. To advance the HDPNx in a given country a shared foundational understanding of the current situation is needed. However it can be challenging to find such a resource perpetuating poor understanding planning and operationalization. This is one of a series of country profiles that have been developed by WHO to address that need. Each profile provides an overview of health related nexus efforts in the country and will be updated regularly.

Awareness, knowledge, attitudes, and behaviors related to COVID-19 in Libya: a nation-wide online survey.

INTRODUCTION: the World Health Organization declared the COVID-19 outbreak to be a global pandemic in March 2020. However, the pandemic cannot be ended overnight and more social distancing and other self-care measures are needed to protect our communities. Therefore, people´s awareness, knowledge, attitudes, and appropriate behaviors are instrumental to containing the pandemic. The aim of this study was to determine COVID-19 awareness, knowledge, attitudes, and related behaviors in Libya. METHODS: a cross-sectional online survey was conducted from October 10th to November 10th, 2020 in 24 cities in Libya. The participants were non-medical professionals who were living in Libya for at least 2 years and were at least 18 years old. RESULTS: a total of 1018 participants completed the questionnaire, with ages ranging from 18-74 years (Mean ± SD = 33.49±13.24); nearly two-thirds were < 40, and 68.2% were females. Almost half of the participants considered the potential threat of COVID-19 to be low, and one in five reported that they were "Not worried at all" about getting COVID-19. In multivariate analyses, participants who were 40-49 years old, had master´s degrees or higher, and worked in the private sector reflected high mean scores for both knowledge and attitudes, while those who lived in the Eastern or Southern regions had lower mean attitude scores. CONCLUSION: the low levels of awareness as well as the attitudes and behaviors among the public in Libya are worrisome. This study highlighted profound gaps that may put Libyan communities at high risk of a COVID-19 explosion. Therefore, immediate action is needed to address public awareness and attitudes and to improve COVID-19 related behaviors among the Libyan public.

Whole-genome sequencing of SARS-COV-2 showed wide spread of B.1.525 in February 2021 in Libya.

Alpha (B.1.1.7) SARS-COV-2 variant was detected in September 2020 in minks and humans in Denmark and UK. This variant has several mutations in the spike region (S) which could increase the transmissibility of the virus 43-90% over previously circulating variants. The National Center for Disease Control (NCDC) announced on 24 February 2021 a 25% frequency of B.1.1.7 strain in Libya using a reverse-transcriptase quantitative PCR assay. This assay relies on the specific identification of the H69-V70 deletion in S gene which causes its failure of amplification (SGTF). This deletion is not specific for B.1.1.7, but is also characteristic of two other SARS-COV-2 variants. This study aimed to estimate the frequency of B.1.1.7 and identify other variants circulating in Libya in February 2021. We performed whole genome sequencing of 67 positive SARS-COV-2 samples collected on 25 February 2021 in Libya which were also tested by RT-qPCR for SGTF. Our results showed that 55% of samples had mutations specific to B.1.525 strain and only ~3% of samples belonged to B.1.1.7. These findings suggested that B.1.525 was spreading widely in Libya. The use of such RT-qPCR assay, although useful to track some variants, cannot discriminate between variants with H69-V70 deletion. RT-qPCR assays could be multiplexed to identify multiple variants and screen samples prior to sequencing. We emphasize on the need for providing whole-genome sequencing to the main COVID-19 diagnostic laboratories in Libya as well as establishing international collaboration for building capacity and advancing research in this time of the pandemic.

Travel during COVID-19 pandemic in Libya: reasons of travel, disease importation and travel regulations.

Restriction of mobility between countries is an important regulatory measure to combat pandemics such as the coronavirus disease 2019 (COVID-19). Currently, PCR testing is required to enter the Libyan borders. However, no post-travel quarantine is employed. In this report, we briefly discuss travel regulations in Libya during the COVID-19 pandemic and disease importation by travelers. The results showed that almost half of the sample travel because of health care and therapy reasons. Tunisia was the most visited destination mainly for trading and business and receiving healthcare. Importantly, 13% of asymptomatic travelers were SARS-CoV-2 positive. Issues regarding repeated testing among very frequent travelers and variant importation needs to be addressed in a more efficient manner.

Arabic validation and cross-cultural adaptation of the 5C scale for assessment of COVID-19 vaccines psychological antecedents.

BACKGROUND: In the Arab countries, there has not been yet a specific validated Arabic questionnaire that can assess the psychological antecedents of COVID-19 vaccine among the general population. This study, therefore, aimed to translate, culturally adapt, and validate the 5C scale into the Arabic language. METHODS: The 5C scale was translated into Arabic by two independent bilingual co-authors, and then translated back into English. After reconciling translation disparities, the final Arabic questionnaire was disseminated into four randomly selected Arabic countries (Egypt, Libya, United Arab Emirates (UAE), and Saudi Arabia). Data from 350 Arabic speaking adults (aged ≥18 years) were included in the final analysis. Internal consistency was assessed by Cronbach's alpha. Construct validity was determined by concurrent, convergent, discriminant, exploratory and confirmatory factor analyses. RESULTS: Age of participants ranged between 18 to 73 years; 57.14% were females, 37.43% from Egypt, 36.86%, from UAE, 30% were healthcare workers, and 42.8% had the intention to get COVID-19 vaccines. The 5 sub-scales of the questionnaire met the criterion of internal consistency (Cronbach's alpha ≥0.7). The predictors of intention to get COVID-19 vaccines (concurrent validity) were young age and the 5C sub-scales. Convergent validity was identified by the significant inter-item and item-mean score of the sub-scale correlation (P<0.001). Discriminant validity was reported as inter-factor correlation matrix (<0.7). Kaiser-Meyer-Olkin sampling adequacy measure was 0.80 and Bartlett's sphericity test was highly significant (P<0.001). Exploratory factor analysis indicated that the 15 items of the questionnaire could be summarized into five factors. Confirmatory factor analysis confirmed that the hypothesized five-factor model of the 15-item questionnaire was satisfied with adequate psychometric properties and fit with observed data (RMSEA = 0.060, GFI = 0.924, CFI = 0.957, TLI = 0.937, SRMR = 0.076 & NFI = 906). CONCLUSION: The Arabic version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of COVID-19 vaccine among Arab population.

The Epidemiological and Spatiotemporal Characteristics of the 2019 Novel Coronavirus Disease (COVID-19) in Libya.

COVID-19 is a global pandemic that has affected all aspects of life. Understanding its geographical and epidemiological characteristics has become particularly important in controlling the spread of the pandemic. Such studies are lacking in North African countries, particularly in Libya, which has the second largest area of any country in Africa and the longest coast facing Europe. The objectives of this study are to determine the epidemiological parameters and spatiotemporal patterns of COVID-19 and outline strategies for containing the spread and consequences of the pandemic. This comprehensive study included all the confirmed cases of COVID-19 since its emergence in Libya on March 24, 2020 until July 31, 2020. The epidemiological characteristics of COVID-19 were analyzed and the spatial dynamic trends were explored. Regional counts of weekly reported cases were used to characterize the spatial dynamics of COVID-19. A total of 3,695 confirmed cases of COVID-19 were recorded: 2,515 men (68.1%) and 1,180 women (31.9%), with a male-to-female ratio of 2.1:1. Ages ranged between 2 and 78 years. Older patients infected with COVID-19 were at a risk of higher disease severity and mortality. Broad geographic variability and spatiotemporal spread variation of the COVID-19 pandemic in Libya was observed, indicating a significant increase of COVID-19 spread starting in the middle of July 2020, particularly in the western and southern regions, although it was consistently reported in the central and eastern regions as well. Assessing the spatiotemporal dynamics of COVID-19 in the early stages of the epidemic is particularly important in understanding the pandemic spread. Such assessments are essential for designing effective prevention and control programs aimed at reducing the impact of the COVID- 19 pandemic, particularly in countries with limited resources.

The Impact of Armed Conflict on the Epidemiological Situation of COVID-19 in Libya, Syria and Yemen.

Background: Since the Arab uprising in 2011, Libya, Syria and Yemen have gone through major internal armed conflicts. This resulted in large numbers of deaths, injuries, and population displacements, with collapse of the healthcare systems. Furthermore, the situation was complicated by the emergence of COVID-19 as a global pandemic, which made the populations of these countries struggle under unusual conditions to deal with both the pandemic and the ongoing wars. This study aimed to determine the impact of the armed conflicts on the epidemiology of the novel coronavirus (SARS-CoV-2) within these war-torn countries and highlight the strategies needed to combat the spread of the pandemic and its consequences. Methods: Official and public data concerning the dynamics of the armed conflicts and the spread of SARS-COV-2 in Libya, Syria and Yemen were collected from all available sources, starting from the emergence of COVID-19 in each country until the end of December 2020. Datasets were analyzed by a set of statistical techniques and the weekly resolved data were used to probe the link between the intensity levels of the conflict and the prevalence of COVID-19. Results: The data indicated that there was an increase in the intensity of the violence at an early stage from March to August 2020, when it approximately doubled in the three countries, particularly in Libya. During that period, few cases of COVID-19 were reported, ranging from 5 to 53 cases/day. From September to December 2020, a significant decline in the intensity of the armed conflicts was accompanied by steep upsurges in the rate of COVID-19 cases, which reached up to 500 cases/day. The accumulative cases vary from one country to another during the armed conflict. The highest cumulative number of cases were reported in Libya, Syria and Yemen. Conclusions: Our analysis demonstrates that the armed conflict provided an opportunity for SARS-CoV-2 to spread. The early weeks of the pandemic coincided with the most intense period of the armed conflicts, and few cases were officially reported. This indicates undercounting and hidden spread during the early stage of the pandemic. The pandemic then spread dramatically as the armed conflict declined, reaching its greatest spread by December 2020. Full-blown transmission of the COVID-19 pandemic in these countries is expected. Therefore, urgent national and international strategies should be implemented to combat the pandemic and its consequences.

Knowledge, attitude, and acceptance of healthcare workers and the public regarding the COVID-19 vaccine: a cross-sectional study.

BACKGROUND: This study determined the knowledge, attitudes, and practice regarding COVID-19 and assessed the acceptance of the COVID-19 vaccine among healthcare workers and the general population. METHODS: A web-based, cross-sectional study was conducted using convenience sampling in Libya from December 1 to 18, 2020 among the general population and healthcare workers. Data on demographic characteristics, COVID-19 vaccination-related concerns, knowledge, attitudes, and practice regarding COVID-19, and knowledge, attitudes, and acceptance regarding the COVID-19 vaccine were collected using a self-administered survey. A binomial logistic regression was performed with 70% efficacy to determine the association between acceptance of the vaccine and study variables. RESULTS: Valid and complete responses were collected from 15,087 participants. Of these, 6227 (41.3%) were male and 8860 (58.7%) were female, with a mean (SD) age of 30.6 ± 9.8 years. Moreover, 485 (3.2%) participants were infected with COVID-19 at the time of the study, while 2000 (13.3%) had been previously infected. Overall, 2452 (16.3%) participants agreed, and 3127 (20.7%) strongly agreed, with "having concerns about serious vaccine-related complications." Mask-wearing adherence was reported by 10,268 (68.1%) of the participants. Most participants (14,050, 93.1%) believed that the vaccine should be provided for free, while 7272 (48.2%) were willing to buy it. Regarding vaccine acceptance and efficacy, 12,006 (79.6%) reported their willingness to take the vaccine with an efficacy of 90% or more, 9143 (60.6%) with an efficacy of 70% or more, and only 6212 (41.2%) with an efficacy of 50%. The binomial logistic regression revealed that vaccine acceptance was not associated with belonging to the medical field versus the general population. Acceptance was statistically associated with younger age groups, especially 31-40 (OR = 1.3 [1.09, 1.55]) and 41-50 years (OR = 1.29, [1.09, 1.54]). However, having a family member or friend infected with COVID-19 was positively associated with the likelihood of vaccine acceptance (OR = 1.09 [1.02, 1.18]), while having a friend or family member who died due to COVID-19 was negatively associated with it (OR = 0.89 [0.84, 0.97]). CONCLUSIONS: Acceptance of the COVID-19 vaccine is an essential determinant of vaccine uptake and the likelihood of controlling the COVID-19 pandemic. Developing strategies to decrease public hesitation and increase trust is vital for implementing vaccination programs.

Genomic Analysis and Lineage Identification of SARS-CoV-2 Strains in Migrants Accessing Europe Through the Libyan Route.

Many African countries, representing the origin of the majority of refugees, asylum-seekers, and other migrants, toward regions bordering on the Mediterranean area, are experiencing sustained local transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sicily is one of the main entry gates of migrants crossing into Europe. We conducted a pilot study, based on the full-genome sequencing of SARS-CoV-2 strains isolated from migrants coming to Sicily by crossing the Mediterranean Sea, with the aim to investigate the viral genome polymorphism and to describe their genetic variations and the phylogenetic relationships. On June 21, a nongovernmental organization vessel rescued 210 migrants crossing the Mediterranean Sea from Libya to Sicily. Of them, 13.4% tested positive for SARS-CoV-2. Eighteen whole genome sequences were obtained to explore viral genetic variability. All but one of the sequences clustered with other viral African strains within the lineage A, whereas only one intermixed among B.1 lineage genomes. Our findings documented that most of the investigated migrants acquired SARS-CoV-2 infection before landing in Sicily. However, SARS-CoV-2 transmission during travel or in overcrowded Libyan immigrant camps and/or illegal transport boats could not be ruled out. SARS-CoV-2 molecular surveillance on migrants arriving in Europe through the Sicilian gate may improve the knowledge of global SARS-CoV-2 transmission dynamic also in light of the emergence of new variants.