Media attention and Vaccine Hesitancy: Examining the mediating effects of Fear of COVID-19 and the moderating role of Trust in leadership.

Vaccination has emerged as the most cost-effective public health strategy for maintaining population health, with various social and economic benefits. These vaccines, however, cannot be effective without widespread acceptance. The present study examines the effect of media attention on COVID-19 vaccine hesitancy by incorporating fear of COVID-19 as a mediator, whereas trust in leadership served as a moderator. An analytical cross-sectional study is performed among rural folks in the Wassa Amenfi Central of Ghana. Using a questionnaire survey, we were able to collect 3079 valid responses. The Smart PLS was used to estimate the relationship among the variables. The results revealed that media attention had a significant influence on vaccine hesitancy. Furthermore, the results showed that fear of COVID-19 played a significant mediating role in the relationship between media and vaccine hesitancy. However, trust in leadership had an insignificant moderating relationship on the fear of COVID-19 and vaccine hesitancy. The study suggests that the health management team can reduce vaccine hesitancy if they focus on lessening the negative impact of media and other antecedents like fear on trust in leadership.

Exploring rural inhabitants' perceptions towards food wastage during COVID-19 lockdowns: Implications for food security in Pakistan.

The lessening of food wastage, specifically among nations where about half of its worldwide quantity is produced, has turned to be a mammoth challenge for environmental, social and economic sustainability, and represents one of the seventeen Sustainable Development Goals (SDG) within the Agenda 2030. The quantity of food being thrown away in spite of being in an edible condition has become alarming in middle and high income countries. The COVID-19 lockdown strategy, both at local and international levels, has expressively altered work, life and food consumption behaviors globally, directing to food wastage as a multi sectoral issue. Pakistan has no exception to such manifestations. The main objective of this study is to analyze the perceptions of rural people of Pakistan regarding food wastage during the COVID-19 pandemic. To evaluate whether behavior about food wastage among rural households varied or not during the pandemic, a descriptive survey was carried out using a self-administered questionnaire and 963 responses were selected for further empirical investigations. The findings of the study reveal that food waste actually decreased in spite of an increased amount of purchased food during the lockdown. Our results highlight that the effect of the pandemic has led to reduction in food wastage among rural respondents, an increased consciousness for the morals of food waste, and awareness of environmental impacts of food wastage. The conclusions of this study highlight that rural consumers of Pakistan are emerging with a new level of responsiveness about food wastage with possible positive impact on the environment in terms of decreased greenhouse gas (GHG) emission and other pollutants. The study findings imply that this pandemic time provides a suitable window to raise awareness about food wastage among rural as well as urban households while contemplating effective strategies to overcome the issue of food wastage in the country.

The change of myopic prevalence in children and adolescents before and after COVID-19 pandemic in Suqian, China.

PURPOSE: The aim of this study was to investigate the change of myopic prevalence in students with different demographic characteristics before and after the COVID-19 pandemic in Suqian, China. METHODS: A retrospective, cross-sectional study was conducted. Student data from 52 schools in 2019 and 2020 were collected from the electronic medical records database through cluster sampling. Ophthalmic examinations were conducted on students from September to December in 2019 and 2020. Measurements of uncorrected visual acuity (UCVA) and noncycloplegic autorefraction were included to obtain the spherical equivalent refraction (SER) and prevalence of myopia. The difference in the rate of myopia and SER of students ages 6 to 18 with various demographic characteristics was compared between the two years. RESULTS: Records from 118,479 students in 2019 and the 121,881 students in 2020 were obtained. In 2019 and 2020, the prevalence of overall myopia increased from 43.1% to 48.9% (5.8 percentage point), and a substantial shift in myopic rate occurred in grades 4 to 6 (6.9 percentage point). The change in the prevalence of myopia in girls (5.9 percentage point) was approximately equal to that in boys (5.8 percentage point) and it was more common in rural students (5.9 percentage point) than in urban students (5.1 percentage point). The prevalence of low myopia increased more in children, and the prevalence of moderate myopia increased more in adolescents. The mean spherical equivalent refraction (SER) (-1.34±2.03 D) was lower in 2020 than in 2019 (-1.16±1.92 D), while SER decreased mainly at ages 7 to 15. The SER presented myopic status at the age of 9 (-0.55±1.26 D in 2019, -0.71±1.42 D in 2020), and attained moderate myopia at the age of 15 (-3.06±2.41 D in 2019, -3.22±2.40 D in 2020). CONCLUSIONS: After the COVID-19 pandemic, myopia increased in this population with variable rates of increase in different demographic groups. The change of myopia in children was comparatively greater than that in adolescents. Therefore, we should take measures to prevent and control the development of myopia after the COVID-19 pandemic, especially for younger students.

Predictors of social distancing and hand washing among adults in five countries during COVID-19.

The purpose of this cross-sectional study is to examine disparities in hand washing and social distancing among 2,509 adults from the United States, Italy, Spain, the Kingdom of Saudi Arabia, and India. Respondents were recruited via Qualtrics' participant pool and completed an online survey in the most common language spoken in each country. In hierarchical linear regression models, living in a rural area (ß = -0.08, p = .001), older age (ß = 0.07, p < .001), identifying as a woman (ß = 0.07, p = .001), and greater educational attainment (ß = 0.07, p = .017) were significantly associated with hand washing. Similar results were found regarding social distancing, in which living in a rural area (ß = -0.10, p < .001), country of residence (ß = 0.11, p < .001), older age (ß = 0.17, p < .001), identifying as a woman (ß = 0.11, p < .001), and greater educational attainment (ß = 0.06, p = .019) were significant predictors. Results from the multivariable linear regression models demonstrate more nuanced findings with distinct and significant disparities across the five countries found with respect to hand washing and social distancing. Taken together, the results suggest multiple influencing factors that contribute to existing disparities regarding social distancing and hand washing among adults internationally. As such, more tailored public interventions are needed to promote preventive measures to mitigate existing COVID-related disparities.

Differences in Preventive Behaviors of COVID-19 between Urban and Rural Residents: Lessons Learned from A Cross-Sectional Study in China.

Purpose: The purpose of this study is to examine the differences in preventive behaviors of COVID-19 between urban and rural residents, as well as identify the factors that might contribute to such differences. Methods: Our online survey included 1591 participants from 31 provinces of China with 87% urban and 13% rural residents. We performed multiple linear regressions and path analysis to examine the relationship between rural status and behavioral intention, attitude, subjective norms, information appraisal, knowledge, variety of information source use, and preventive behaviors against COVID-19. Findings: Compared with urban residents, rural residents were less likely to perform preventive behaviors, more likely to hold a negative attitude toward the effectiveness of performing preventive behaviors, and more likely to have lower levels of information appraisal skills. We identified information appraisal as a significant factor that might contribute to the rural/urban differences in preventive behaviors against COVID-19 through attitude, subjective norms, and intention. We found no rural/urban differences in behavioral intention, subjective norms, knowledge about preventive behaviors, or the variety of interpersonal/media source use. Conclusions: As the first wave of the pandemic inundated urban areas, the current media coverage about COVID-19 prevention may not fully satisfy the specific needs of rural populations. Thus, rural residents were less likely to engage in a thoughtful process of information appraisal and adopt the appropriate preventive measures. Tailoring health messages to meet rural populations' unique needs can be an effective strategy to promote preventive health behaviors against COVID-19.

Exploring the impact of COVID-19 on women's alcohol use, mental health, and experiences of intimate partner violence in Wakiso, Uganda.

INTRODUCTION: Uganda confirmed its first COVID-19 case in March 2020, leading to country-wide closures and a stay-at-home order. Infectious disease pandemics can overwhelm adaptive coping capacity (e.g., general self-efficacy and resilience) and increase the risk for mental distress. For individuals experiencing intimate partner violence (IPV) and cohabitating with a perpetrator, stay-at-home orders can also increase risk of violence, which can further exacerbate mental distress. The present study explores women's perceived self-efficacy and resilient coping, mental health outcomes (depression and COVID-19 related anxiety), hazardous alcohol use and IPV in the context of Uganda's national 2020 lockdown. METHODS: A phone-based survey was undertaken from June-August of 2020 in Wakiso District, Uganda. The study sample consisted of Africa Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (APHS) study participants who agreed to be contacted for future research. The analytic sample was restricted to women aged 13-80 years. Bivariate analysis and multivariable models explored associations between experiences of IPV and measures of adaptive coping, mental health and alcohol use. RESULTS: A total of 556 women aged 13-79 years (mean age of 33.4 years) participated. Over half (55%) were currently married. The majority (60%) reported a decrease in alcohol use during the lockdown. Nearly half of the sample were experiencing physical or verbal IPV and reported an increase in violence during the lockdown. In adjusted analysis, alcohol use was associated with four times greater odds of recent physical IPV (aOR 4.06, 95% CI = 1.65-10.02, p = 0.0024), while participants had lower odds of experiencing any form of IPV as general self-efficacy increased (aOR 0.95, 95% CI = 0.91-0.99, p = 0.0308). CONCLUSION: Lockdown measures in Uganda may have mitigated increased alcohol consumption. IPV was exacerbated during lockdown; more than 2 in 5 IPV victims experienced increased physical or verbal violence. Development of programming and policies aimed at mitigating women's risk of IPV during future lockdowns are needed.

Disability-adjusted life years (DALYs) due to the direct health impact of COVID-19 in India, 2020.

COVID-19 has affected all countries. Its containment represents a unique challenge for India due to a large population (> 1.38 billion) across a wide range of population densities. Assessment of the COVID-19 disease burden is required to put the disease impact into context and support future pandemic policy development. Here, we present the national-level burden of COVID-19 in India in 2020 that accounts for differences across urban and rural regions and across age groups. Input data were collected from official records or published literature. The proportion of excess COVID-19 deaths was estimated using the Institute for Health Metrics and Evaluation, Washington data. Disability-adjusted life years (DALY) due to COVID-19 were estimated in the Indian population in 2020, comprised of years of life lost (YLL) and years lived with disability (YLD). YLL was estimated by multiplying the number of deaths due to COVID-19 by the residual standard life expectancy at the age of death due to the disease. YLD was calculated as a product of the number of incident cases of COVID-19, disease duration and disability weight. Scenario analyses were conducted to account for excess deaths not recorded in the official data and for reported COVID-19 deaths. The direct impact of COVID-19 in 2020 in India was responsible for 14,100,422 (95% uncertainty interval [UI] 14,030,129-14,213,231) DALYs, consisting of 99.2% (95% UI 98.47-99.64%) YLLs and 0.80% (95% UI 0.36-1.53) YLDs. DALYs were higher in urban (56%; 95% UI 56-57%) than rural areas (44%; 95% UI 43.4-43.6) and in men (64%) than women (36%). In absolute terms, the highest DALYs occurred in the 51-60-year-old age group (28%) but the highest DALYs per 100,000 persons were estimated for the 71-80 years old age group (5481; 95% UI 5464-5500 years). There were 4,815,908 (95% UI 4,760,908-4,924,307) DALYs after considering reported COVID-19 deaths only. The DALY estimations have direct and immediate implications not only for public policy in India, but also internationally given that India represents one sixth of the world's population.

Nationally representative SARS-CoV-2 antibody prevalence estimates after the first epidemic wave in Mexico.

Seroprevalence surveys provide estimates of the extent of SARS-CoV-2 infections in the population, regardless of disease severity and test availability. In Mexico in 2020, COVID-19 cases reached a maximum in July and December. We aimed to estimate the national and regional seroprevalence of SARS-CoV-2 antibodies across demographic and socioeconomic groups in Mexico after the first wave, from August to November 2020. We used nationally representative survey data including 9,640 blood samples. Seroprevalence was estimated by socioeconomic and demographic characteristics, adjusting by the sensitivity and specificity of the immunoassay test. The national seroprevalence of SARS-CoV-2 antibodies was 24.9% (95%CI 22.2, 26.7), being lower for adults 60 years and older. We found higher seroprevalence among urban and metropolitan areas, low socioeconomic status, low education and workers. Among seropositive people, 67.3% were asymptomatic. Social distancing, lockdown measures and vaccination programs need to consider that vulnerable groups are more exposed to the virus and unable to comply with lockdown measures.

Anxiety among urban, semi-urban and rural school adolescents in Dhaka, Bangladesh: Investigating prevalence and associated factors.

BACKGROUND: Anxiety disorder is one of the emerging public health problems in many low- and middle-income countries (LMICs). Likewise, in Bangladesh, a growing number of adolescents are experiencing such symptoms though we have very limited research evidence available. The purpose of this study was to investigate the prevalence of anxiety and the factors associated with this condition among urban, semi-urban, and rural school adolescents in Bangladesh. METHODS: This cross-sectional study used a two-stage cluster sampling procedure. A self-administered questionnaire was conveyed to 2355 adolescents from nine secondary schools of Dhaka, Bangladesh. Of the respondents, 2313 completed the seven-item Generalized Anxiety Disorder (GAD-7). Besides, sociodemographic information, self-reported body image as well as modification of Leisure Time Exercise Questionnaire (LTEQ) and WHO Global PA Questionnaire (GPAQ) were used to determine the sociodemographic and lifestyle factors associated with anxiety among adolescents. RESULTS: A total of 20.1% of adolescents were experiencing moderate to severe anxiety; of them, a significantly higher proportion (49.9%) of female adolescents were suffering more than males (40.1%). Furthermore, age, student's grade, father's educational level, number of family members, and residential setting were found to be significantly associated with anxiety among adolescents. In terms of lifestyle factors, irregular physical activity (AOR: 1.31; 95% CI: 1.05-1.63), high screen time (AOR: 1.51; 95% CI:1.21-1.88), sleep dissatisfaction (AOR: 3.79; 95% CI: 3.02-4.76), and underweight body image (AOR: 2.37; 95% CI:1.70-3.28) were found to be significantly associated with anxiety among school adolescents of urban, semi-urban, and rural residential settings. CONCLUSIONS: Anxiety is prevalent among urban, semi-urban, and rural school adolescents in Dhaka, Bangladesh. To lessen this prevalence of anxiety among Bangladeshi adolescents, evidence-based health programs- healthy school trials-and policies should therefore be taken based on the findings of this study.

COVID-19 in a remote First Nations community in British Columbia, Canada: an outbreak report.

BACKGROUND: In April 2020, British Columbia experienced its first outbreak of COVID-19 in a remote First Nations community. The objective of this paper was to describe the outbreak, including epidemiological and laboratory findings, and the public health response. METHODS: This report summarizes an outbreak of COVID-19 on Cormorant Island, British Columbia, in March and April 2020. Confirmed cases underwent investigation and contact tracing. Supports were provided to ensure successful isolation and quarantine for cases and contacts. Messaging to the community was circulated by trusted community members. Descriptive and social network analyses were conducted to describe the outbreak as it evolved. All case specimens underwent whole-genome sequencing. RESULTS: Thirty cases of SARS-CoV-2 infection were identified. Those infected had a median age of 34 years (range 15-77), and the majority identified as female (19, 63%) and as First Nations (27, 90%). The most common symptoms included chills, cough, diarrhea, headache and fever. Five people were hospitalized (17%) and 1 died (3%). Percent positivity in the community was 18%. Transmission occurred primarily during evening social gatherings and within households. Two weeks after control measures were initiated, no further cases were identified. All cases were genetically related by 2 single nucleotide polymorphisms or fewer, and they belonged to the most dominant SARS-CoV-2 lineage present in British Columbia in April 2020. INTERPRETATION: A community-led response was essential for the effective containment of this outbreak that included 30 cases, preventing onward transmission of the virus. Lessons learned from the management of this outbreak can inform response to other similar outbreaks in First Nations communities across Canada.

High SARS-CoV-2 Seroprevalence in Rural Peru, 2021: a Cross-Sectional Population-Based Study.

Latin America has been severely affected by the COVID-19 pandemic. The COVID-19 burden in rural settings in Latin America is unclear. We performed a cross-sectional, population-based, random-selection SARS-CoV-2 serologic study during March 2021 in the rural population of San Martin region, northern Peru. In total, 563 persons from 288 houses across 10 provinces were enrolled, reaching 0.2% of the total rural population of San Martin. Screening for SARS-CoV-2 IgG antibodies was done using a chemiluminescence immunoassay (CLIA), and reactive sera were confirmed using a SARS-CoV-2 surrogate virus neutralization test (sVNT). Validation of the testing algorithm using prepandemic sera from two regions of Peru showed false-positive results in the CLIA (23/84 sera; 27%) but not in the sVNT, highlighting the pitfalls of SARS-CoV-2 antibody testing in tropical regions and the high specificity of the two-step algorithm used in this study. An overall 59.0% seroprevalence (95% confidence interval [CI], 55 to 63%) corroborated intense SARS-CoV-2 spread in San Martin. Seroprevalence rates between the 10 provinces varied from 41.3 to 74.0% (95% CI, 30 to 84%). Higher seroprevalence was not associated with population size, population density, surface area, mean altitude, or poverty index in Spearman correlations. Seroprevalence and reported incidence diverged substantially between provinces, suggesting regional biases of COVID-19 surveillance data. Potentially, limited health care access due to environmental, economic, and cultural factors might lead to undetected infections in rural populations. Additionally, test avoidance to evade mandatory quarantine might affect rural regions more than urban regions. Serologic diagnostics should be pursued in resource-limited settings to inform country-level surveillance and vaccination strategies and to support control measures for COVID-19. IMPORTANCE Latin America is a global hot spot of the COVID-19 pandemic. Serologic studies in Latin America have been mostly performed in urban settings. Rural populations comprise 20% of the total Latin American population. Nevertheless, information on COVID-19 spread in rural settings is scarce. Using a representative population-based seroprevalence study, we detected a high seroprevalence in rural populations in San Martin, northern Peru, in 2021, reaching 41 to 74%. However, seroprevalence and reported incidence diverged substantially between regions, potentially due to limited health care access or test avoidance due to mandatory quarantine. Our results suggest that rural populations are highly affected by SARS-CoV-2 even though they are sociodemographically distinct from urban populations and that highly specific serological diagnostics should be performed in resource-limited settings to support public health strategies of COVID-19 control.

The Impact of the COVID-19 Epidemic on Older Adults in Rural and Urban Areas in Mexico.

OBJECTIVES: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. METHOD: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. RESULTS: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). DISCUSSION: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.

COVID-19 vaccine demand, hesitancy, and nationalism: a case of protection motivation behavior in Bangladesh.

INTRODUCTION: Immunization, as a process of fighting against the COVID-19, has gained important research appeal, but very limited endeavor has been paid for vaccine behavioral studies in underdeveloped and developing countries. This study explores the vaccine demand, hesitancy, and nationalism as well as vaccine acceptance and domestic vaccine preference among young adults in Bangladesh. METHODOLOGY: This quantitative study followed the snowball sampling technique and collected responses from 1,018 individuals from various social media platforms. The analysis covered both descriptive and inferential statistics including chi-square, F-statistic, and logistic regression. RESULTS: The findings of the fully-adjusted regression model suggest that the individuals who had more vaccine demand were 3.29 times (95% confidence interval = 2.39-4.54; p < 0.001) higher to accept vaccine compared to those who had no vaccine demand. Conversely, vaccine hesitancy was negatively associated with vaccine acceptance. Here, the odds ratio was found 0.70 (95% confidence interval = 0.62-0.80; p < 0.001), which means that those who had higher vaccine hesitancy were about 30% less likely to accept vaccines than those who had no hesitancy. In addition, the persons who had vaccine nationalism were 1.75 times (95% confidence interval = 1.62-1.88; p < 0.001) more prone to prefer domestic vaccine. CONCLUSIONS: This study suggests that policymakers may take initiatives for making people aware and knowledgeable about the severity and vulnerability to specific health threats. In this concern, perception and efficacy-increasing programs may take part in increasing protection motivation behaviors like vaccine acceptance and (domestic) vaccine preference.

Qualitative Accounts of School-Aged Children's Diets during the COVID-19 Pandemic in Rural, Central, Kenya.

The COVID-19 pandemic has caused disruption to food security in many countries, including Kenya. However, the impact of this on food provision to children at an individual level is unknown. This small study aimed to provide a qualitative snapshot of the diets of children during the COVID-19 pandemic. During completion of 24-h food recalls, with 15 families with children aged 5-8 years, caregivers were asked about changes they had made to foods given to their children due to the pandemic. Food recalls were analysed to assess nutrient intakes. Qualitative comments were thematically analysed. Most of the families reported making some changes to foods they provided to their children due to COVID-19. Reasons for these changes fell into three themes, inability to access foods (both due to formal restriction of movements and fear of leaving the house), poorer availability of foods, and financial constraints (both decreases in income and increases in food prices). The COVID-19 pandemic has affected some foods parents in rural Kenya can provide to their children.

Characterizing human mobility patterns in rural settings of sub-Saharan Africa.

Human mobility is a core component of human behavior and its quantification is critical for understanding its impact on infectious disease transmission, traffic forecasting, access to resources and care, intervention strategies, and migratory flows. When mobility data are limited, spatial interaction models have been widely used to estimate human travel, but have not been extensively validated in low- and middle-income settings. Geographic, sociodemographic, and infrastructure differences may impact the ability for models to capture these patterns, particularly in rural settings. Here, we analyzed mobility patterns inferred from mobile phone data in four Sub-Saharan African countries to investigate the ability for variants on gravity and radiation models to estimate travel. Adjusting the gravity model such that parameters were fit to different trip types, including travel between more or less populated areas and/or different regions, improved model fit in all four countries. This suggests that alternative models may be more useful in these settings and better able to capture the range of mobility patterns observed.

The evolution trend of availability of China's community-based care services and its impact on the cognitive function of elderly people: 2008-2018.

BACKGROUND: To address the challenge of the aging population, community-based care services (CBCS) have been developed rapidly in China as a new way of satisfying the needs of elderly people. Few studies have described the evolution trend of availability of CBCS in rural and urban areas and evaluated their effectiveness. This study aims to show the availability of China's CBCS and further analyze the effect of the CBCS on the cognitive function of elderly people. METHODS: Longitudinal analysis was performed using data from the 2008 to 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 23937 observations from 8421 elderly people were included in the study. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. We aggregated similar CBCS to generate three binary variable categories (daily life support, emotional comfort and entertainment services, medical support and health services) indicating the availability of CBCS (1 = yes, 0 = no). Multilevel growth models were employed to estimate the association between CBCS and cognitive function while adjusting for many demographic and socioeconomic characteristics. RESULTS: The availability of CBCS increased a lot from 2008 to 2018 in China. Although the availability of CBCS in urban areas was higher than that in rural areas in 2008, by 2018 the gap narrowed significantly. Emotional comfort and entertainment services (B = 0.331, 95% CI = 0.090 to 0.572) and medical support and health services (B = 1.041, 95% CI = 0.854 to 1.228) were significantly and positively associated with cognitive function after adjusting for the covariates. CONCLUSION: There was a significant increase in the availability of CBCS from 2008 to 2018 in China. This study sheds light on the positive correlation between CBCS and cognitive function among Chinese elderly individuals. The results suggest that policymakers should pay more attention to the development of CBCS and the equity of the supply of CBCS in urban and rural areas.

Modelling COVID-19 severity in the Republic of Ireland using patient co-morbidities, socioeconomic profile and geographic location, February to November 2020.

Understanding patient progression from symptomatic COVID-19 infection to a severe outcome represents an important tool for improved diagnoses, surveillance, and triage. A series of models have been developed and validated to elucidate hospitalization, admission to an intensive care unit (ICU) and mortality in patients from the Republic of Ireland. This retrospective cohort study of patients with laboratory-confirmed symptomatic COVID-19 infection included data extracted from national COVID-19 surveillance forms (i.e., age, gender, underlying health conditions, occupation) and geographically-referenced potential predictors (i.e., urban/rural classification, socio-economic profile). Generalised linear models and recursive partitioning and regression trees were used to elucidate COVID-19 progression. The incidence of symptomatic infection over the study-period was 0.96% (n = 47,265), of whom 3781 (8%) required hospitalisation, 615 (1.3%) were admitted to ICU and 1326 (2.8%) died. Models demonstrated an increasingly efficacious fit for predicting hospitalization [AUC 0.816 (95% CI 0.809, 0.822)], admission to ICU [AUC 0.885 (95% CI 0.88 0.89)] and death [AUC of 0.955 (95% CI 0.951 0.959)]. Severe obesity (BMI ≥ 40) was identified as a risk factor across all prognostic models; severely obese patients were substantially more likely to receive ICU treatment [OR 19.630] or die [OR 10.802]. Rural living was associated with an increased risk of hospitalization (OR 1.200 (95% CI 1.143-1.261)]. Urban living was associated with ICU admission [OR 1.533 (95% CI 1.606-1.682)]. Models provide approaches for predicting COVID-19 prognoses, allowing for evidence-based decision-making pertaining to targeted non-pharmaceutical interventions, risk-based vaccination priorities and improved patient triage.

SARS-CoV-2 RNA in Swabbed Samples from Latrines and Flushing Toilets: A Case-Control Study in a Rural Latin American Setting.

Information about factors potentially favoring the spread of SARS-CoV-2 in rural settings is limited. Following a case-control study design in a rural Ecuadorian village that was severely struck by the pandemic, SARS-CoV-2 RNA were detected by real-time PCR in swabs obtained from inner and upper walls in 24/48 randomly selected latrines from case-houses and in 12/48 flushing toilets from paired control-houses (P = 0.014; McNemar's test). This association persisted in a conditional logistic regression model adjusted for relevant covariates (OR: 4.82; 95% CI: 1.38-16.8; P = 0.014). In addition, SARS-CoV-2-seropositive subjects were more often identified among those living in houses with a latrine (P = 0.002). Latrines have almost five times the odds of containing SARS-CoV-2 RNA than their paired flushing toilets. Latrines are reservoirs of SARS-CoV-2 RNA, and it cannot be ruled out that latrines could contribute to viral transmission in rural settings. Frequent disinfection of latrines should be recommended to reduce the likelihood of fecal contamination.