Contextually appropriate communication strategies for COVID-19 prevention in Kenya border regions: evidence from a mixed methods observational study in Busia and Mandera counties.

OBJECTIVES: Kenya has long and porous borders with its neighbouring countries. These regions, predominantly inhabited by highly mobile rural communities with strong cross-border cultural ties, present major challenges in managing movement of people and COVID-19 preventive measures. Our study sought to assess knowledge of COVID-19 prevention behaviours, how these varied by socioeconomic (SEC) factors and the challenges of engagement and implementation, in two border counties of Kenya. METHODS: We conducted a mixed methods study using a household e-survey (Busia, N=294; Mandera, N=288; 57% females, 43% males), and qualitative telephone interviews (N=73: Busia 55; Mandera 18) with policy actors, healthcare workers, truckers and traders, and community members. Interviews were transcribed, English translated and analysed using the framework method. Associations between SEC (wealth quintiles, educational level) and knowledge of COVID-19 preventive behaviours were explored using Poisson regression. RESULTS: Participants were mostly educated to primary school level (54.4% Busia, 61.6% Mandera). Knowledge of COVID-19 prevention varied by behaviour: hand washing-86.5%, use of hand sanitiser-74.8%, wearing a face mask-63.1%, covering the mouth when sneezing or coughing-56.3% and social distancing-40.1%. Differences in knowledge by area, educational level and the wealth index were marked, greatest for Mandera, the less educated and the poor. Interviews with stakeholders revealed challenges in health messaging, psychosocial and socioeconomic factors, lack of preparedness for truck border crossings, language barrier, denial and livelihood insecurity as key challenges to engagement with and implementation of COVID-19 prevention behaviours in the border regions. CONCLUSION: The influence of SEC disparities and border dynamics on knowledge and engagement with COVID-19 prevention behaviours calls for contextually appropriate risk communication strategies that are cognisant of community needs and local patterns of information flow. Coordinating response measures across border points is crucial in winning communities' trust and maintaining essential economic and social activities.

Dynamics of anti-S IgG antibodies titers after the second dose of COVID 19 mRNA and non-mRNA vaccines in the manual and craft worker population of Qatar (preprint)

Background: There is limited sero epidemiological evidence on the magnitude and long-term durability of antibody titers of mRNA and non-mRNA vaccines in the Qatari population. This study was conducted to generate evidence on long-term anti-S IgG antibodies titers and their dynamics in individuals who have completed a primary COVID-19 vaccination schedule. Methods: A total of 300 participants who received any of the following vaccines BNT162b2/Comirnaty or mRNA-1273 or ChAdOx1-S/Covishield or COVID-19 Vaccine Janssen/Johnson or BBIBP-CorV or Covaxin were enrolled in our study. All sera samples were tested by chemiluminescent microparticle immunoassay (CMIA) for the quantitative determination of IgG antibodies to SARS-CoV-2, receptor-binding domain (RBD) of the S1 subunit of the spike protein of SARS-CoV-2. Antibodies against SARS-CoV-2 nucleocapsid (SARS-CoV-2 N-protein IgG) were also determined. Kaplan-Meier survival curves were used to compare the time from the last dose of the primary vaccination schedule to the time by which anti-S IgG antibodies titers fell into the lowest quartile (range of values collected) for the mRNA and non-mRNA vaccines. Results: Participants vaccinated with mRNA vaccines had higher median anti-S IgG antibody titers. Participants vaccinated with the mRNA-1273 vaccine had the highest median anti-S-antibody level of 13720.9 AU/mL (IQR 6426.5 to 30185.6 AU/mL) followed by BNT162b2 (median, 7570.9 AU/ml; IQR, 3757.9 to 16577.4 AU/mL); while the median anti-S antibody titer for non-mRNA vaccinated participants was 3759.7 AU/mL (IQR, 2059.7-5693.5 AU/mL). The median time to reach the lowest quartile was 3.53 months (IQR, 2.2-4.5 months) and 7.63 months (IQR, 6.3-8.4 months) for the non-mRNA vaccine recipients and Pfizer vaccine recipients, respectively. However, more than 50% of the Moderna vaccine recipients did not reach the lowest quartile by the end of the follow-up period. Conclusions: This evidence on anti-S IgG antibody titers, their durability and decay over time should be considered for the utility of these assays in transmission dynamics after the full course of primary vaccination.

Attitudes toward Receiving COVID-19 Booster Dose in the Middle East and North Africa (MENA) Region: A Cross-Sectional Study of 3041 Fully Vaccinated Participants.

COVID-19 vaccines are crucial to control the pandemic and avoid COVID-19 severe infections. The rapid evolution of COVID-19 variants such as B.1.1.529 is alarming, especially with the gradual decrease in serum antibody levels in vaccinated individuals. Middle Eastern countries were less likely to accept the initial doses of vaccines. This study was directed to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in the MENA region to attain public herd immunity. We conducted an online survey in five countries (Egypt, Iraq, Palestine, Saudi Arabia, and Sudan) in November and December 2021. The questionnaire included self-reported information about the vaccine type, side effects, fear level, and several demographic factors. Kruskal-Wallis ANOVA was used to associate the fear level with the type of COVID-19 vaccine. Logistic regression was performed to confirm the results and reported as odds ratios (ORs) and 95% confidence intervals. The final analysis included 3041 fully vaccinated participants. Overall, 60.2% of the respondents reported willingness to receive the COVID-19 booster dose, while 20.4% were hesitant. Safety uncertainties and opinions that the booster dose is not necessary were the primary reasons for refusing the booster dose. The willingness to receive the booster dose was in a triangular relationship with the side effects of first and second doses and the fear (p < 0.0001). Females, individuals with normal body mass index, history of COVID-19 infection, and influenza-unvaccinated individuals were significantly associated with declining the booster dose. Higher fear levels were observed in females, rural citizens, and chronic and immunosuppressed patients. Our results suggest that vaccine hesitancy and fear in several highlighted groups continue to be challenges for healthcare providers, necessitating public health intervention, prioritizing the need for targeted awareness campaigns, and facilitating the spread of evidence-based scientific communication.

Modular Single-Stage Three-Phase Flyback Differential Inverter for Medium/High-Power Grid Integrated Applications.

This paper proposes a single-stage three-phase modular flyback differential inverter (MFBDI) for medium/high power solar PV grid-integrated applications. The proposed inverter structure consists of parallel modules of flyback DC-DC converters based on the required power level. The MFBDI offers many features for renewable energy applications, such as reduced components, single-stage power processing, high-power density, voltage-boosting property, improved footprint, flexibility with modular extension capability, and galvanic isolation. The proposed inverter has been modelled, designed, and scaled up to the required application rating. A new mathematical model of the proposed MFBDI is presented and analyzed with a time-varying duty-cycle, wide-range of frequency variation, and power balancing in order to display its grid current harmonic orders for grid-tied applications. In addition, an LPF-based harmonic compensation strategy is used for second-order harmonic component (SOHC) compensation. With the help of the compensation technique, the grid current THD is reduced from 36% to 4.6% by diminishing the SOHC from 51% to 0.8%. Moreover, the SOHC compensation technique eliminates third-order harmonic components from the DC input current. In addition, a 15% parameters mismatch has been applied between the flyback parallel modules to confirm the modular operation of the proposed MFBDI under modules divergence. In addition, SiC MOSFETs are used for inverter switches implementation, which decrease the inverter switching losses at high-switching frequency. The proposed MFBDI is verified by using three flyback parallel modules/phase using PSIM/Simulink software, with a rating of 5 kW, 200 V, and 50 kHz switching frequency, as well as experimental environments.

Validation of a novel fluorescent lateral flow assay for rapid qualitative and quantitative assessment of total anti-SARS-CoV-2 S-RBD binding antibody units (BAU) from plasma or fingerstick whole-blood of COVID-19 vaccinees (preprint)

BackgroundLimited commercial LFA assays are available to provide a reliable quantitative measurement of the total binding antibody units (BAU/mL) against the receptor-binding domain of the SARS-CoV-2 spike protein (S-RBD). AimTo evaluate the performance of FinecareTM2019-nCoV S-RBD LFA and its fluorescent reader (FinecareTM-FIA Meter) against the following reference methods (i) The FDA-approved Genscript surrogate virus-neutralizing assay (sVNT), and (ii) three highly performing automated immunoassays: BioMerieux VIDAS(R)3, Ortho VITROS(R), and Mindray CL-900i(R). MethodsPlasma from 488 vaccinees were tested by all aforementioned assays. Fingerstick whole-blood samples from 156 vaccinees were also tested by FinecareTM. Results and conclusionsFinecareTM showed 100% specificity as none of the pre-pandemic samples tested positive. Equivalent FinecareTM results were observed among the samples taken from fingerstick or plasma (Pearson correlation r=0.9, p<0.0001), suggesting that fingerstick samples are sufficient to quantitate the S-RBD BAU/mL. A moderate correlation was observed between FinecareTM and sVNT (r=0.5, p<0.0001), indicating that FinecareTM can be used for rapid prediction of the neutralization antibody post-vaccination. FinecareTM BAU results showed strong correlation with VIDAS(R)3 (r=0.6, p<0.0001), and moderate correlation with VITROS(R) (r=0.5, p<0.0001), and CL-900i(R) (r=0.4, p<0.0001), suggesting that FinecareTM be used as a surrogate for the advanced automated assays to measure S-RBD BAU/mL.

People Financing Entrepreneurs within and outside the Family: Pandemic Decline and Resilience in Cultures around the World

People may finance entrepreneurs, often family members. Here, the question is: how has the COVID-19 pandemic affected people’s funding of family-related entrepreneurs and non-family-related entrepreneurs? The pandemic predictably reduced the funding of family-related entrepreneurs and especially the financing of non-family-related entrepreneurs. However, a culture supportive of family businesses may alleviate the declining funding of family-related entrepreneurs, predictably, while a secular–rational culture supportive of non-family businesses may alleviate the declining financing of non-family-related entrepreneurs. Similar to a field experiment, a globally representative survey was conducted before and after the disruption in 42 countries, interviewing 266,983 adults either before or after the disruption. The individual-level data are combined with national-level data on culture, amenable to hierarchical linear modeling. People’s financing of family-related entrepreneurs and especially of non-family-related entrepreneurs are found to have declined with the COVID-19 pandemic. However, culture provides resilience, in that the declining funding of family-related entrepreneurs was alleviated where the culture supports family businesses, and the declining funding of non-family-related entrepreneurs was alleviated in societies with a secular–rational culture. The findings contribute to contextualizing business angel financing temporally, as embedded in time before and after the COVID-19 pandemic disruption, and societally, as embedded in culture providing resilience.

Comparison of antibody immune responses between BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines in naive and previously infected individuals (preprint)

Two mRNA vaccines, Pfizer-BNT162b2 and Moderna-mRNA-1273, were granted the US Food and Drug Administration Emergency Use Authorization for preventing COVID-19. However, little is known about the difference in antibody responses induced by the two mRNA vaccines in naive and individuals with a previous history of infections (PI group). Therefore, we investigated the levels of anti-S-RBD total antibodies (IgM, IgA, and IgG), anti-S-RBD IgG, and anti-S-RBD IgA in these two groups 1-13 (median=6) weeks following administration of two doses of mRNA-1273 or BNT162b2 vaccines. Results showed that in naive-vaccinated group, the mRNA-1327 vaccine induces significantly higher levels of S-RBD total antibodies (3.5-fold; p<0.001), S-RBD IgG (2-fold-p<0.01), and S-IgA (2.1-fold, p<0.001) than the BNT162b2 vaccine. In the PI-vaccinated group, both vaccines produce significantly higher S-RBD total antibodies level than those of the naive-vaccinated group. The PI group produced a higher level of S-RBD IgG than the naive-BNT162b2 (p=0.05) but not more than the naive-mRNA-1273 (p=0.9) group. Interestingly, the PI-vaccinated group produced a comparable level of IgA ratio to the naive-mRNA-1273 group but significantly higher than the naive-BNT162b2 group (1.6-fold, p<0.001). Our results showed that the mRNA-1327 vaccine is more immunogenic and induces a greater antibody response than the BNT162b2 vaccine.

Uv-Vis and Electrical Impedance Characterizations of the Hydroxychloroquine-Zinc Complex in the Phospholipid-Like Oleic Acid Phase (preprint)

UV-vis and impedance measurements were performed to determine the stable formation of the Hydroxychloroquine-Zinc (HCQ-Zn) complex within the oleic acid (oil) phase of the oil-water system. Decreased UV absorbance with increased Zn concentration was associated with the gradual formation of the complexes within the oil phase, agreeing with existing reports and our time-dependent-density-functional calculations. The reproducibility of our data over a long period indicates the stability of the complex within the oil phase. The impedance measurement showed that the dielectric loss of the oil phase due to the polarization of the complex is less than that due to the polarization of HCQ. A basic impedance measurement revealed that the aqueous-to-oil transfer of Zn is not possible without the HCQ, a result pertinent to the recent report that HCQ is Zn ionophore. Our work is thus important to the fundamental physical chemistry and the current COVID-19 issue where the Zn infusion across the living cell phospholipid membrane (mimicked as an oil-water interface) reduces viral replication.

Computerized tomography of the Thorax for surgical patients during the COVID-19 pandemic: Was it useful? (preprint)

Objectives: Diagnostic challenges during the COVID-19 pandemic forced the radiology regulating body to adopt the use of CT Chest as a triage and diagnostic tool, which was subsequently abandoned. The Royal Wolverhampton hospital followed both protocols. Here, we investigate the evidence behind this decision within the context of surgical admissions during the COVID-19 peak in our hospital. Methods Retrospective data collection and analysis of all surgical admissions between the 1st of March to the 31st of May. Data was collected from the radiology and electronic portal looking into patients undergoing CT chest to diagnose the presence of C-19 as well as swab results. Results 78 patients fulfilled our inclusion criteria. The scan either confirmed the presence or absence (4, 63 patients) of C-19 but was sometimes inconclusive (11 patients). Comparing these to the results of the swabs; CT showed sensitivity 42.86 %, Specificity 97.92%, and accuracy 90.91 %. In the inconclusive CT report group, chances of having a positive swab result were 45%: None of the scan results changed any of the surgical planning. Lymphocyte count in the context of surgical presentation did not have any statistical significance to predict the presence of C-19 (P=0.7). Cost implications on our cohort of patients for adding the chest CT is estimated to be around £31,000. Conclusion CT Thorax during the pandemic was a good negative predictor but had limited diagnostic value and did not change patient management. Newer, faster techniques of PCR swabs and antibody testing would be a better and cheaper alternative. Advances in knowledge This paper provides evidence to support the decision from the regulatory bodies not to use CT scan as a screening tool for COVID 19 diagnosis.

Seroprevalence of SARS-CoV-2 infection in the craft and manual worker population of Qatar (preprint)

Background: Qatar experienced a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic that disproportionately affected the craft and manual worker (CMW) population who comprise 60% of the total population. This study aimed to assess the proportions of ever and/or current infection in this population. Methods: A cross-sectional population-based survey was conducted during July 26-September 09, 2020 to assess both anti-SARS-CoV-2 positivity through serological testing and polymerase chain reaction (PCR) positivity through PCR testing. Associations with antibody and PCR positivity were identified through regression analyses. Results: Study included 2,641 participants, 69.3% of whom were <40 years of age. Anti-SARS-CoV-2 positivity was estimated at 55.3% (95% CI: 53.3-57.3%) and was significantly associated with nationality, geographic location, educational attainment, occupation, presence of symptoms in the two weeks preceding the survey, and previous infection diagnosis. PCR positivity was assessed at 11.3% (95% CI: 9.9-12.8%) and was significantly associated with geographic location, contact with an infected person, and reporting two or more symptoms. Infection positivity (antibody and/or PCR positive) was assessed at 60.6% (95% CI: 9.9-12.8%). The proportion of antibody-positive CMWs that had a prior SARS-CoV-2 diagnosis was 9.3% (95% CI: 7.9-11.0%). Only seven infections were ever severe and one was ever critical - an infection severity rate of 0.5% (95% CI: 0.2-1.0%). Conclusions: Six in every 10 CMWs have been infected, suggestive of reaching the herd immunity threshold. Infection severity was low with only one in every 200 infections progressing to be severe or critical. Only one in every 10 infections had been previously diagnosed suggestive of mostly asymptomatic or minimally mild infections.