What contributes to the re-positive nucleic acid test results for the omicron variant of SARS-CoV-2 in the shelter cabin hospital in Shanghai, China?

Background: Despite the increasing reports of re-positive SARS-CoV-2 cases after recovery and discharge from hospitals, our knowledge remains very limited regarding the contributing factors of re-positivity and its roles in the transmission and epidemiology of the Omicron variant. Methods: In this retrospective study, re-positivity is defined as the positive nucleic acid result (Ct < 35) following two consecutive negative results during hospitalization. A total of 751 patients from Shanghai Shelter Cabin Hospital were enrolled and divided with a ratio of about 1:2 into the re-positivity group and the non-re-positivity group. Patients required three consecutive negative results daily as the de-isolation criterion. The follow-up time of discharged patients lasted five weeks. Univariate regression analysis was used to compare variables between the re-positivity and non-re-positivity groups, and the single re-positivity and multiple re-positivity groups, with P < 0.05 defined as the statistical significance of differences. Subsequently, variables with P < 0.2 were subjected to multivariate logistic regression analysis to investigate the odds ratio (OR) of re-positivity and the influencing factors of re-positivity of the Omicron variant. Results: The re-positivity group had a higher proportion of males (68.1% vs 58.1%, p = 0.000), a higher education level (31.9% vs 12.7%, p = 0.007), a longer hospitalization duration (13 days vs 8 days, p = 0.000), and a higher Convidecia vaccination rate (6.0% vs 2.4%, p = 0.011). Further multivariable analysis showed male (OR = 2.168, p = 0.000), Convidecia vaccination (OR = 2.634, p = 0.014), hospitalization duration (OR = 2.146, p = 0.000) and education level (OR = 1.595, p = 0.007) were associated with re-positivity. The average rate of re-positivity was 25% during hospitalization and decreased to 0.4% among discharged patients. Re-positivity was more common in the period with a larger number of hospitalized patients and in larger wards with a larger number of patients. Conclusion: A large number of hospitalized patients, large-sized wards, and gender are significant contributing factors to re-positivity. Division of the shelter cabin hospital into small independent wards and requirement of three consecutive results daily as the de-isolation criterion might be more beneficial to the control and prevention of the spread of the Omicron variant.

[From Invisible to Visible - Validating Media Presence: Forging a New Image of Nursing in the Post-Pandemic Era].

The COVID-19 pandemic has increased the exposure and attention given to nurses in the global media. Although media outlets have repeatedly praised them as "heroes" or "angels", nurses continue to be regular targets of stigmatization during infectious outbreaks. The lack of a strong public image may be an important reason behind why the general public has yet to adequately understand and acknowledge the nursing profession. Therefore, new branding is needed to improve the public image of nursing in the post-pandemic era. In this article, common stereotypes regarding nurses are reviewed, the heroic narrative is introduced, and suggestions regarding how to leverage social media to improve the image of nursing are provided. To give nurses a more respected voice, make the invisible visible, and validate a stronger media presence in line with International Council of Nurses tenets, nurses should be united together under a shared professional image to be a positive force for global health.

Impact of Personality Traits and Information Privacy Concern on E-Learning Environment Adoption during COVID-19 Pandemic: An Empirical Investigation

In response to the COVID-19 pandemic, teaching and learning processes have experienced significant changes. Higher education institutions in Taiwan employed crisis intervention measures to instantly implement unified learning methods such as online teaching and learning. However, students had no time to prepare. Thus, the study explored the relationship between personality traits and the belief in conspiracy theory as antecedents of students' concern for information privacy (CFIP) and the subsequent relationship between students' CFIP and behavioral intention to report their personal information to e-learning service providers concerning the adoption of the e-learning environment. This cross-sectional study employed a questionnaire to accumulate data from university students in Taiwan. A total of 285 valid responses were used for the final analysis. The research framework was evaluated by structural equation modeling (SEM). The results suggest the proposed model explains about 66.4% of the variance of behavioral intention (R2 = 0.664). The findings support that four personality traits-agreeableness, openness to experiences, conscientiousness, and neuroticism-and belief in conspiracy theory significantly influenced students' CFIP. However, concerning extraversion, an insignificant path coefficient was reported. CFIP mediates the relationship between belief in conspiracy theory and behavioral intention. E-learning service providers should consider these determinants in improving and endorsing principles concerning e-learning environment adoption.

Effect of COVID-19 Pandemic on Influenza Vaccination Intention: A Meta-Analysis and Systematic Review.

Poorer outcomes have been reported with COVID-19 and influenza coinfections. As the COVID-19 pandemic rages on, protection against influenza by vaccination is becoming increasingly important. This study examines how COVID-19 has influenced influenza vaccination intentions from a global perspective. A literature search was conducted on Embase, PubMed, and CNKI from 1 January 2019 to 31 December 2021 for articles reporting rates of influenza vaccination pre-COVID-19 (19/20 season), and intention and/or uptake of influenza vaccination post-COVID-19 (20/21 season). The changes in vaccination intention and reasons for changes were reported. Subgroup analyses were performed by region, gender, age, and occupation. Newcastle Ottawa Scale was used for quality assessment of the articles. Twenty-seven studies with 39,193 participants were included. Among 22 studies reporting intention to vaccinate in 20/21, there was increased intention to vaccinate (RR 1.50, 95% CI 1.32-1.69, p < 0.001) regardless of age, gender, and occupation. The remaining five studies reporting vaccination intention and uptake in 20/21 showed a similar increase (RR 1.68, 95%CI 1.20-2.36). Important determinants include historical vaccine acceptance, and perception of influenza severity and vaccine safety. The COVID-19 pandemic has increased intention to vaccinate against influenza internationally. The pandemic could be a window of opportunity to promote influenza vaccination and decrease vaccine hesitancy.

Role of Infodemics on Social Media in the Development of People's Readiness to Follow COVID-19 Preventive Measures.

Unparalleled levels of misinformation have contributed to widespread misunderstandings about the nature of the coronavirus, its cure and preventative measures. Misinformation crosses borders rapidly with the help of social media, and this phenomenon is constantly increasing. Thus, the current study proposes a research framework to explore how citizens' trust in government and social media influences their readiness to follow COVID-19 preventive measures. Additionally, the role of a health infodemic was explored in perceptions and relationships among factors influencing an individual's readiness to follow COVID-19 preventive measures with data collected from 396 participants in Taiwan. The findings indicate citizens' trust in social media (TRSM), attitude (ATT), perceived benefit (PBT), personal innovativeness, and how peer referents positively influence their readiness. However, the relationship between citizens' trust in the government (TRGT) and their readiness to follow COVID-19 preventive measures (INT) is not statistically significant. The current study also explores the negative moderating effect of health infodemics on the relationship between TRSM and INT, TRGT and INT, ATT and INT, PBT and INT. Thus, the Taiwanese government must consider the current study's findings to develop attractively, informed, and evidence-based content, which helps its citizens improve their health literacy and counter the spread of misinformation.

Breastfeeding Mother and Child Clinical Outcomes After COVID-19 Vaccination.

BACKGROUND: Pre-approval clinical trials of the Pfizer/BioNTech messenger RNA COVID-19 vaccine, BNT162b2 did not include participants who were breastfeeding. Therefore, there is limited evidence about outcomes of breastfeeding mother-child dyads and effects on breastfeeding after vaccination. RESEARCH AIMS: To determine: (1) solicited adverse effects (e.g., axillary lymphadenopathy, mastitis, and breast engorgement), which are unique to lactating individuals; and (2) systemic and local adverse effects of COVID-19 mRNA vaccine on mothers and potential effects on their breastfed infants. METHOD: This was a prospective cohort study of lactating healthcare workers (N = 88) in Singapore who received two doses of BNT162b2 vaccination (Pfizer/BioNTech). The outcomes of mother-child dyads within 28 days after the second vaccine dose were determined through a participant-completed questionnaire. RESULTS: Minimal effects related to breastfeeding were reported by this cohort; three of 88 (3.4%) participants had mastitis, one (1.1%) participant experienced breast engorgement, five of 88 (5.7%) participants reported cervical or axillary lymphadenopathy. There was no change in human milk supply after vaccination. The most common side effect was pain/redness/swelling at the injection site, which was experienced by 57 (64.8%) participants. There were no serious adverse events of anaphylaxis or hospital admissions. There were no short-term adverse effects reported in the infants of 67 lactating participants who breastfed within 72 hr after BNT162b2 vaccination. CONCLUSIONS: BNT162b2 vaccination was well tolerated in lactating participants and was not associated with short-term adverse effects in their breastfed infants. STUDY PROTOCOL REGISTRATION: The study protocol was registered at clinicaltrials.gov (NCT04802278).

Clinical features and outcomes of neonatal COVID-19: a systematic review

BackgroundIn general, children with COVID-19 have milder illness and better prognosis compared to adults. However, the neonatal population (from birth to 28 days of life) may be more vulnerable to severe COVID-19 disease due to the immaturity of neonatal immune system and possibility of in-utero infection from infected mothers. Comprehensive data on neonatal COVID-19 manifestations is currently lacking.ObjectivesWe aimed to determine the clinical manifestations and outcomes of neonates with COVID-19, and characterise these clinical characteristics based on illness severity.MethodsA systematic review (CRD42020183500) was conducted following the PRISMA guidelines with Embase, PubMed, and China Knowledge Resource Integrated (CNKI) databases until 1 August 2020. Additional studies were identified from references of included studies and the John Hopkins Centre for Humanitarian Health database. Studies reporting neonates (≤ 28 days old) who tested positive for SARS-CoV-2 by reverse transcriptase PCR (RT-PCR) were included. Descriptive statistics were used to compare mild-moderately ill neonates (non-severe group) with severely-critically ill neonates (severe group). This grouping was based on the World Health Organization’s definition. Continuous variables were analysed using Wilcoxon-Rank Sum Test. Dichotomous or categorical data were analysed with Chi-square and Fisher’s Exact Tests. Quality of the studies were reviewed with Newcastle-Ottawa Scale and Murad Tool.ResultsSixty-seven studies were included out of 199 full text articles screened. Studies comprised of case reports, case series or cohort studies. Of ninety-nine neonates with COVID-19 infection, 72 (72.7%) were symptomatic. Amongst the symptomatic neonates, respiratory symptoms were common: shortness of breath (36.1%), nasal symptoms (19.4%), cough (18.1%). Other symptoms included fever (55.6%), feeding problems (31.9%) and gastrointestinal (GI) symptoms (16.7%). Lymphopenia was present in 43.9% (18 of 41 neonates tested). Elevated C-reactive protein was only reported in 13.2% (5 of 38 neonates tested), while 65.4% (34 of 52 neonates) had chest radiographs suggestive of pneumonia. Thirty neonates (30.3%) had severe-critical illness (severe group), while 69 (69.9%) had mild-moderate illness (non-severe group). Compared with the non-severe group, more neonates in the severe group were symptomatic (100% vs 60.9%, p<0.001), had dyspnoea (66.7% vs 14.3%, p<0.001) and abnormal chest radiographic findings (84.6% vs 61.5%, p=0.038). Accordingly, more neonates in the severe group were admitted to the intensive care unit (91.7% vs 41.7%, p<0.001). On the contrary, mild-moderately ill neonates had increased incidence of fever (69.0% vs 36.7%, p=0.006), and GI symptoms (26.2% vs 3.33%, p=0.01). Ten out of 11 of mild-moderately ill neonates displaying GI symptoms did not have dyspnoea. Laboratory findings, duration of hospital stay, birth characteristics and age at COVID-19 diagnoses were similar between these two groups. No mortalities were reported.ConclusionsPrognosis of COVID-19 neonates were favourable. We postulate that GI symptoms alone predict a better prognosis, while GI symptoms with dyspnoea predict a worse prognosis, as observed in adults. However, our studies were of moderate quality, and clinical findings and investigation results were not completely reported. As the pandemic evolves, prospective studies and more systematic reporting of cases will improve our understanding of neonatal COVID-19 and verify utility of symptoms and laboratory tests in predicting the severity of disease.

Codominant IgG and IgA expression with minimal vaccine mRNA in milk of BNT162b2 vaccinees.

Lactating women can produce protective antibodies in their milk after vaccination, which has informed antenatal vaccination programs for diseases such as influenza and pertussis. However, whether SARS-CoV-2-specific antibodies are produced in human milk as a result of COVID-19 vaccination is still unclear. In this study, we show that lactating mothers who received the BNT162b2 vaccine secreted SARS-CoV-2-specific IgA and IgG antibodies into milk, with the most significant increase at 3-7 days post-dose 2. Virus-specific IgG titers were stable out to 4-6 weeks after dose 2. In contrast, SARS-CoV-2-specific IgA levels showed substantial decay. Vaccine mRNA was detected in few milk samples (maximum of 2 ng/ml), indicative of minimal transfer. Additionally, infants who consumed post-vaccination human milk had no reported adverse effects up to 28 days post-ingestion. Our results define the safety and efficacy profiles of the vaccine in this demographic and provide initial evidence for protective immunity conferred by milk-borne SARS-CoV-2-specific antibodies. Taken together, our study supports recommendations for uninterrupted breastfeeding subsequent to mRNA vaccination against COVID-19.

Interpreting Usability Factors Predicting Sustainable Adoption of Cloud-Based E-Learning Environment during COVID-19 Pandemic

The COVID-19 pandemic affected educational institutions in an unrivaled way around the globe and forced them to switch from conventional classroom learning mode to e-learning mode within a short time period. Neither instructors nor students had ample time to prepare. The purpose of the current study is to accomplish two objectives: to explore the functional relationship between attitudinal readiness (ATR), subjective well-being (SWB), and cloud-based e-learning adoption intention in Taiwan and examine the constancy of recommended proposed relationships among different students’ groups. The model was then empirically tested using data of 256 university students by structural equation modeling. The current study demonstrates that ATR is completely explained through four dimensions: peer reference, perceived ease of use, perceived usefulness, and perceived ubiquity. SWB is positively interpreted through four dimensions: online course quality, system quality, perceived service quality, and perceived closeness. Self-efficacy has a significant relationship with both attitudinal readiness and adoption intention of a cloud-based e-learning system. Finally, the invariance test explores substantial variance among students who intend to use the system and students who reject it. Therefore, researchers and practitioners regarding educational, technological innovation must consider this empirical evidence to develop and validate a sustainable cloud-based e-learning program in higher education.

Role of Hypertension on the Severity of COVID-19: A Review.

ABSTRACT: The novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly evolved into a global pandemic. The substantial morbidity and mortality associated with the infection has prompted us to understand potential risk factors that can predict patient outcomes. Hypertension has been identified as the most prevalent cardiovascular comorbidity in patients infected with COVID-19 that demonstrably increases the risk of hospitalization and death. Initial studies implied that renin-angiotensin-aldosterone system inhibitors might increase the risk of viral infection and aggravate disease severity, thereby causing panic given the high global prevalence of hypertension. Nonetheless, subsequent evidence supported the administration of antihypertensive drugs and noted that they do not increase the severity of COVID-19 infection in patients with hypertension, rather may have a beneficial effect. To date, the precise mechanism by which hypertension predisposes to unfavorable outcomes in patients infected with COVID-19 remains unknown. In this mini review, we elaborate on the pathology of SARS-CoV-2 infection coexisting with hypertension and summarize potential mechanisms, focusing on the dual roles of angiotensin-converting enzyme 2 and the disorders of renin-angiotensin-aldosterone system in COVID-19 and hypertension. The effects of proinflammatory factors released because of immune response and gastrointestinal dysfunction in COVID-19 are also discussed.

Titres and neutralising capacity of SARS-CoV-2-specific antibodies in human milk: a systematic review.

OBJECTIVE: Synthesise evidence on production of SARS-CoV-2 antibodies in human milk of individuals who had COVID-19, and antibodies' ability to neutralise SARS-CoV-2 infectivity. DESIGN: A systematic review of studies published from 1 December 2019 to 16 February 2021 without study design restrictions. SETTING: Data were sourced from PubMed, MEDLINE, Embase, CNKI, CINAHL and WHO COVID-19 database. Search was also performed through reviewing references of selected articles, Google Scholar and preprint servers. Studies that tested human milk for antibodies to SARS-CoV-2 were included. PATIENTS: Individuals with COVID-19 infection and human milk tested for anti-SARS-CoV-2 neutralising antibodies. MAIN OUTCOME MEASURES: The presence of neutralising antibodies in milk samples provided by individuals with COVID-19 infection. RESULTS: Individual participant data from 161 persons (14 studies) were extracted and re-pooled. Milk from 133 (82.6%) individuals demonstrated the presence of anti-SARS-CoV-2 immunoglobulin A (IgA), IgM and/or IgG. Illness severity data were available in 146 individuals; 5 (3.4%) had severe disease, 128 (87.7%) had mild disease, while 13 (8.9%) were asymptomatic. Presence of neutralising antibodies in milk from 20 (41.7%) of 48 individuals neutralised SARS-CoV-2 infectivity in vitro. Neutralising capacity of antibodies was lost after Holder pasteurisation but preserved after high-pressure pasteurisation. CONCLUSION: Human milk of lactating individuals after COVID-19 infection contains anti-SARS-CoV-2-specific IgG, IgM and/or IgA, even after mild or asymptomatic infection. Current evidence demonstrates that these antibodies can neutralise SARS-CoV-2 virus in vitro. Holder pasteurisation deactivates SARS-CoV-2-specific IgA, while high-pressure pasteurisation preserves the SARS-CoV-2-specific IgA function.

Breastfeeding mother-child clinical outcomes after COVID-19 vaccination (preprint)

This is a prospective cohort study of 88 lactating women in Singapore who received two doses of BNT162b2 vaccination (Pfizer/BioNTech), whereby outcomes of mother-child dyads within 28 days after the second vaccine dose were determined through a structured questionnaire. Minimal effects related to breastfeeding were reported in this cohort; 3 of 88 (3.4%) women had mastitis with 1 of 88 (1.1%) women experiencing breast engorgement. We report an incidence of lymphadenopathy in our cohort at 5 of 88 (5.7%). Reassuringly, there was no change in reported breastmilk supply after vaccination. The most common side effect was pain/redness/swelling at the injection site, which was experienced by 57 of 88 (64.8%) women. There were no serious adverse events of anaphylaxis and hospital admissions. No adverse symptoms were reported in 67 of 88 (76.1%) breastfed children.

[Nurses: A Voice to Lead, Nursing the World to Health-Viewing COVID-19 Epidemic Prevention Efforts in Light of Nightingale's Perspective on Infection Control].

Florence Nightingale (1820-1910), extolled as the founder of modern nursing, contributed greatly to the advancement of modern public health. Written 150 years ago, Nightingale's advice on infection control, addressing the importance of hand washing, environmental sanitation, ventilation, sunshine, statistical data, and health literacy, remains highly relevant in today's global fight against the coronavirus. In honor of Florence Nightingale's 200th birthday, World Health Organization declared 2020 the International Year of the Nurse and Midwife. The era of "Nurses: A Voice to Lead - Nursing the World to Health" is drawing near. This article addresses the profound impact of Nightingale's infection control and public health perspectives on measures currently being taken to contain coronavirus disease 2019 (COVID-19). Furthermore, we call on governments throughout the world to invest proactively in nursing to assure the safety of patients and promote public health in order to achieve the pledge of the United Nations' sustainable development goals to leave no one behind.

BNT162b2 vaccination induces SARS-CoV-2 specific antibody secretion into human milk with minimal transfer of vaccine mRNA (preprint)

ImportanceTo examine the impact of SARS-CoV-2 vaccination of lactating mothers on human milk Objective(1) To quantify SARS-CoV-2-specific immunoglobulin A (IgA) and immunoglobulin G (IgG) in human milk of lactating mothers who received the BNT162b2 vaccine, with reference to a cohort convalescent from antenatal COVID-19, and healthy lactating mothers. (2) To detect and quantify vaccine mRNA in human milk after BNT162b2 vaccination. DesignGestational Immunity For Transfer 2 (GIFT-2) is a prospective cohort study of lactating mothers who were due to receive two doses of BNT162b2 vaccine, recruited between 5th February 2021 and 9th February 2021. SettingLactating healthcare workers living in Singapore ParticipantsConvenience sample of ten lactating healthcare workers. Human milk samples were collected at four time points: pre-vaccination, 1-3 days after dose one, 7-10 days after dose one, and 3-7 days after dose two of the BNT162b2 vaccine. ExposureTwo doses of the BNT162b2 vaccine 21 days apart. Main Outcome and Measure(i) SARS-CoV-2-specific IgA and IgG in human milk of lactating mothers who received BNT162b2 vaccine, (ii) Detection and quantification of vaccine mRNA in human milk after BNT162b2 vaccination. ResultsTen lactating healthcare workers aged 32.5 years (range 29 - 42) were recruited, with 40 human milk samples collected and analysed. SARS-CoV-2-specific IgA was predominant in human milk of lactating mothers who received BNT162b2 vaccine. The sharpest rise in antibody production was 3 -7 days after dose two of the BNT162b2 vaccine, with medians of 1110 picomolar of anti-SARS-CoV-2 spike and 374 picomolar of anti-Receptor Binding Domain IgA. Vaccine mRNA was detected only on rare occasions, at a maximum concentration of 2 ng/mL. Conclusions and RelevanceIn this cohort of ten lactating mothers following BNT162b2 vaccination, nine (90%) produced SARS-CoV-2 IgA, and ten (100%) produced IgG in human milk with minimal amounts of vaccine mRNA. Lactating individuals should continue breastfeeding in an uninterrupted manner after receiving mRNA vaccination for SARS-CoV-2. Trial RegistrationRegistered at clinicaltrials.gov (NCT04802278). Key PointsO_ST_ABSQuestionC_ST_ABSDoes BNT162b2 (i) induce the production and secretion of SARS-CoV-2 specific antibodies into human milk, and/or (ii) get secreted into human milk? FindingsIn this cohort that included ten lactating healthcare workers following BNT162b2 vaccination, 90% produced SARS-CoV-2 immunoglobulin A, and 100% produced immunoglobulin G in human milk, with minimal amounts of vaccine mRNA transfer. MeaningLactating individuals should continue breastfeeding in an uninterrupted manner after receiving SARS-CoV-2 mRNA vaccination.

Breastfeeding in COVID-19: A Pragmatic Approach.

The novel coronavirus disease 2019 (COVID-19) pandemic has resulted in changes to perinatal and neonatal care, concentrating on minimizing risks of transmission to the newborn and health care staff while ensuring medical care is not compromised for both mother and infant. Current recommendations on infant care and feeding when mother has COVID-19 ranges from mother-infant separation and avoidance of human milk feeding, to initiation of early skin-to-skin contact and direct breastfeeding. Health care providers fearing risks of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) maternal-infant transmission may veer toward restricted breastfeeding practices. We reviewed guidelines and published literature and propose three options for infant feeding depending on various scenarios. Option A involves direct breastfeeding with the infant being cared for by the mother or caregiver. In option B, the infant is cared for by another caregiver and receives mother's expressed milk. In the third option, the infant is not breastfed directly and does not receive mother's expressed milk. We recommend joint decision making by parents and the health care team. This decision is also flexible as situation changes. We also provide a framework for counseling mothers on these options using a visual aid and a corresponding structured training program for health care providers. Future research questions are also proposed. We conclude that evidence and knowledge about COVID-19 and breastfeeding are still evolving. Our options can provide a quick and flexible reference guide that can be adapted to local needs. KEY POINTS: · SARS-CoV-2 is unlikely transmitted via human milk.. · A shared decision making on infant feeding is the preferred approach.. · Mothers can safely breastfeed with appropriate infection control measures..

[The Key Role of Taiwanese Nurses in Combating COVID-19 Pandemic].

As the COVID-19 pandemic continues to rage worldwide, Taiwan has achieved outstanding performance in controlling the spread of the outbreak domestically, earning global appreciation. Nurses on the frontlines deserve much of the credit for the ongoing success in fighting against this outbreak in Taiwan. Taiwan's success to date is grounded in proactive preparedness and deployment by the government and effective teamwork among government agencies, medical institutions, enterprises, and the public. Comprehensive containment strategies and preparedness have allowed nurses to effectively perform their duties and combat the pandemic. Nurses safeguard the public's health a myriad of ways, including implementing quarantine measures at air and seaports, conducting fever screenings, delivering inpatient isolation treatments, performing case contact tracing, providing community care services, and operating special chartered-flight services. The Taiwan Nurses Association (TWNA) provides vital lead in this pandemic response, advocating for the safety, health and wellbeing of nurses; highlighting the contributions and value of nurses; and enhancing the professional image and status of nurses. Furthermore, through its global platform, TWNA shares with peer organizations worldwide the content and efficacy of actions taken by the national government, the contributions of healthcare workers, and the support and encouragement received from the public in COVID-19 containment to demonstrate values of Taiwan and nursing.