Children and adolescents coping with home isolation and social distancing during Covid-19 in Qatar: a cross sectional study with qualitative items.

BACKGROUND: Covid-19 related studies report psychological impacts during home isolation and social distancing. Despite that, children and adolescents were able to adopt coping strategies that assisted in lowering severe levels of psychological disorders. This study aims to report on the psychosocial implications of social distancing and isolation on children of different nationalities who reside in Qatar, and to reveal their coping ways. METHODS: This is a cross sectional study with qualitative component at its end. The study is a part of a larger study that reported the results of a national screening for psychological disorders experienced by children and adolescents in Qatar. A bilingual online questionnaire included close-ended and one open-ended question to screen for psychological changes and identify coping strategies practiced by children and adolescents (7-18 years) during home-isolation and social distancing. The quantitative questionnaire had five main sections as follows: the sociodemographic characteristics, Spence Children's Anxiety Scale, Kutcher Adolescent Depression Scale, and Clinical Anger Scale). The last section screened for eight different coping strategies. The summative content analysis was used to analyze the open-ended question "What practices do you do at home that make you happy?". First, open coding was used (for identification), followed by the axial coding (for comparison), and lasted by sorting of coping strategies inductively. RESULTS: Six thousand six hundred and eight (6608) subjects participated between June 23 and July 18, 2020. The clinical outcomes of the study had varying prevalence and levels of severity, which ranged from mild to severe. Higher prevalence was noted for adjustment disorder 66.5% (n = 4396), and generalized anxiety 60% (n = 3858), in comparison to depression 40% (n = 2588). Additionally, participants reported using cognitive, spiritual, social, and physical coping strategies. Eight higher order themes were identified to reflect the coping strategies: playing with siblings or pets, gardening, cooking, practicing arts and crafts, and doing chores. Furthermore, Sociodemographic factors such as ethnicity, religion and family status played a considerable role in choosing the type of coping strategy. CONCLUSION: The uniqueness of the study is bringing the psychosocial implications of social distancing through the voices of children and adolescents, and coping strategies from their perspective. These results are of importance for educational and healthcare systems that are recommended to collaborate even in "normal" times to prepare these age categories for any future crises. The importance of daily lifestyle and family is highlighted as protectors, and crucial factors in emotional management.

Isolation and lockdown: The other pandemic in the social sphere / Aislamiento y confinamiento: La otra pandemia en el ámbito social / Isolamento e confinamento: A outra pandemia na esfera social

Introducción: El aislamiento y el confinamiento son medidas de alto impacto social que, a nivel mundial y en mayor o menor grado de intensidad, han provocado cambio, temporales o permanentes, respecto a la forma en que se realizan las interacciones sociales. Objetivo: realizar un estudio en el ámbito de lo doméstico y de las modificaciones externas que obligaron a un encierro drástico en la población colombiana en los primeros meses de la pandemia por la COVID-19. Materiales y métodos: Se realizó un estudio con enfoque cualitativo a partir de la aplicación de entrevistas en profundidad a 45 participantes residentes en la ciudad de Bucaramanga, Colombia, logrando la reconstrucción de rutas de vida para evaluar el momento más drástico del encierro de la población. Resultados: Desde los hallazgos, se resalta la capacidad de asimilación de las fuertes medidas de confinamiento, la colectivización de las justificaciones más legitimadas desde el discurso médico y la construcción de medidas de autocuidado constituidas en el ámbito de lo doméstico como lugar y espacio relacional clave para enfrentar la incertidumbre social frente a la ausencia de respuestas efectivas para el control del contagio y de la enfermedad. Conclusión: El drástico encierro de la población colombiana a partir de las medidas transitorias, conlleva una alta incertidumbre de los grupos familiares, pero también una respuesta generalmente positiva.

Introduction: Isolation and confinement are measures of high social impact that ­worldwide and to a greater or lesser degree of intensity­ have brought about temporary or permanent changes in how social interactions are conducted. Objective: To conduct a study on the domestic sphere and the external modifications that forced a drastic lockdown in the Colombian population during the first months of the COVID-19 pandemic. Materials and Methods: A qualitative study was carried out by conducting in-depth interviews with 45 participants living in the city of Bucaramanga, Colombia, reconstructing life pathways to evaluate the most drastic moment in the population's lockdown. Results: From the findings, the ability to assimilate strong lockdown measures, the collectivization of the medical discourse's most legitimate justifications, and the construction of self-care measures in the domestic sphere ­a key place and relational space to face social uncertainty in the absence of effective responses to control contagion and disease­ are highlighted. Conclusion: The drastic lockdown of the Colombian population due to the transitory measures entailed a high level of uncertainty for family groups but also a generally positive response.

Introdução: Isolamento e confinamento são medidas de alto impacto social que, em todo o mundo e em maior ou menor grau de intensidade, têm causado mudanças temporárias ou permanentes na forma como as interações sociais são realizadas. Objetivo: realizar um estudo no âmbito doméstico e as modificações externas que forçaram um confinamento drástico na população colombiana nos primeiros meses da pandemia de COVID-19. Materiais e Métodos: Realizou-se um estudo com abordagem qualitativa a partir da aplicação de entrevistas em profundidade a 45 participantes residentes na cidade de Bucaramanga, Colômbia, realizando a reconstrução de rotas de vida para avaliar o momento mais drástico do confinamento de a população. Resultados: A partir dos achados, destaca-se a capacidade de assimilação das medidas de confinamento forte, a coletivização das justificativas mais legítimas do discurso médico e a construção de medidas de autocuidado constituídas na esfera doméstica como lugar e espaço relacional fundamental. enfrentam a incerteza social na ausência de respostas eficazes para controlar o contágio e a doença. Conclusão: O confinamento drástico da população colombiana como resultado das medidas transitórias acarreta um alto grau de incerteza para os grupos familiares, mas também uma resposta geralmente positiva.

COVID-19 epidemic in Switzerland: on the importance of testing, contact tracing and isolation.

Switzerland is among the countries with the highest number of coronavirus disease-2019 (COVID-19) cases per capita in the world. There are likely many people with undetected SARS-CoV-2 infection because testing efforts are currently not detecting all infected people, including some with clinical disease compatible with COVID-19. Testing on its own will not stop the spread of SARS-CoV-2. Testing is part of a strategy. The World Health Organization recommends a combination of measures: rapid diagnosis and immediate isolation of cases, rigorous tracking and precautionary self-isolation of close contacts. In this article, we explain why the testing strategy in Switzerland should be strengthened urgently, as a core component of a combination approach to control COVID-19.

Intervention effects in the transmission of COVID-19 depending on the detection rate and extent of isolation.

OBJECTIVE: In 2020, the coronavirus disease 2019 (COVID-19) respiratory infection is spreading in Korea. In order to prevent the spread of an infectious disease, infected people must be quickly identified and isolated, and contact with the infected must be blocked early. This study attempted to verify the intervention effects on the spread of an infectious disease by using these measures in a mathematical model. METHODS: We used the susceptible-infectious-recovery (SIR) model for a virtual population group connected by a special structured network. In the model, the infected state (I) was divided into I in which the infection is undetected and Ix in which the infection is detected. The probability of transitioning from an I state to Ix can be viewed as the rate at which an infected person is found. We assumed that only those connected to each other in the network can cause infection. In addition, this study attempted to evaluate the effects of isolation by temporarily removing the connection among these people. RESULTS: In Scenario 1, only the infected are isolated; in Scenario 2, those who are connected to an infected person and are also found to be infected are isolated as well. In Scenario 3, everyone connected to an infected person are isolated. In Scenario 3, it was possible to effectively suppress the infectious disease even with a relatively slow rate of diagnosis and relatively high infection rate. CONCLUSION: During the epidemic, quick identification of the infected is helpful. In addition, it was possible to quantitatively show through a simulation evaluation that the management of infected individuals as well as those who are connected greatly helped to suppress the spread of infectious diseases.

Exploring staff perspectives on caring for isolated hospitalised patients during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Strict isolation of COVID-19 patients to prevent cross infection may inadvertently cause serious adverse outcomes including psychological harm, limitations to care, increased incidence of delirium, deconditioning and reduced quality of life. Previous research exploring the staff perspective of the effect of isolation on patients is limited. The aim of this study is to understand staff perceptions and interpretations of their experiences of the care and treatment of isolated patients and the impact of isolation on patients, families, and staff. METHOD: This qualitative, exploratory study is set in a major metropolitan, quaternary hospital in Melbourne, Australia. Data was collected in focus groups with clinical and non-clinical staff and analysed using content analysis. The hospital ethics committee granted approval. Each participant gave informed verbal consent. RESULTS: Participants included 58 nursing, medical, allied health, and non-clinical staff. Six main themes were identified: 1) Communication challenges during COVID-19; 2) Impact of isolation on family; 3) Challenges to patients' health and safety; 4) Impact on staff; 5) Challenging standards of care; 6) Contextual influences: policy, decision-makers and the environment. CONCLUSION: Isolating patients and restricting visitors resulted in good pandemic management, but staff perceived it came at considerable cost to staff and consumers. Innovative communication technology may facilitate improved connection between all parties. Mental health support is needed for patients, families, and staff. Further research using a co-design model with input from patients, families and staff is recommended to determine appropriate interventions to improve care. Preventing the spread of infection is essential for good pandemic management, but the cost to consumers and staff must be mitigated. Preparation for future pandemics must consider workforce preparedness, adapted models of care and workflow.

Stemming the Shadow Pandemic: Integrating Sociolegal Services in Contact Tracing and Beyond.

The COVID-19 pandemic has shed light on the challenges of complying with public health guidance to isolate or quarantine without access to adequate income, housing, food, and other resources. When people cannot safely isolate or quarantine during an outbreak of infectious disease, a critical public health strategy fails. This article proposes integrating sociolegal needs screening and services into contact tracing as a way to mitigate public health harms and pandemic-related health inequities.

Experiencing COVID-19, home isolation and primary health care: A mixed-methods study.

Objectives: Although the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020). Methods: A mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol. Results: A total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear. Conclusions: Our study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.

An Updated Review of Literature for Air Medical Evacuation High-Level Containment Transport During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: In 2019, our team conducted a literature review of air medical evacuation high-level containment transport (AE-HLCT) of patients infected with high-consequence pathogens. Since that publication, the coronavirus disease 2019 (COVID-19) pandemic has resulted in numerous air medical evacuations. We re-examined the new literature associated with AE-HLCTs to determine new innovations developed as a result of the pandemic. METHODS: A literature search was performed in PubMed/MEDLINE from February 2019 to October 2021. The authors screened abstracts for the inclusion criteria and reviewed full articles if the abstract was relevant to the aim. RESULTS: Our search criteria yielded 19 publications. Many of the early transports of patients with COVID-19 used established protocols for AE-HLCT, which were built from the most recent transports of patients with Ebola virus disease. Innovations from the identified articles are subdivided into preflight considerations, in-flight operations, and postflight operations. CONCLUSION: Lessons gleaned from AE-HLCTs of patients with COVID-19 in the early weeks of the pandemic, when little was known about transmission or the severity of the novel disease, have advanced the field of AE-HLCT. Teams that had never conducted such transports now have experience and processes. However, more research into AE-HLCT is needed, including research related to single-patient portable isolation units as well as containerized/multipatient transportation systems.

[Patient isolation during Sars-CoV-2 pandemic: the caregivers' experience in a neuro-rehabilitation unit]. / L'isolamento degli assistiti durante la pandemia da Sars-CoV-2: il vissuto dei familiari in un reparto di riabilitazione.

. Patient isolation during Sars-CoV-2 pandemic: the caregivers' experience in a neuro-rehabilitation unit. INTRODUCTION: During the Covid-19 pandemic, caregiver visits were suspended in many health care facilities and, even today, limitations remain. These restrictions have impacted not only the patients but also caregivers. AIM: To explore the life experience of caregivers of hospitalized patients, during the pandemic and the impact of visit limitations in a rehabilitation unit. METHOD: An exploratory qualitative study was conducted, following the COREQ guidelines. Caregivers of inpatients were purposefully sampled and interviewed, until data saturation. A qualitative thematic analysis with an inductive approach was performed. RESULTS: Fifteen caregivers were interviewed. The themes emerged were: 1. perception of the illness as a sudden change; 2. concerns for their loved one (i.e. the loneliness or the suffering); 3. critical (difficult to organize and perceived too short) and positive aspects of the visits; 4. barriers to communication (for example, masks when in presence; or the difficult use of technologies by elders); 5. patient's protection and support (thinking that the relative's presence may improve the rehabilitation); 6. emotions (from discouragement when visits were not allowed, to joy when meeting their loved one). CONCLUSIONS: Caregivers experienced uncertainty, worry, anxiety, fear, and lack of understanding of their loved one's clinical situation. Alternatives to the visits or the visits with physical barriers were helpful but not always effective.

Mathematical analysis of a COVID-19 model with different types of quarantine and isolation.

A COVID-19 deterministic compartmental mathematical model with different types of quarantine and isolation is proposed to investigate their role in the disease transmission dynamics. The quarantine compartment is subdivided into short and long quarantine classes, and the isolation compartment is subdivided into tested and non-tested home-isolated individuals and institutionally isolated individuals. The proposed model has been fully analyzed. The analysis includes the positivity and boundedness of solutions, calculation of the control reproduction number and its relation to all transmission routes, existence and stability analysis of disease-free and endemic equilibrium points and bifurcation analysis. The model parameters have been estimated using a dataset for Oman. Using the fitted parameters, the estimated values of the control reproduction number and the contribution of all transmission routes to the reproduction number have been calculated. Sensitivity analysis of the control reproduction number to model parameters has also been performed. Finally, numerical simulations to demonstrate the effect of some model parameters related to the different types of quarantine and isolation on the disease transmission dynamics have been carried out, and the results have been demonstrated graphically.

Recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 patients: A comparison of international guidelines.

This mini-review provides the practice guideline recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 Patients. Remodeled "quasi-negative-pressure" isolation wards had been proved a feasible, inexpensive, safe, and effective measure to contain nosocomial outbreaks. We should first determine the minimum required ventilation volume of an isolation ward based on the severity of COVID-19 patients. Mechanical ventilation remains the mainstay for achieving the requirement, while the assistance of recirculation is also helpful. Beyond adequate ventilation volume, the "clean to less-clean" directional airflow remains the golden rule for the solution of indoor ventilation. The virus-laden exhaust should be treated with HEPA/UV device or be kept away from living organisms, buildings, and air inlets.

Respiratory surveillance wards as a strategy to reduce nosocomial transmission of COVID-19 through early detection: The experience of a tertiary-care hospital in Singapore.

OBJECTIVES: Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Early isolation and containment is challenging. Although screening all patients with respiratory symptoms for COVID-19 has been recommended, the practicality of such an effort has yet to be assessed. METHODS: Over a 6-week period during a SARS-CoV-2 outbreak, our institution introduced a "respiratory surveillance ward" (RSW) to segregate all patients with respiratory symptoms in designated areas, where appropriate personal protective equipment (PPE) could be utilized until SARS-CoV-2 testing was done. Patients could be transferred when SARS-CoV-2 tests were negative on 2 consecutive occasions, 24 hours apart. RESULTS: Over the study period, 1,178 patients were admitted to the RSWs. The mean length-of-stay (LOS) was 1.89 days (SD, 1.23). Among confirmed cases of pneumonia admitted to the RSW, 5 of 310 patients (1.61%) tested positive for SARS-CoV-2. This finding was comparable to the pickup rate from our isolation ward. In total, 126 HCWs were potentially exposed to these cases; however, only 3 (2.38%) required quarantine because most used appropriate PPE. In addition, 13 inpatients overlapped with the index cases during their stay in the RSW; of these 13 exposed inpatients, 1 patient subsequently developed COVID-19 after exposure. No patient-HCW transmission was detected despite intensive surveillance. CONCLUSIONS: Our institution successfully utilized the strategy of an RSW over a 6-week period to contain a cluster of COVID-19 cases and to prevent patient-HCW transmission. However, this method was resource-intensive in terms of testing and bed capacity.

COVID-19 Response Among US Hospitals with Emerging Special Pathogen Programs.

In February 2015, the US Department of Health and Human Services developed a tiered hospital network to deliver safe and effective care to patients with Ebola virus disease (EVD) and other special pathogens. The tiered network consisted of regional special pathogen treatment centers, state- or jurisdiction-designated treatment centers, assessment hospitals able to safely isolate a patient until a diagnosis of EVD was confirmed and transfer the patient, and frontline healthcare facilities able to identify and isolate patients with EVD and facilitate transport to higher-tier facilities. The National Emerging Special Pathogens Training and Education Center (NETEC) was established in tandem to support the development of healthcare facility special pathogen management capabilities. In August 2020, 20 hospitals that previously received an onsite readiness consultation by NETEC were surveyed to assess how special pathogen programs were leveraged for COVID-19 response. All surveyed facilities indicated their programs were leveraged for COVID-19 response in at least 1 of the following ways: NETEC-sponsored resources and training, utilization of patient isolation spaces, specially trained staff, and supplies. Personal protective equipment shortages were experienced by 95% of facilities, with 80% of facilities reporting that special pathogens program personal protective equipment was used to support facility response to COVID-19 admissions. More than half of facilities (63%) reported leveraging biocontainment unit staff to provide training and education to frontline staff during initial response to COVID-19. These findings have implications for planning and investments to avoid the panic-then-forget cycle that hinders sustained preparedness for future special pathogens.

Contributions of the Regional Emerging Special Pathogen Treatment Centers to the US COVID-19 Pandemic Response.

The National Emerging Special Pathogens Training and Education Center (NETEC) was established in 2015 to improve the capabilities of healthcare facilities to provide safe and effective care to patients with Ebola and other special pathogens in the United States. Through NETEC, a collaborative network of 10 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) undertook readiness activities that included potential respiratory pathogens. These preparations, which took place before the COVID-19 pandemic, established a foundation of readiness that enabled RESPTCs to play a pivotal role in the US COVID-19 pandemic response. As initial COVID-19 cases were detected in the United States, RESPTCs provided essential isolation capacity, supplies, and subject matter expertise that allowed for additional time for healthcare systems to prepare. Through the Special Pathogen Research Network, RESPTCs rapidly enrolled patients into early clinical trials. During periods of high community transmission, RESPTCs provided educational, clinical, and logistical support to a wide range of healthcare and nonhealthcare settings. In this article, we describe how NETEC and the RESPTC network leveraged this foundation of special pathogen readiness to strengthen the national healthcare system's response to the COVID-19 pandemic. NETEC and the RESPTC network have proven to be an effective model that can support the national response to future emerging special pathogens.

Telephone Monitoring of Isolated Patients With Suspected COVID-19 Disease in Primary Care: Prospective Cohort Study.

Objective: Isolation of suspected cases of COVID-19 has been shown effective in reducing disease transmission and monitoring these patients from primary care allows to detect complications. The objective of this study is to determine the evolution of a cohort of patients with suspected COVID-19, and to analyse the factors associated with hospital admissions due to their unfavourable evolution. Methods: Prospective cohort study. A cohort of 166 patients with COVID-19 symptoms was selected and was followed-up by telephone calls during 14 days of home isolation. Results: By the end of the follow-up, a hospital admission had taken place in 14.7% of patients. The mean survival time until admission among diabetics was 12.6, 10.9 days for chronic kidney diseases, and 9.3 days in immunocompromised patients. Immunosuppression was a risk factor for admission over 50 years of age. Conclusion: Hospital admissions for suspected cases of COVID-19 are associated with diabetes, chronic kidney disease, and immunosuppression. Telephone monitoring of these patients from primary care allows for home isolation and early detection of disease complications.

Increase in coercive measures in psychiatric hospitals in Germany during the COVID-19 pandemic.

OBJECTIVE: To examine whether the pandemic in 2020 caused changes in psychiatric hospital cases, the percentage of patients exposed to coercive interventions, and aggressive incidents. METHODS: We used the case registry for coercive measures of the State of Baden-Wuerttemberg, comprising case-related data on mechanical restraint, seclusion, physical restraint, and forced medication in each of the State's 31 licensed hospitals treating adults, to compare data from 2019 and 2020. RESULTS: The number of cases in adult psychiatry decreased by 7.6% from 105,782 to 97,761. The percentage of involuntary cases increased from 12.3 to 14.1%, and the absolute number of coercive measures increased by 4.7% from 26,269 to 27,514. The percentage of cases exposed to any kind of coercive measure increased by 24.6% from 6.5 to 8.1%, and the median cumulative duration per affected case increased by 13.1% from 12.2 to 13.8 hrs, where seclusion increased more than mechanical restraint. The percentage of patients with aggressive incidents, collected in 10 hospitals, remained unchanged. CONCLUSIONS: While voluntary cases decreased considerably during the pandemic, involuntary cases increased slightly. However, the increased percentage of patients exposed to coercion is not only due to a decreased percentage of voluntary patients, as the duration of coercive measures per case also increased. The changes that indicate deterioration in treatment quality were probably caused by the multitude of measures to manage the pandemic. The focus of attention and internal rules as well have shifted from prevention of coercion to prevention of infection.

Risk of Airborne Transmission During Home Isolation: A Modeling Study.

OBJECTIVE: The worldwide pandemic of SARS-CoV-2 and its B.1.1.529 variant, Omicron, remain a threat to health. In Japan, self-isolation in a room at home has been recommended in some prefectures to reduce the burden on hospitals. With the aim of preventing the infection of family members in other rooms, this study quantified the risk of infection by airborne transmission to mask-wearing, non-infected members of the household. METHODS: A mathematical modeling approach was used to estimate the risk of airborne infection. RESULTS: For pre-SARS-CoV-2 variants of concern (VOC), the risk of infection of non-mask-wearing family members had an LN distribution with GM of 0.11, GD of 5.38, and median of 0.11; whereas that of mask-wearing members had an LN distribution with GM of 0.05, GD of 5.46, and median of 0.05. For Delta variant, the risk of infection of non-mask-wearing family members had an LN distribution with GM of 0.39, GD of 76.30, and median of 0.40, and that of mask-wearing members had an LN distribution with GM of 0.18, GD of 76.30, and median of 0.18. The difference of these medians was 0.22, which suggests that family members wearing masks is effective for preventing infection, even for highly infectious variants.