Protecting great apes from disease: Compliance with measures to reduce anthroponotic disease transmission

The emergence of infectious diseases, such as COVID-19, impacts livelihood strategies and conservation tools reliant on human-wildlife interactions, such as wildlife-based tourism and research. This is particularly relevant to great ape conservation, as humans and great apes are susceptible to being infected by similar pathogens. Evidence-based strategies are required to prevent infectious disease transmission to great apes and people involved in, or living close to, tourism sites. The development of disease-safe recommendations and their effective operationalisation require an understanding of what affects visitor compliance. Based on an international sample of past (N = 420) and potential future visitors (N = 569) to wild great ape tourism sites in Africa, we used an online questionnaire to characterise visitors' practices, assess expectations (e.g. about proximity to great apes) and identify key factors related to potential compliance with disease mitigation measures. This was implemented adapting a framework from health literature (the Health Belief Model;HBM), particularly focused on reducing COVID-19 transmission at an early stage of the pandemic. Visitors expressed less willingness to being vaccinated against COVID-19 (which, at the time our survey was conducted, had only just started being administered to very high-risk groups), wearing a facemask during trekking (although willing when viewing the apes) and quarantine after international travel before visiting great apes. Region of nationality, expectations about the visitor experience and perceived effectiveness of specific measures were important factors explaining variation in potential compliance across multiple behaviours. By gaining a better understanding of what fosters compliance with disease mitigation measures, we obtained insights that are essential for assessing feasibility, facilitating effective communication, and guiding implementation at great ape tourism sites with importance not only for COVID-19 but also for other infectious diseases more broadly, particularly at early stages of future pandemics. While requiring adaptive management as situations evolve (e.g. vaccination becoming more widely accessible), these will contribute towards a more sustainable visitor experience that can effectively deliver positive outcomes for people and biodiversity. Read the free Plain Language Summary for this article on the Journal blog. © 2022 The Authors. People and Nature published by John Wiley & Sons Ltd on behalf of British Ecological Society.

Incidence of imaging confirmed stroke and thrombotic events in older adults with severe COVID-19 infection

During the initial phase of the response to COVID-19, concern was raised regarding a potential link with increased risk of stroke. We aimed to explore the incidence of stroke and thrombotic events within our local population with COVID-19 infection who required admission to the Intensive Care Unit (ICU). Methods: Retrospective analysis of 57 consecutive patients with a diagnosis of COVID-19 infection admitted to Barnet General Hospital ICU between 6th March and 26th April 2020. Cases were reviewed to establish whether there had been imaging (CT or MRI) confirmed ischaemic stroke, intra-cerebral haemorrhage (ICH), venous sinus thrombosis (VST) or other thrombotic event, including pulmonary embolism (PE). Data was collected on baseline characteristics and blood tests including D-Dimer levels. Statistical analysis was performed using two-tailed t-test and Fischer's exact test (FET). Findings: Nineteen patients (33%) were age 65 years or older (mean age 69, range 65 to 74 years) and of these 2 patients (10.5%) had imaging confirmed acute ischaemic stroke. In those under 65 (mean age 54, range 29-64 years) there was one confirmed ICH and one VST. The incidence of PE was 21% in both groups. Survival was significantly lower in the age 65 or older group (26.3% versus 63.2%, p=0.0119 (FET)). Peak recorded D-Dimer levels also appeared to be significantly higher in the age 65 or older group (p=0.0003, 95% CI 13068.89 to 39858.68). Conclusions and limitations: These findings highlight the importance of awareness of risk of thrombotic events, including acute stroke, in older adults with severe Covid-19 infection. It is possible that the incidence of stroke was underestimated, including due to challenges identifying clinical signs of acute stroke and safely obtaining imaging in this population. Further, ideally prospective, studies are required to more clearly elucidate the degree of association between COVID-19 infection and stroke and VST.