The WHO Unity Studies initiative engaged low- and middle-income countries in the implementation of standardized SARS-CoV-2 sero-epidemiological investigation protocols and timely sharing of comparable results for evidence-based action. To gain a deeper understanding of the methodological challenges faced when conducting seroprevalence studies in the Africa region, we conducted unstructured interviews with key study teams in five countries. We discuss the challenges identified: participant recruitment and retention, sample frame, sample and data management, data analysis and presentation to policy makers. Potential solutions to aid future implementation include preparedness actions such as the development of new tools, robust planning and practice.

Clinical and histopathological evidence suggest that the male reproductive system may be negatively impacted in patients with coronavirus disease (COVID-19). The objective of this study is to investigate the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on semen parameters by comparing semen analyses before and after COVID-19 diagnosis in the same patient. We retrospectively analyzed 342 semen analyses by reviewing medical records. The study included two groups of patients: (i) those who underwent two consecutive semen analyses within 6 months, one before (n=114) and one after (n=114) COVID-19 diagnosis, and (ii) a control group (n=114) that was age-matched and did not receive a diagnosis of COVID-19. The study results indicated a significant decrease in semen volume, total sperm count per ejaculate, progressive motile sperm count, total motile sperm count, and normal sperm morphology after SARS-CoV-2 infection in comparison to their respective values before the infection. Subgroup analyses showed that the duration of COVID-19 diagnosis (short-term vs long-term) did not impact the changes in semen parameters. However, fever during the COVID-19 process had a negative effect on semen parameters, particularly sperm concentration, unlike in patients without fever. In conclusion, our findings suggest that SARS-CoV-2 infection is associated with a decline in semen quality, which may potentially impact male fertility. Furthermore, it’s important to note that the negative effects on semen parameters may persist in the long-term. Our results also indicate that fever during active infection could be a significant risk factor that negatively affects spermatogenesis.

The emergence of COVID-19 as a global pandemic has had far-reaching effects on the health of individuals worldwide. Although there has been a decrease in the severity of the disease, there is a growing concern about the long-term impact of COVID-19 on the health of individuals, particularly cardiovascular complications, known as Long-COVID, which can significantly increase morbidity and mortality rates in people recovering from COVID-19 in the recent past. The severity of COVID-19 has been linked to various factors, including the role of neutrophils and neutrophil extracellular traps (NET). These extracellular webs, composed of chromatin, microbicidal proteins, and oxidant enzymes, are released by neutrophils to fight infections. However, if not properly regulated, NETs can lead to thrombo-inflammatory states and microangiopathy in the body, resulting in complications such as sepsis, thrombosis, and respiratory failure. Understanding the detailed pathophysiology and association of NETs with the prognosis of COVID-19 infection is crucial for future implications and management. The purpose of this review is to analyze the potential contribution of NETosis in the pathophysiology of COVID-19 and its subsequent complications apart from its beneficial effect. This may provide insight into potential therapeutic interventions for COVID-19 patients.

The deployment of e-assessments has been so frequent in educational institutions worldwide during the COVID-19 pandemic. It is worth questioning the efficacy of this newly adopted evaluation method. The study aims to determine how far this testing effectively achieves the Course Learning Outcomes. It also tries to explore the extent of difference between the online assessment method from the pre-pandemic testing methods stated in the course specification. Another aim of the study is to check the acceptance of e-tests by the learners. This study employs a quantitative approach encompassing a Likert-type online questionnaire to gather the response of 70 faculty members at XXXX in Saudi Arabia. The primary result of this study is that e-assessment succeeds in attaining Course Learning Outcomes to a great extent. Though these newly adopted tests shifted away from the stated measurement methods in the course specification, the learners accepted them enthusiastically. It was discovered in the study that if educational institutes have well-structured e-learning infrastructures and regularly use these setups competently, they confront minor complexities to switching to online ones and achieve Course Learning Outcomes applying e-assessment systems.

Background: Various studies suggest that coinfection with two or more respiratory pathogens is common. Coinfection with two viruses affects the host and exerts synergic effect as well and can influence the disease pathogenesis, immune system responses and treatment and outcome. Influenza and COVID-19 respiratory viruses have very similar symptoms and for this reason, bring about problems including delayed treatment and right diagnosis. This report describes three cases of coinfection with COVID-19 and influenza. Case Presentation: First case is a 46 years old Iranian housewife with the history of chronic coughs from two months ago who presented with exacerbation of coughs together with dyspnea. The second case is a 62 years old Iranian housewife with history of diabetes mellitus type 2 (DM-2) who presented with productive coughs, dyspnea and weakness. The third case is an Iranian pregnant housewife who presented with myalgia, fever and chills and dry coughs from a week ago. All three cases were tested positive for influenza and COVID-19 PCR tests. Conclusion: coinfection with two viruses can result in synergism of pathogens. Moreover, coinfection with a bacterial pathogen can make further problems. In these cases, coinfection with two viruses and mycobacterial infection in one of the cases along with comorbidities and pregnancy implied that these conditions entail immediate diagnosis as well as appropriate treatment choices.

Purpose - Purpose of this paper is to understand the interrelationship among the factors that are critical in the treatment of COVID-19 patients. An attempt to comprehend the essential requirement of the medical facilities to deal with the pandemic load on healthcare sector. Design/Methodology/Approach - Total Interpretive Structural Modelling (TISM) technique has been used to develop the hierarchical interrelationship among various factors of healthcare related to COVID-19 medical facilities. Impact Matrix Cross-Reference Multiplication Applied to a Classification (MICMAC) examines dependent and driving power of the factors. Findings - Total ten factors have been identified through literature review, which are essential for the medical facilities to prepare to deal with the pandemic load. ‘COVID-19 positive cases per day’ and ‘efficiency of covid-19 testing facility’ are factors that drives two dependent factors, ‘COVID-19 bed availability’ and ‘oxygen demand’ while remaining factors as intermediate linkage factors. Research Limitations/Implications - Examination of the interrelationships among factors can support in decision making about capacity building for COVID-19 medical facilities in hospitals. The impact of these resources on the recovery rate of COVID-19 patients can be studied further. The factors identification has been done from the perspective of India and region specific factors can be added or deleted from the TISM model. Originally/Value - An analytic study of the literature review demonstrates the relationship among the factors for healthcare accessibility to every COVID-19 positive patient and TISM examines “why” and “what” factors need more consideration for the development of the healthcare infrastructure for COVID-19 patients.

Introduction: Coronavirus disease-2019 (COVID-19) is a novel infection, that first appeared in Wuhan, China. It has been well established that different organs including the heart, kidney, pulmonary and gastrointestinal systems might be involved during or post COVID-19 infection. A possible reason is that the virus enters host cells through the angiotensin-converting enzyme 2 (ACE 2) receptor and this receptor is expressed by different human organs [1]. ACE 2 receptor is also expressed in different parts of the eyes including the conjunctiva, cornea, limbus, aqueous humor, and retina [2].In addition, COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) can affect different organ systems including skin, renal, cardiac, hematological, and gastrointestinal systems. But ocular involvement is not still a part of the world health organization (WHO) criteria or the Center for Disease Control and Prevention criteria for MIS-C [3].Whether uveitis or optic disk edema would be manifestations of acute COVID-19 infection or they can occur as a part of COVID-19-associated MIS-C is still unknown.

Recent trials have highlighted the potential of oral antiviral VV116 in addressing mild COVID-19 patients. However, there are presently no comprehensive studies to assess the safety and efficacy of VV116. Thus, we conducted a systematic review to assess the safety and efficacy for VV116. A comprehensive search was conducted in PubMed, Scopus database, and Google Scholar website, with a cut-off date of March 23, to identify pertinent studies. The results from the three included studies indicated that no serious adverse events were reported in the VV116 experimental groups, which exhibited a 2.57-day faster time to viral shedding than the control group and demonstrated non-inferiority to the Nirmatrelvir-Ritonavir control group in alleviating major symptoms. Collectively, the available studies suggest a reliable safety and efficacy profile for VV116. However, the limited number of three trials is insufficient for meta-analysis, and the included population consists of younger individuals with mild and moderate symptoms, not encompassing the elderly who are severely impacted by COVID-19. We hope that more studies will be conducted in the future to ensure that VV116 has a more reliable safety and efficacy profile in the clinical setting, especially for severe or critical patients.

Human Adenoviruses (HAdV) are implicated in multiples pathologies causing mild to severe disease. The predominant genotypes detected in association with disease differ among different countries or regions, and change over time. In Spain and elsewhere little is known about the molecular epidemiology of HAdV. From a total of 250 HAdV, members of five species were present: A (1), B (126), C (87), D (27) and E (9). The most found genotypes were B3 (119), C2 (48), C1 (29) and D8 (26). Genotypes E4, C5, C6, B7, A31, B35 and D56 were also detected. HAdV diversity increases over the years until the B3 genotype displaces all other types in 2016 and 2023. HAdV detected in Asturias were similar to those already described in other countries, no new local genotype were observed. Genotypes 1-7 were more frequent in children under 15 years of age, while types 8-56 were more frequent in the elderly. Multiple HAdV introductions must have occurred given that only small transmission clades can be inferred. The diversity of the epidemic increased with the years until it disappeared one year periodically .The COVID-19 epidemic accelerated the loss of diversity suggesting that interventions during the pandemic were able to reduce HAdV transmission.

Several medications and treatments are being investigated for their potential effectiveness against coronavirus disease 2019 (COVID-19), including androgen and other sex hormones. However, the causal relationships between serum sex hormones and COVID-19 susceptibility and severity, particularly with regards to potentially sex-specific effects, remain largely unknown. In this study, we used the latest data from the UK Biobank (up to 424,907 individuals) and COVID-19 Host Genetics Initiative (up to 1,878,143 individuals) to systematically assess the sex-specific causal effects of serum sex hormone levels on COVID-19 outcomes within a two-sample Mendelian randomization (MR) framework. The inverse-variance weighted method was used in the main MR analysis. We additionally performed a series of sensitivity analysis to assess the robustness of MR effect estimates to potentially invalid genetic variants. Our MR analysis revealed novel causal associations between serum estradiol and bioavailable testosterone levels and SARS-CoV-2 infection in women, but not men, except for a suggestive inverse causal association between estradiol levels and COVID-19 severity in men. These novel findings improve our understanding of the sex-specific causal nature of sex hormones in relation to COVID-19 outcomes, and suggest that sex hormones may serve as potential therapeutic targets for preventing SARS-CoV-2 infection and improving patient outcomes.

Objective: A nationally representative sample of US adults was used to examine the prevalence of COVID-19 cases, testing, symptoms, and vaccine uptake, and associations with tobacco product use. Methods: Data came from the 2021 National Health Interview Survey. The 2021 Sample Adult component included 29,482 participants with a response rate of 50.9%. We investigated COVID-19-related outcomes by tobacco product use status and reported national estimates. Multivariable regression models were performed accounting for demographics (e.g., age, sex, poverty level), serious psychological distress, disability, and chronic health condition. Results: In our regression analyses, odds of self-reported COVID-19 infection were significantly lower for combustible tobacco product users (vs. non-users; Adjusted Odds ratio [AOR=0.73; 95% confidence interval [CI]=0.62-0.85]. Combustible tobacco users also were less likely to report ever testing for COVID-19 (AOR=0.88; 95% CI=0.79-0.98), ever testing positive for COVID-19 (AOR =0.66; 95% CI=0.56-0.77), and ever receiving COVID-19 vaccine (AOR=0.58; 95% CI=0.51-0.66) compared to their non-user peers. Compared to non-users, users of any type of tobacco who contracted COVID-19 had higher odds of losing smell (AOR=1.36; 95%CI=1.04-1.77), which was more pronounced among exclusive e-cigarette users. The odds of receiving vaccine were lower for all current exclusive tobacco product users compared to non-users (AORs= 0.40 to 0.70). Conclusions: Continued monitoring of tobacco product use amid the COVID-19 pandemic is crucial to inform public health policies and programs. In addition, efforts to promote COVID-19 vaccination, especially among tobacco product users, are warranted.

Purpose: Inhalation of crystalline silica-rich dust particles can result in the deadly occupational lung disorder called silicosis. The risk of contracting tuberculosis and the potential for lung cancer increase as a result of silicosis. This review article aims to bring to light the state of Silicosis and TB scenario in the world and India for evaluating hurdles in the present and future to achieve the elimination road map, and assess these conditions in the backdrop of the COVID-19 pandemic. Methods: A PubMed Central search was conducted using the keywords “silico-tuberculosis” and “prevalence” and the time period of the last 20 years, which yielded 15 studies, out of which only the following were found to be relevant in terms of exemplifying the prevalence of Silico-tuberculosis at various geographical locations around the world. Results: A patient with silicosis has a 2.8-2.9 times higher risk of developing pulmonary tuberculosis and 3.7 times that of extrapulmonary tuberculosis. Incidences of missed cases when tuberculosis was misdiagnosed with silicosis due to indifferent clinical manifestations of the two in the initial stages aren’t uncommon. The duration of exposure to silica and the severity of silicosis, have a direct relation with the propensity to develop tuberculosis. As per a study, an average gap of 7.6 years has been noticed in a South African population for Silico-tuberculosis to develop post silicosis. In a study done on mine workers at Jodhpur, Rajasthan, it was seen that there is no definitive relation between patient with silicosis and possibility of having Covid-19. Conclusions: This paper has focused on the coexistence of silicosis and tuberculosis. It has been seen that the risk of tuberculosis is highly increased with pre-existing silicosis. There is a big need for the integration of the Silicosis control programme with Tuberculosis elimination programme for the government. A few of the steps that can include assessing the workplaces, periodic monitoring of the workers’ health, active case surveillance, identification of hotspots, and introducing reforms to curb the spread of dust and particulate matter from industrialized areas be taken in this regard.

A Novel Treatment Paradigm for the Treatment of COVID-19 Induced Acute Respiratory Distress Syndrome (ARDS) Acute respiratory distress syndrome due to the SARS-CoV-2 virus (COVID-19 ARDS) demonstrates the same pathologic changes of diffuse alveolar damage as classic ARDS, and ARDS develops in 33%-42% of hospitalized patients with COVID-19 and in 61-81% of patients admitted to the intensive care unit (ICU).1,2 Regardless of etiology, ARDS treatment options are limited to supportive care with mechanical ventilation (MV) and new, effective treatments are needed.3ExoFloTM is an acellular extracellular vesicle (EV) product isolated from a single donor bone marrow mesenchymal stem cell (bmMSC) culture that confers the promising anti-inflammatory and regenerative benefits of bmMSCs for treatment of ARDS without the drawbacks associated with viable cell therapy.4-12 We proposed that ExoFlo could safely reduce lung injury from COVID-19, and possibly assist in the lung’s recovery process. We describe the case of a patient with severe respiratory failure and subsequent ARDS requiring prolonged mechanical ventilation who recovered after receiving ExoFlo. This case highlights this EV product as a novel therapeutic for the treatment of COVID-ARDS.The patient is a 40-year-old female with a history of mild intermittent asthma, diverticulosis, and a remote history of thyroid cancer status post thyroidectomy. The patient had a prolonged ICU course due to COVID-19 induced ARDS that started four days after delivering her second child via a Cesarean section. Treatment for ARDS included mechanical lung ventilation with prone positioning, treatment of secondary infections with intravenous antibiotics, and supportive care for multisystem organ failure. She also received standard supportive care for COVID ARDS including lung protective ventilation, intermittent neuromuscular blockade, and intravenous steroids.After one month of supportive care failed to improve her status, an eIND (IND #28207) was approved by the Food and Drug Administration (FDA) for the administration of 15 mL of ExoFlo. At the time of ExoFlo administration, she was sedated with an FiO2 of 100% and PEEP of 15cm H2O, and she was receiving norepinephrine to maintain adequate perfusion. She received two doses of ExoFlo on Day 1 and Day 2 with slight improvement. She was not considered a candidate for extracorporeal membrane oxygenation (ECMO) due to the prolonged mechanical ventilation. Seventeen days later, she continued having febrile episodes and still required maximum ventilatory support. Her FiO2 on the ventilator was 90% and her PEEP was at 14cm H2O. Since her lung function had not improved, an additional treatment course of ExoFlo was approved by the FDA. After the second day of her second course of ExoFlo treatment, we were able to wean the PEEP, wean sedation and she began to move her lower extremities again. Due to this clear improvement, she continued the ExoFlo treatment course with 15 mL every 24 hours for a total of 5 days. By the fifth dose of ExoFlo, her ventilatory requirements had improved to 55% FiO2 and a PEEP of 8. The day after her fifth dose, two months from her ARDS diagnosis, she underwent a bedside tracheostomy and PEG tube placement.Two days following her second round of ExoFlo treatment, her sedation continued to be weaned, her urine output began to increase, and she was initiated on oral intake with ice chips. Two weeks following this treatment course, the FDA approved a third treatment course with ExoFlo. Following her third course of ExoFlo (5 days, 15 mL Q 24 hours) her tracheostomy was downsized, ventilatory support was discontinued, and she achieved 96% oxygen saturation on trach collar. (Figure 1. A. Chest computed tomography (CT) imaging before five-day course of ExoFlo. B. Chest CT showing improvement after five-day course of ExoFlo.)Four days after her third treatment course with ExoFlo, she was discharged from the hospital to a rehabilitation facility. She was still regaining strength and remained on oxygen at rest. Eight months after discharge from the hospital, she was able to return to work part time. One year after discharge, she has regained most of her strength. She still has some fine motor deficits in her right hand, and she still requires oxygen with exertion. She has a mild restrictive pattern and mild DLCO reduction on her pulmonary function tests, but her chest CT and overall functional status have both greatly improved. Her most recent CT shows improvement in the fibrotic injury appreciated on her earlier chest CTs. (Figure 2. A. Chest CT before five-day course of ExoFlo B. Chest CT one year after discharge from hospital).Prior to her second course of ExoFlo, the ICU team was discussing palliative care options with the family, since she was in the severe COVID ARDS category of patients who often did not recover. Once she started showing signs of major improvement during her second course of treatment with ExoFlo, it became apparent that she had a good chance for a meaningful recovery. The multiplicity of molecules contained within ExoFlo may have promoted healing and regeneration of healthy lung tissue in this patient who appeared to have irreversible ARDS. Currently a Phase III, randomized, blinded trial is underway to evaluate the efficacy of ExoFlo in patients with moderated to severe COVID related ARDS.

Background: As people in China travel less and consume less imported frozen food during the COVID-19 pandemic, the composition ratio of allergens may have changed. Objective: To investigate the changes of composition ratio of 20 types of specific allergens from January 2020 to June 2021 of 618 patients in China. Methods: The 20 items of allergen-specific IgE (sIgE) detection includes dermatophagoides pteronyssinus, dermatophagoides farina, ambrosia artemisiifolia, salix babylonica, dander of dog, alternaria, cockroach, artemisia argyi, dander of cat, house dust, milk, hen’s egg, mutton, cod, peanut, beef, soybean, shrimp, crab and wheat. The results of detection were collected from patients of dermatology, pediatrics or allergy department. They are from 17 hospitals in China from January 2020 to June 2021, and participants were required to have at least one positive result of sIgE detection (≥0.35 IU/mL). The age ranges from 0 to 89 years old. Serum detection was performed by enzyme allegro-sorbent test (REAST). Chi-square test and SPSS 22.0 software were used for statistical analysis to understand the sIgE proportion changes of different allergens. Results: The proportion of inhaled allergens in 618 patients was significantly lower than that of ingested allergens. Most of the inhaled allergens were indoor allergens. In the first half of 2020, the second half of 2020 and the first half of 2021, the positive proportions of wheat, shrimp and crab were changed. Compared with the same period in 2020, the positive proportion of wheat and shrimp in the spring of 2021 significantly decreased, while that of crab was significantly increased. The ratio fluctuation of dermatophagoides pteronyssinus and dermatophagoides farina was related to seasonal factors. There was no significant difference in the proportion of other allergens. Conclusion: The special historical background of the epidemic may have a certain influence on the change of the proportion of allergens, but it is not the only factor.

An unprecedented surge of Omicron infections appeared nationwide in China in December 2022 after the adjustment of COVID-19 response policy. In this study, we report the clinical and virological characteristics of SARS-CoV-2 Omicron BA.5 infections among children in Shanghai during the outbreak in late December 2022. We sequenced the 64 SARS-CoV-2 positive samples obtained from hospitalized children. The genomic monitoring revealed that the current outbreak was driven by the BA.5.2.48 and BF.7.14 subvariants. Additionally, children with BA.5.2.48 infection were more frequently observed to experience vomiting/diarrhea compared to those with BF.7.14 infection. The high-frequency unique non-synonymous mutations were present in BA.5.2.48 (N: Q241K) and BF.7.14 (nsp2: V94I, nsp12: L247F, S: C1243F, ORF7a: H47Y) with respect to their parental lineages. Of these mutations, C1243F mutation in S protein, L247F mutation in nsp12, and H47Y mutation in ORF7a protein were predicted to have a deleterious effect on the protein function. Besides, H47Y mutation was also found to increase the stability of ORF7a protein. Therefore, attention should be paid to these specific mutations, especially for H47Y mutation, which could serve as a viral immune escape strategy due to the potential immunomodulatory ability of the ORF7a protein. Continuous genomic monitoring and clinical manifestation assessments of the emerging variants will be crucial for effective responses to the ongoing COVID-19 pandemic.

Objective During the COVID-19 pandemic, the adopted containment measures have affected other respiratory virus epidemiology. Consequently, we aimed to describe the characteristics of respiratory virus infection in hospitalized pediatric acute respiratory infections (ARIs) patients prior to and throughout COVID-19 in East China.   Methods Nasopharyngeal secretions were collected from 9782 pediatric ARIs patients hospitalized in Shaoxing Maternal and Child Health Hospital from January 2018 to December 2022.  Changes in positivity viral detection rates and epidemiological as well as clinical characteristics were analyzed and compared. Results 1633 strains of 7 common respiratory viruses were detected, with a total positive rate of 16.37% (821/5021) in 2018-2019 and 17.06% (812/4761) in 2020-2022.  Compared with 2018-2019, RSV positive rate increased significantly in 2020-2022, while ADV, PIV-2, PIV-3, and flu-B detection rates were significantly reduced (P < 0.05).  The RSV-positive rate in winter increased significantly more than in other seasons (P < 0.05), while PIV-3 was mainly prevalent in spring and summer.   Conclusion During the COVID-19 pandemic, there were significant age distribution and seasonal differences in respiratory virus infection among hospitalized children with ARIs in East China.

This study investigates the impact of coronavirus (covid-19) pandemic on households’ livelihood in Sokoto State, Nigeria using a survey dataset for a sample of two hundred and seventeen (217). The study applied mean and standard deviation in analyzing the data and finding suggests that covid-19 has negatively has negatively affected the household’s livelihood in terms of food security, market accessibility, and income generation activities and women and youths empowerment. The study further revealed that the pandemic put on negative influence on social activities of the households such as children education, social structure and gender relations. Furthermore, the study concludes that, covid-19 has negative effects on cultural activities of the households such as community events, funeral activities, ceremonies, sports activities and cultural values. In addition to covid-19 pandemic, this study also indicated that psychological behaviour of household such as sustainable behavior, uncertainty; infections fears and family relations were negatively affected. From the foregoing, this study recommends the needs for the government to create a window in fiscal policy that will accommodate any unforeseen health challenges in the future. Based on the previous experience, the study further recommends the urgent need for the households to be on alert on the future pandemic

Background/aim: The relationship between COVID-19 fatality and quality health care in OECD countries was aimed to be examined, considering the effectiveness of primary health care, the effectiveness of secondary health care. Materials and methods: Data from OECD countries were collected from open-access websites. Dependent variable is COVID-19 fatality, independent variables are effectiveness of primary health care, the effectiveness of secondary health care, gross domestic product, median age, number of hospital beds, number of intensive care unit beds, number of doctors and nurses, number of computed tomography scanners, educational status and air pollution. Spearman Rho correlation and partial correlation were used in the analysis of the data, and generalized linear regression analysis was performed. Results: A statistically significant relationship was found between case fatality rates and the effectiveness of secondary health care (p<0,05). The relationships between case fatality rates and other health, demographic indicators are not statistically significant. In Generalized Linear Model (GLM-Logit Model) analysis results, only the effectiveness of secondary health care (p< 0,01) and the number of hospital beds (p<0,05) were found to be statistically significant. Conclusion: Satisfaction with quality health care is not associated with COVID-19 fatality. As the effectiveness of secondary health care increases, the fatality of COVID-19 decreases. The effectiveness of primary health care has no effect on COVID-19 fatality.

Background: The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is complex and multifactorial. We aimed to identify the risk factors for infection among the household contacts of index patients and to determine the incubation period, serial interval, and estimates of secondary infection rate. Methods: We conducted a study in three districts of Kerala among the inhabitants of households of reverse transcriptase polymerase chain reaction (RT-PCR)-positive coronavirus disease (COVID-19) patients between January and July 2021. COVID-19-positive patients and corresponding contacts were enrolled and followed up for 28 days to determine RT-PCR positivity and the presence of total antibodies against SARS-CoV-2 on days 1, 7, 14, and 28 from the date of enrolment. Results: The mean incubation period, serial interval, and generation time were 1.6, 3, and 3.9 days, respectively. The secondary infection rate was 43.0%. Individuals who worked outside the home were protected, whereas those who had kissed the COVID-19-positive patients during illness were more than twice at risk of infection than those who had not kissed the COVID-19-positive patients. Similarly, the contacts who had shared a toilet with the COVID-19-positive patients were more at risk than those who had not shared a toilet. However, the contacts who reported using masks were at a higher risk of infection in household settings. Conclusions Assessment of SARS-CoV-2 transmission in household settings is important, considering its high secondary infection rate. Close physical contact and toilet sharing increase the risk of infection. This study demonstrates shorter incubation period and serial interval.

Covid-19 causedhospitalizations, severe disease and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LUS) in children with Covid-19. We enrolled children between 1 month and 18 years of age diagnosed with SARS-CoV2 infection and whounderwenta lung ultrasound within 6 hours from firstmedical evaluation. A total of 213 children were enrolled, 51.6%were male, median age was2 years and 5 months (IQR 4mm- 11 yearsand4 months).One hundred and fortyeight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit.We found an inverse correlation between the LUS score and the oxygen saturationatthe clinical evaluation (r = −0.16; p = 0.019). Moreover, LUS scores were significantly higher in patients requiring oxygen supplementation (8 (IQR 3 - 19) vs 2 (IQR 0 - 4); p= 0.001). Among LUS pathological findings, irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequentin patients whoneeded oxygen supplementation (p = 0.007; p = 0.006 andp = 0.001, respectively). This multicentric study confirmed that LUS is able to detect Covid-19 low respiratory tract involvement, which is characterized by pleural line irregularities, vertical artifacts and subpleural consolidations. Notably, children with higher LUS score have an higher risk of hospitalization or need for oxygen supplementation, supporting LUS as a valid and safe point-of-care first level tool for the clinical evaluation of children with Covid-19.

Background: Data on the outcome and risk factors of pediatric patients with SARS-CoV-2 infection (COVID-19) following hematopoietic stem cell transplantation (HSCT) are limited. Objectives: We aimed to describe risk factors for a severe course and mortality. Method: In this nationwide study, data were collected retrospectively from 28 transplant centers. Results: One hundred ninety-six children [(63.8% male; median age 8.75 (IQR, 4.86-14.30)] who received allogeneic (n: 184, 93.9%) or autologous (n: 12, 6.1%) HSCT were included. The median time from HSCT to SARS-CoV-2 infection was 207.5 days (IQR, 110.2-207.5). The most common clinical manifestation was fever (58.2%), followed by cough (33.7%); 43 cases (21.9%) were asymptomatic. Lower respiratory tract disease (LRTD) and multisystem inflammatory syndrome in children (MIS-C) developed in 58 (29.6%) and 8 (4.1%) patients, respectively. Twenty-six patients (13.3%) required ICU admission. Nine patients died at a median of 17 days (min-max 1-33) after COVID-19 diagnosis, 6 of whom died due to the disease, with a COVID-19 lethality rate of 3.1%. The 6-week overall survival was 95.4% (95% CI 92.5-98.3). Multivariate analysis found that HSCT with a mismatched donor (OR, 8.98, p: 0.039) and LRTD (OR, 61.55, p: 0.001) were independent risk factors for ICU admission; MIS-C (OR, 9.55, p: 0.044) and lymphopenia (OR, 4.01, p: 0.030) at diagnosis were risk factors for mortality. Conclusion: Overall mortality was lower in children than in adult counterparts, and HSCT with a mismatched donor, lymphopenia, LRTD, MIS-C and ICU admission were important risk factors for adverse outcomes.

Although, the COVID-19 pandemic is profoundly changing, data on the effect of vaccination and duration of protection can still be advantageous, especially for patients with COPD, who are more vulnerable to respiratory infections. The Hungarian-COVID-19 registry was retrospectively investigated for vaccine effectiveness (VE) and daily risk for infection and hospitalization by time since the last vaccination and vaccine type in adults with COPD diagnosis and an exact-matched control group during the Delta VOC wave in Hungary. For the matching sex, age, major comorbidities, vaccination status, and prior infection was used on August 23, 2021. The study population included 373 962 cases divided into COPD patients (age: 66.67±12.66) and a 1:1 matched group (age: 66.73±12.67). In both groups, the female/male ratio was 52.2:47.7. There was no significant difference between the groups in daily risks for infection or hospitalization among the unvaccinated. Regarding vaccinated cases, a faster decline of effectiveness was noted for hospitalization prevention in the COPD group regardless of vaccine type. The VE reduction in this group was from 90.1% (mRNA) and 87.8% (other) to 48.8% and 34.1% respectively in 180 days. Based on the time-stratified multivariate Cox analysis of the vaccinated cases, the hazard ratio was 1.09 (95% CI: 1.05-1.14) for infection and 1.87 (95% CI: 1.59-2.19) for hospitalization in the COPD group. Based on our study COPD patients are at higher risk for SARS-Cov2 VE waning and have altogether a higher risk for infection and need for hospitalization emphasizing suggestion for revaccination measures in this patient population.

The song alluded in the title could be continued by saying that people around the countries criticised the measures to contain COVID-19. Beliefs in a just word (BJW) are related with affective reactions triggered by extreme events. The aim was to test Affective Events Theory (AET) by analysing to what extent work environments have influence on affective experience and job outcomes. Participated 449 teleworkers in Brazil and 236 in France, countries with similar periods of compulsory telework, but that adopted different policies. Results revel low positive emotions tend to decrease perceived job satisfaction when BJW is high in both contexts. Among French teleworkers, it is also true when we have high negative emotions. BJW directly affects job performance and satisfaction in Brazil, but it is only valid for job satisfaction in France. Results offers support for AET and presents how work environments indirectly influence affective experience and job outcomes.

SARS-CoV-2 and its ever-emerging variants, are spread from host-to-host via expelled respiratory aerosols and saliva droplets. Knowing the number of virions which are exhaled by a person requires precise measurements of the size, count, velocity and trajectory of the virus-laden particles that are ejected directly from the mouth. These measurements are achieved in 3D, at 15000 images/second, and are applied when speaking, yelling, and coughing. In this study 33 events have been analysed by post-processing ~500000 images. Using these data, the flow rate of SARS-CoV-2 virions have been evaluated. At high concentrations, 10^7 virions/mL, it is found that 136 to 231 virions are ejected during a single cough, where the virion flow rate peak is capable of reaching 32 virions within a millisecond. This peak can reach tens of virions/ms when yelling, but reduced to only a few virions/ms when speaking. At medium concentrations, ~10^5 virions/mL, those results are hundreds of times lower. The total number of virions that are ejected when yelling at 110db, instead of speaking at 85db, increases by two to three fold. From the measured data analysed in this article, the flow rate of other diseases such as influenza, tuberculosis or measles, can also be estimated. As these data are openly accessible, they can be used by modellers for the simulation of saliva droplet transport and evaporation, allowing to further advance our understanding of airborne pathogen transmission.