COVID, Volume 3, Issue 8 (August 2023) – 9 articles

Almost a year after the declaration of the pandemic due to the SARS-CoV-2 virus which causes the COVID-19 disease and the need to contain the progression and treatment, the promising option was designing an effective and safe vaccine to reach a state of massive immunity. The first vaccine approved was the one produced by Pfizer–BioNTech, and its application started in December 2020. Within days of the first applications, 0.2% of adverse events were reported. Herein, a series of 26 cases with the manifestation of adverse events related to the application of the first dose of the BNT162b2 vaccine from Pfizer–BioNTech in healthcare workers from Mexico. Of these cases, only five patients were classified with a certainty of anaphylaxis; two of them presented seizures, and their management is described individually. After the examination of all the cases, the symptoms were resolved. In Mexico and around the globe, the vaccination process continues, and the report of possible AEFIs is still needed to contribute to the pharmacovigilance of this new vaccine and improve its safety profile. Full article

During COVID-19, self-directed learning, contrasted with standardized learning, became a necessary and promoted learning method in public schools—one potentially supportive of mental health regularly in public schools through the use of online learning. This is important because negative mental health has been classified as a global crisis, with the highest and lowest student achievers recognized as at greatest risk. Therefore, the conditions under which public school students’ mental health has been improved, leading to positive psychosocial outcomes, are relevant. Studies have identified that positive psychosocial outcomes in this regard require self-initiation of students’ self-directed learning. Also necessary is a reduction in the standardized expectations of parents to lead to positive psychosocial outcomes. Unknown is what research identifies the relevance of both self-initiated self-directed online learning and a reduction in parental expectations of standardization. To investigate this, self-directed learning, online learning, mental health, public schools, and COVID-19 were keywords searched following PRISMA guidelines for scoping reviews. The result: few returns considered either factor and those that did reinforce the need for both. The conclusion: self-initiated self-directed online learning supported by public schools and parents should be central in the aim of reducing the mental health crisis in students post COVID-19. Full article

The Coronavirus disease 2019 (COVID-19) has significantly affected kidney transplantation activities around the world, thus resulting in a substantial decrease in both deceased and living transplants. This study presents a COVID-19 overview from the perspective of the Brazilian kidney transplant program by comparing its differences or similarities with the situations observed in other countries. During the first year of the pandemic, there was a 40% reduction in the number of kidney transplants worldwide. A similar scenario was observed in Brazil, which has the world’s largest public transplantation program. Beyond its effect on transplant activity, COVID-19 has influenced the outcomes of prevalent kidney transplant recipients (KTRs) because the prolonged use of immunosuppressive drugs and comorbidities increase the susceptibility of such patients to severe disease and death. In the pre-vaccination era, almost two-thirds of KTRs required hospitalization, more than 20% required dialysis, and one-third was admitted to the intensive care unit. In the pre-vaccination period in Brazil, 15% and 21% of KTRs died within 28 and 90 days of COVID-19 diagnosis, respectively. Although high vaccination coverage rates have altered the COVID-19 landscape in many populations, persistently low immunogenicity rates following sequential vaccination shots and the absence of targeted treatments for severe cases continue to classify KTRs as highly vulnerable, thus warranting significant concern. Full article

Background: The coronavirus disease (COVID) 2019 pandemic has been reported to have resulted in psychological disturbances. The Japanese term “hikikomori” refers to a state of preferring to stay at home. The COVID pandemic provided an opportunity to extend our current understanding of hikikomori by examining the psychological states of individuals who were in this state under lockdown, during which, paradoxically, their condition may have been adaptive. Methods: We administered a questionnaire to examine psychological changes among 600 people with hikikomori traits in Japan. The Hospital Anxiety and Depression Scale (HADS), Subjective Stress Scale, and Stigma Questions for hikikomori were administered retrospectively at three time points. We also collected descriptive data regarding the participants’ coping strategies. Results: The participants’ sense of stigma regarding hikikomori was improved during the pandemic, whereas depression and anxiety worsened. The participants with ‘definite’ hikikomori (they met the diagnostic criteria) reported more severe depression and anxiety than those with ‘possible’ hikikomori. Their coping strategies were adaptive to the pandemic situation. Conclusion: Although the sense of stigma against hikikomori was improved and adaptive strategies were employed, the participants with hikikomori experienced a worsening of depression and anxiety during the COVID lockdowns. The improvement of stigma and the participants’ indoor adaptive coping strategies could not ameliorate the mental state of hikikomori. Therapeutic interventions should be considered in the future for definite hikikomori meeting the criteria. Full article

Background: The COVID-19 pandemic disrupted global healthcare systems, requiring rapid adaptations. This study evaluates the impact on health systems and services in India during the peak of the first wave and its aftermath. It analyses disruptions, adaptive measures, and challenges faced by healthcare providers and seekers to enhance future preparedness. Methods: Primary studies conducted in India exploring the impact of COVID-19 on health services provision, utilisation, availability, and the well-being of providers and seekers were included. Electronic searches were conducted in six databases: PubMed, MEDLINE, Embase, Global Health, CINAHL, and the WHO database on COVID-19. The results were analysed using narrative synthesis. Results and Conclusion: The review examined 38 articles with 22,502 subjects. Health service provision, utilisation, and availability were significantly impacted, particularly in outpatient departments (n = 19) and elective services (n = 16), while emergency services remained sub-optimal (n = 20). Adaptations were made in precautionary measures, protocols, staff allocation, training, personal protective equipment (PPE), infrastructure, and resources. Providers faced mental health challenges including depression, stress (n = 14), fear of infection (n = 9), stigmatisation (n = 5), and financial repercussions (n = 5). Seekers also encountered notable challenges (n = 13). Future preparedness necessitates improved healthcare infrastructure, resource optimisation, and comprehensive protocols. Lessons should inform strategies to mitigate disruptions and prioritise the well-being of providers and seekers in future outbreaks. Full article

The coronavirus disease-2019 (COVID-19) pandemic has had a profound impact on the world, causing loss of life, economic damage, and social disruption. Individuals with chronic kidney disease (CKD) are prone to complications and increased mortality related to COVID-19. Efforts have been made to increase understanding of the effects of COVID-19 in individuals with CKD. This paper aims to gather and discuss the state-of-the-art in the COVID-19 and CKD literature, involving the early history of COVID-19, the immunological aspects of CKD (such as abnormalities in neutrophilicand dendritic cells functions), the mechanisms of kidney injury by SARS-CoV-2 (for example, viral tropism to kidney tissue and direct cytotoxicity), the clinical course of the disease and consequences for CKD individuals (including kidney transplant recipients), and the emerging treatments (such as the use of Remdesivir, nirmatrelvir, and monoclonal neutralizing antibodies) and immunization for the CKD population. Full article

The World Health Organization (WHO)-confirmed pandemic (March 2020) of the new Coronavirus 2 severe acute respiratory syndrome infection (SARS-CoV-2) reported in Wuhan, China, in December 2019 (first reported cases), then spread to Italy and successively around the world. The objective of this study is to evaluate the effectiveness of the restrictions implemented by different governments from a statistical point of view. We quantitatively evaluated how restrictions influenced the temporal evolution of the distribution of the weekly number of hospitalized patients in the intensive care unit (ICU) for different countries that applied different levels of restrictions, which can be summarized with the average stringency index, a synthetic index that represents a metric for quantifying the severity of the restrictions applied. We found that the stringency index is strongly correlated with the distribution skewness, while standard deviation and kurtosis are poorly and moderately influenced. Furthermore, we compared the values of the skewness of the distribution of hospitalized patients during several pre-pandemic influenza outbreaks in Italy (data not available for other countries). Analysis shows that for normal flu, there is a substantial difference in skewness (as much as 70%) in the distribution with respect to the first COVID-19 pandemic outbreak, where social restrictions were applied. This large difference highlights that the restrictions implemented modify the symmetry of the peak of the distribution of the hospitalized patient in the ICU. Therefore, skewness can be used as a valid indicator to assess whether restriction has any effect on pandemic transmission and can be used as a support for decision makers. Full article

In evaluating the effectiveness of COVID-19 control measures, we propose a standardized approach to assess the impact of COVID-19 management on flattening the curve by analyzing the case data of Victoria, Australia. Its capital, Melbourne, is considered the most lock-downed city in the world. We used the daily case data from Victoria and their first time derivative and compared the dates when the six lockdowns were imposed with the start and end of the effective period, i.e., the period between the maximum and minimum acceleration. Lockdowns 1, 2 (Level 4 restrictions), 3, and 4 were found to be implemented too late, as they were expected to come into effect at the end or after the effective phase, and they were therefore ineffective. It was determined that Lockdown 2 (Level 3 restrictions) did not initiate the effective phase, and it was therefore ineffective, too. Lockdown 5 was expected to take effect in the second half of the effective phase, but showed no changes in the acceleration curve, and it was therefore also ineffective. Lockdown 6, implemented well before the effective period, did not flatten the curve, and was thus also found to be ineffective. The mask mandate between Lockdown 2 (Level 3 and 4 restrictions) initiated the effective phase (likely along with Lockdown 2, Level 3 restrictions), and was therefore found to effectively flatten the curve. The temporal relationship between the assumed cause (control measure) and the observed effect (flattening of the curve) is thus a crucial parameter for assessing the effect of control measures. Full article

Located in the center of the largest river basin in the world, the State of Amazonas in Brazil has an extensive network of more than 20 thousand kilometers of navigable waterways, which is the main mode of transportation between localities, both for cargo and passengers. The region is practically disconnected from the rest of the country due to the lack of roads. Thus, the Amazon River network acted as an efficient means of transmission of the new coronavirus (COVID-19), rapidly transforming the region into an epicenter of the pandemic with one of the highest infection rates in Brazil. Despite the adoption of national and state measures to combat new infections, the situation continued to deteriorate for reasons still under investigation. Given this scenario, this work aims to identify possible infection risks in typical passenger vessels used in the Brazilian Amazon. Three case studies of different passenger vessels were considered, discussing possible scenarios that could allow the spread of COVID and proposing some recommendations for infection prevention. It is hoped that this communication will contribute to the dissemination of information related to the typical means of long-distance passenger transport in the Amazon, to the planning of infectious disease prevention strategies on board regional ships and to ensure a sustainable future for the Amazonian population. Furthermore, this research aims to contribute to the sustainable development goals of the United Nations 2030 Agenda on health and well-being. Full article