Excess mortality during the COVID-19 pandemic in low-and lower-middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Although the COVID-19 pandemic claimed a great deal of lives, it is still unclear how it affected mortality in low- and lower-middle-income countries (LLMICs). This review summarized the available literature on excess mortality during the COVID-19 pandemic in LLMICs, including methods, sources of data, and potential contributing factors that might have influenced excess mortality. METHODS: We conducted a systematic review and meta-analysis on excess mortality during the COVID-19 pandemic in LLMICs in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines We searched PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Scopus. We included studies published from 2019 onwards with a non-COVID-19 period of at least one year as a comparator. The meta-analysis included studies reporting data on population size, as well as observed and expected deaths. We used the Mantel-Haenszel method to estimate the pooled risk ratio with 95% confidence intervals. The protocol was registered in PROSPERO (ID: CRD42022378267). RESULTS: The review covered 29 countries, with 10 countries included in the meta-analysis. The pooled meta-analysis included 1,405,128,717 individuals, for which 2,152,474 deaths were expected, and 3,555,880 deaths were reported. Calculated excess mortality was 100.3 deaths per 100,000 population per year, with an excess risk of death of 1.65 (95% CI: 1.649, 1.655, p < 0.001). The data sources used in the studies included civil registration systems, surveys, public cemeteries, funeral counts, obituary notifications, burial site imaging, and demographic surveillance systems. The primary techniques used to estimate excess mortality were statistical forecast modelling and geospatial analysis. One out of the 24 studies found higher excess mortality in urban settings. CONCLUSION: Our findings demonstrate that excess mortality in LLMICs during the pandemic was substantial. However, estimates of excess mortality are uncertain due to relatively poor data. Understanding the drivers of excess mortality, will require more research using various techniques and data sources.

Animal Health Discourse during Ecological Crises in the Media-Lessons Learnt from the Flood in Thessaly from the One Health Perspective.

Due to the increasing risk of extreme events caused by climate change (i.e., floods, fires and hurricanes) or wars, European veterinary public health may need some improvement. Utilizing a mix of qualitative (participatory observation) and quantitative methods (Internet mining), we analyzed the Greek media's responses to the millennial flood in Thessaly (September 2023), focusing on animal health (including wild, companion animals and livestock) and public sentiment towards epizootic/epidemic threats. The study revealed a gap in crisis management plans regarding veterinary-related issues, emphasizing the need for comprehensive emergency response strategies. Our findings show how (i) the lay referral system is projecting the perception of epidemic threats into the population; (ii) the emotional load of images of animal carcasses is misused by media creators aiming for a big audience; and (iii) pets' owners are creating online communities for the searching and treatment of their pets. Our results stress the importance of integrating crisis communication in consecutive phases of the discourse, such as the following: (i) weather change; (ii) acute flood; (iii) recovery; and (iv) outbreaks, into veterinary practices to better prepare for such disasters.

Excess mortality during the COVID-19 pandemic in low-income and lower middle-income countries: protocol for a systematic review and meta-analysis.

INTRODUCTION: The COVID-19 pandemic has been marked by a massive death toll. However, the overall effect of the pandemic, including potential unintended negative impacts of some control measures, on mortality remains poorly understood in low-income and lower middle-income countries (LLMICs). This review aims to summarise the available literature on excess mortality in LLMICs, focusing on the methods and data sources used in estimating excess mortality and the drivers of excess mortality. METHODS AND ANALYSIS: We will review the available literature and report results in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis. Searches will be conducted in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar and Scopus. All published studies that report on the estimates of excess mortality in populations of LLMICs will be included. This will include those with a publication date from 2019 onwards and those with at least a 1-year non-COVID-19 period as the comparator in the estimation of excess mortality during the pandemic. There will be no language restrictions on the search. The meta-analysis will include studies with extractable data on excess mortality, methods, population size, and observed and expected deaths. We will use the Mantel-Haenszel method to estimate the pooled risk ratio with 95% CIs. ETHICS AND DISSEMINATION: As there is no primary data collection, there is no requirement for ethical review. The results will be disseminated through peer-reviewed journal publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42022378267.

Telemonitoring in Long-COVID Patients-Preliminary Findings.

The COVID-19 pandemic has revealed the high usefulness of telemedicine. To date, no uniform recommendations or diagnostic protocols for long-COVID patients have been developed. This article presents the preliminary results of the examination of patients after SARS-CoV-2 infection who were provided with medical telemonitoring devices in order to oversee their pulmonological and cardiological health. Three cases have been analyzed. Each patient underwent a 10-day registration of basic vital signs, in three 15-min sessions daily: RR (respiratory rate), ECG (electrocardiogram), HR (pulse), SPO2 (saturation), body temperature and cough. Rule methods and machine learning were employed to automatically detect events. As a result, serious disorders of all the three patients were detected: cardiological and respiratory disorders that required extended diagnostics. Furthermore, average values of the selected parameters (RR, HR, SPO2) were calculated for every patient, including an indication of how often they exceeded the alarm thresholds. In conclusion, monitoring parameters in patients using telemedicine, especially in a time of limited access to the healthcare system, is a valuable clinical instrument. It enables medical professionals to recognize conditions which may endanger a patient's health or life. Telemedicine provides a reliable assessment of a patient's health status made over a distance, which can alleviate a patient's stress caused by long-COVID syndrome. Telemedicine allows identification of disorders and performing further diagnosis, which is possible owing to the implementation of advanced analysis. Telemedicine, however, requires flexibility and the engagement of a multidisciplinary team, who will respond to patients' problems on an ongoing basis.

Mild Adverse Events of Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning.

BACKGROUND: There is a limited amount of data on the safety profile of the COVID-19 vector vaccine Gam-COVID-Vac (Sputnik V). Previous infodemiology studies showed that social media discourse could be analyzed to assess the most concerning adverse events (AE) caused by drugs. OBJECTIVE: We aimed to investigate mild AEs of Sputnik V based on a participatory trial conducted on Telegram in the Russian language. We compared AEs extracted from Telegram with other limited databases on Sputnik V and other COVID-19 vaccines. We explored symptom co-occurrence patterns and determined how counts of administered doses, age, gender, and sequence of shots could confound the reporting of AEs. METHODS: We collected a unique dataset consisting of 11,515 self-reported Sputnik V vaccine AEs posted on the Telegram group, and we utilized natural language processing methods to extract AEs. Specifically, we performed multilabel classifications using the deep neural language model Bidirectional Encoder Representations from Transformers (BERT) "DeepPavlov," which was pretrained on a Russian language corpus and applied to the Telegram messages. The resulting area under the curve score was 0.991. We chose symptom classes that represented the following AEs: fever, pain, chills, fatigue, nausea/vomiting, headache, insomnia, lymph node enlargement, erythema, pruritus, swelling, and diarrhea. RESULTS: Telegram users complained mostly about pain (5461/11,515, 47.43%), fever (5363/11,515, 46.57%), fatigue (3862/11,515, 33.54%), and headache (2855/11,515, 24.79%). Women reported more AEs than men (1.2-fold, P<.001). In addition, there were more AEs from the first dose than from the second dose (1.1-fold, P<.001), and the number of AEs decreased with age (ß=.05 per year, P<.001). The results also showed that Sputnik V AEs were more similar to other vector vaccines (132 units) than with messenger RNA vaccines (241 units) according to the average Euclidean distance between the vectors of AE frequencies. Elderly Telegram users reported significantly more (5.6-fold on average) systemic AEs than their peers, according to the results of the phase 3 clinical trials published in The Lancet. However, the AEs reported in Telegram posts were consistent (Pearson correlation r=0.94, P=.02) with those reported in the Argentinian postmarketing AE registry. CONCLUSIONS: After the Sputnik V vaccination, Russian Telegram users reported mostly pain, fever, and fatigue. The Sputnik V AE profile was comparable with other vector COVID-19 vaccines. Discussion on social media could provide meaningful information about the AE profile of novel vaccines.

Incidence of Surgical Site Infections in Multicenter Study-Implications for Surveillance Practice and Organization.

INTRODUCTION: WHO core components of healthcare-associated infections (HAIs) prevention and control include their surveillance system. In Poland, there are no widespread multi-center infection surveillance networks based on continuous, targeted, active methodology. One of the most important form of HAIs are surgical site infections (SSIs). The aim of this study was to analyze the incidence of SSIs, in the context of seasonal differentiation. Seasonal differentiation could be connected with weather conditions, but it also can be affected by personnel absence due to holidays and furlough. The second aspect may influence organization of work and increased absenteeism may contribute to lowering the quality of patient care. Healthcare associated infections are the phenomenon which can be especially affected by such factors. METHODS: The data used originate from the targeted, active surveillance reports obtained from the six years period, based on the ECDC recommendations. RESULTS: Highest incidence rates of SSIs were found after operations performed in June and August, equal to 1.8% and 1.5% respectively and the lowest in October was 0.8%. These differences were statistically significant: for June incidence: OR 1.6, 95% CI 1.03-2.5, p = 0.015. Another approach showed a significant difference between the level of incidence in the period from November to January together with from June to August (1.35%), comparing to the rest of the year (1.05%). Also the rates of enterococcal and Enterobacterales infections were significantly higher for the period comprising months from November till January and from June to August. In Poland these are periods of increased number of absences associated with summer, national and religious holidays. CONCLUSIONS: Our results show that the short-term surveillance data limited to several days or months are not sufficient to obtain a valuable description of the epidemiological situation due to HAI. Efforts should be undertaken in order to implement wide net of hospital acquired infections, including SSI on the country level.

Trends in interest of COVID-19 on Polish Internet.

INTRODUCTION: This study aims to investigate the social interest in SARS-CoV-2 and COVID-19 in the Internet media during the epidemic in Poland and serves as a complement to longitudinal surveys monitoring public perception in real time. METHODS: We quantitatively analyzed "coronavirus" digital footprints on the Internet, in particular, on Google, Twitter, YouTube, Wikipedia and electronic media represented by EventRegistry, from 15.01 to 07.04.2020 (before and after official introduction of COVID-19 to Poland on 04.03.2020). We present results on trend analysis supported by statistical techniques. RESULTS: We identified six major temporal clusters of the interest on the topic COVID-19: 1) Chinese, 2) Italian, 3) Waiting, 4) Mitigations, 5) Physical distancing and Lockdown, 6) Anti-crisis shield. There was an exponential increase of the interest when the Polish government "declared a war against disease" around 11/12.03.2020 with a massive response activity. Later on, there was a decay in the interest with additional phases related to physical distancing and an anti-crisis legislation act associated with pronounced local peaks. We have found that declarations of response strategies by the Polish prime minister or the minister of health gathered the highest attention of Internet users. So already enacted or in force events do not affect the interest to such an extent. We have observed very weak or even negative correlations between a colloquial search term "antiviral mask" in Google, encyclopaedic definition in Wikipedia "SARS-CoV-2" as well as official COVID-19 incidence series, implying different mechanisms governing the search for knowledge, panic related behaviour and actual burden of COVID-19. CONCLUSIONS: Traditional and social media do not only reflect reality, but also create it. Interest in COVID-19 (measured by topic intensity on the Internet) is unrelated to the officially notified viral pressure (measured by incidence) and probably physical risk of acquiring infection in Poland. As traditional media are ahead of social media in time, we advise to choose traditional news media for a quick dissemination of information, however for a greater impact, social media should be used. Otherwise public information campaigns might have less impact on society than expected.

Factors Shaping Attitudes of Medical Staff towards Acceptance of the Standard Precautions.

Standard precautions (SPs) guidelines are the minimum infection prevention practices that apply to all types of patient care, regardless of suspected or confirmed infection status of the patient. They are based on risk assessment, make use of common sense practices and personal protective equipment that protect healthcare providers from infection and prevent the spread of infection from patient to patient. The aim of this study was to determine medical staff's attitudes towards SPs and analyse the factors shaping these attitudes. The study was conducted using a questionnaire that comprised 25 statements describing the attitudes of medical personnel towards SPs. They were designed to pinpoint the factors that determine these attitudes. There were five factors identified that shape employees' attitudes towards SPs: assessment of the situation, favourable patterns of behaviour, negative norms, unfavourable patterns of behaviour and rationalising. The study analysed 505 questionnaires filled in by hospital workers from five Polish cities. The majority of the respondents were women (92.1%), nurses (87.5%); the average age was 41.8 and the average seniority was 19.2 years. Over one-third of the respondents worked in non-surgical (36.4%) and surgical (31.6%) wards, 12.3% were employed in intensive care units (ICUs) and 8.9% in emergency departments (EDs). The variable significantly affecting the level of acceptance of SPs was seniority: initially the support was high, then it later decreased, with the greatest decrease occurring between the third and eighth year of work. The staff of medical wards and ICUs demonstrated significantly lower support for SPs and strong environmental impact on SPs perception; low degree of acceptance among medical ward staff correlated negatively with factors from the category "favourable patterns of behaviour". The substantially strongest support for SPs was found in ED workers. The results indicate the need for continuous education of individual groups of workers concerning the application of SPs, but also the necessity to change the organisational culture in Polish hospitals.

Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study.

BACKGROUND: Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. METHODS: The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. RESULTS: SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. CONCLUSIONS: Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control.

Host-specific Nod-factors associated with Medicago truncatula nodule infection differentially induce calcium influx and calcium spiking in root hairs.

Rhizobial nodulation (Nod) factors activate both nodule morphogenesis and infection thread development during legume nodulation. Nod factors induce two different calcium responses: intra-nuclear calcium oscillations and a calcium influx at the root hair tip. Calcium oscillations activate nodule development; we wanted to test if the calcium influx is associated with infection. Sinorhizobium meliloti nodL and nodF mutations additively reduce infection of Medicago truncatula. Nod-factors made by the nodL mutant lack an acetyl group; mutation of nodF causes the nitrogen (N)-linked C16:2 acyl chain to be replaced by C18:1. We tested whether these Nod-factors differentially induced calcium influx and calcium spiking. The absence of the NodL-determined acetyl group greatly reduced the induction of calcium influx without affecting calcium spiking. The calcium influx was even further reduced if the N-linked C16:2 acyl group was replaced by C18:1. These additive effects on calcium influx correlate with the additive effects of mutations in nodF and nodL on legume infection. Infection thread development is inhibited by ethylene, which also inhibited Nod-factor-induced calcium influx. We conclude that Nod-factor perception differentially activates the two developmental pathways required for nodulation and that activation of the pathway involving the calcium influx is important for efficient infection.