Enhancing home delivery of emergency medicine and medical supplies through clustering and simulation techniques: A case study of COVID-19 home isolation in Bangkok.

This study investigates the enhancement of the home delivery distribution network for COVID-19 Home Isolation (HI) kits during the Delta variant outbreak of the SARS-CoV-2 virus in Bangkok Metropolitan Area, Thailand. It addresses challenges related to limited resources and delays in delivering HI kits, which can exacerbate symptoms and increase mortality rates. A k-means clustering approach is utilized to optimize the assignment of service areas within the COVID-19 HI program, while discrete event simulation (DES) evaluates potential changes in the home delivery logistics network. Real-world data from the peak outbreak is used to determine the optimal allocation of resources and propose a new logistics network based on proximity to patients' residences. Experimental results demonstrate a significant 44.29 % improvement in overall performance and a substantial 40.80 % decrease in maximum service time. The findings offer theoretical and managerial implications for effective HI management, supporting practitioners and policymakers in mitigating the impact of future outbreaks.

Factors associated with the worsening of COVID-19 symptoms among cohorts in community- or home-isolation care in southern Thailand.

Introduction: This study aimed to investigate factors associated with time-to-referral due to worsening symptoms in patients with laboratory-confirmed COVID-19 in southern Thailand. While underlying diseases have been evaluated to assess COVID-19 severity, the influence of vaccinations and treatments is also crucial. Methods: A cohort of 8,638 patients quarantined in home or community isolation with laboratory-confirmed COVID-19 was analyzed. Survival analysis and the Cox proportional hazard ratio were employed to assess factors influencing time-toreferral. Results: Age ≥ 60 years, neurologic disorders, cardiovascular disease, and human immunodeficiency virus infection were identified as significant risk factors for severe COVID-19 referral. Patients who received full- or booster-dose vaccinations had a lower risk of experiencing severe symptoms compared to unvaccinated patients. Notably, individuals vaccinated during the Omicron-dominant period had a substantially lower time-to-referral than those unvaccinated during the Delta-dominant period. Moreover, patients vaccinated between 1 and 6 months prior to infection had a significantly lower risk of time-to-referral than the reference group. Discussion: These findings demonstrate early intervention in high-risk COVID-19 patients and the importance of vaccination efficacy to reduce symptom severity. The study provides valuable insights for guiding future epidemic management strategies and optimising patient care during infectious disease outbreaks.

Utilisation of the web-based Home Assessment Tool among patients with COVID-19 in Selangor, Malaysia: An observational study.

Introduction: The COVID-19 pandemic has caused many countries to turn to web-based solutions. The Home Assessment Tool (HAT) is a web-based system using the MySejahtera application developed by the government. It serves as a communication platform for patients with COVID-19 to self-monitor their clinical symptoms and enables authorised healthcare personnel to access and manage collected data for clinical monitoring. Our study aimed to examine the utilisation of this internet-based tool among patients with COVID-19 in Selangor. Methods: This observational study analysed secondary data from the self-reported HAT within MySejahtera. It included all patients who were diagnosed with COVID-19 through molecular assays such as RT-PCR or RTK-Ag on 1-21 February 2021, aged >18 years and residing in Selangor. Patients who had documented their symptoms at least once in the HAT during the prescribed 10-day isolation period were classified as HAT users. Results: A total of 4438 patients were included, of whom 39.4% were HAT users, while 60.6% were non-HAT users. Logistic regression analysis revealed three significant factors associated with low utilisation of the HAT: absence of medical condition (odds ratio [OR]: 9.4; 95% confidence interval [CI]: 7.49-12.01), advanced age (OR: 1.35; 95% CI: 1.20-1.52) and non-Malaysian citizenship (OR: 3.4; 95% CI: 2.50-4.72). Conclusion: The utilisation of the HAT is low, which is associated with advanced age (>65 years), absence of medical conditions and foreign nationality. It is imperative to develop inventive strategies tailored to address the unique needs of these particular demographics.

CHIVID: A Rapid Deployment of Community and Home Isolation During COVID-19 Pandemics.

BACKGROUND: CHIVID is a telemedicine solution developed under tight time constraints that assists Thai healthcare practitioners in monitoring non-severe COVID-19 patients in isolation programs during crises. It assesses patient health and notifies healthcare practitioners of high-risk scenarios through a chatbot. The system was designed to integrate with the famous Thai messaging app LINE, reducing development time and enhancing user-friendliness, and the system allowed patients to upload a pulse oximeter image automatically processed by the PACMAN function to extract oxygen saturation and heart rate values to reduce patient input errors. METHODS: This article describes the proposed system and presents a mixed-methods study that evaluated the system's performance by collecting survey responses from 70 healthcare practitioners and analyzing 14,817 patient records. RESULTS: Approximately 71.4% of healthcare practitioners use the system more than twice daily, with the majority managing 1-10 patients, while 11.4% handle over 101 patients. The progress note is a function that healthcare practitioners most frequently use and are satisfied with. Regarding patient data, 58.9%(8,724/14,817) are male, and 49.7%(7,367/14,817) within the 18 to 34 age range. The average length of isolation was 7.6 days, and patients submitted progress notes twice daily on average. Notably, individuals aged 18 to 34 demonstrated the highest utilization rates for the PACMAN function. Furthermore, most patients, totaling over 95.52%(14,153/14,817), were discharged normally. CONCLUSION: The findings indicate that CHIVID could be one of the telemedicine solutions for hospitals with patient overflow and healthcare practitioners unfamiliar with telemedicine technology to improve patient care during a critical crisis. Clinical and Translational Impact Statement- CHIVID's success arises from seamlessly integrating telemedicine into third-party application within a limited timeframe and effectively using clinical decision support systems to address challenges during the COVID-19 crisis.

Caregiving experiences of primary family caregivers caring for family members affected by COVID-19 during home isolation: A phenomenology study.

During home isolation due to the coronavirus disease, family caregivers assumed the responsibility of caring for infected family members; however, the full extent of the difficulties and challenges they encountered remains unclear. This study applied a descriptive phenomenology approach, using semi-structured, one-on-one, in-depth interviews to explore the experiences of 16 primary family caregivers during home isolation amid the coronavirus disease. The key themes identified were as follows: (1) protecting family, comprising anxiety over preventing infection and bearing the responsibility of caregiving and a concern about the diagnosis; (2) seeking stability, encompassing the impact of epidemic control policies on daily routines, strategies to overcome obstacles caused by quarantine measures, and gathering resources and receiving support; and (3) reflections on life, including favoring love over discrimination, rediscovering oneself, cherishing family, and acknowledging personal growth and dedication. This study highlights that family members who took on caregiving roles due to obstacles or health risks faced significant pressure to protect their family members during isolation and actively sought professional consultation and acquired caregiving skills to enhance their confidence and adaptability.

Home Isolated COVID-19 Patients Adhering To Recommended Guidelines: A Cross Sectional Survey In Karachi.

Objectives: To assess compliance level of coronavirus disease-2019 patients with recommended isolation guidelines. METHODS: The cross-sectional phone-based survey was conducted in Karachi, from March to October 2020 after approval from the ethics review board of Dow University of Health Sciences, Karachi, and comprised patients of either gender who had been tested positive and were advised home isolation due to mild/asymptomatic nature of their infection. Data was collected using a predesigned 42-item questionnaire in the light of the guidelines issued by the National Institutes of Health, Islamabad, Pakistan. Data was analysed using SPSS 20. RESULTS: Of the 450 patients approached, 305(68%) responded; 176(57.7%) females and 129(41.1%) males. The overall mean age was 35.16±14.15 years (range: 13-78 years). Of the total, 9(2.95%) patients did not isolate themselves at all, 51(16.7%) came into contact with other people, 75(24.6%) broke the home isolation and 69(22.6%) were sharing their rooms with other family members. Overall, 260(85.2%) participants were keeping themselves updated with the changes in the guidelines through conventional and social media. CONCLUSIONS: Coronavirus disease-2019 patients who were advised home isolation adhered to some but not all of the recommendations.

Secondary household transmission of SARS-CoV-2: a case-control study on factors associated with reduced transmission risk.

OBJECTIVES: This study aimed to identify factors deterring secondary household transmission of SARS-CoV-2 from SARS-CoV-2-positive cohabitants. METHODS: A case-control study was conducted with 272 healthcare workers in close contact with SARS-CoV-2-positive cohabitants. Logistic regression modeling was employed to determine the factors independently associated with secondary household transmission. RESULTS: A SARS-CoV-2 infection within the past 6 months was the most protective factor against secondary household transmission (adjusted odds ratio = 0.07, 95% CI: 0.01-0.61, P <0.05). Home isolation and older age of primary index case (7-12, ≥18 years) were also associated with a reduced risk. Both monovalent and bivalent messenger ribonucleic acid booster vaccinations exhibited potential protective tendencies but were not statistically significant. Additionally, bivalent vaccines did not demonstrate a clear advantage over monovalent vaccines. CONCLUSION: A recent history of SARS-CoV-2 infection, home isolation of positive cohabitants, and older age of primary index cases were positively associated with a reduced risk of secondary household transmission. Regarding booster vaccinations, data from a single center with a limited sample size may not capture all statistically significant differences, necessitating broader studies.

Outcomes of home-isolated coronavirus disease 2019 patients in Bahrain.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic resulted in a huge burden on healthcare systems and necessitated a risk assessment of patients and an update of the treatment protocol to include home isolation for low-risk patients. The primary objective was to describe the outcome of home isolation and the characteristics of patients at higher risk of admission. The secondary objectives were to determine the proportion of patients with pneumonia and hypoxemia and the correlation between cycle of the threshold (CT) value and severity of the disease. MATERIALS AND METHODS: For this study, 394 patients were randomly selected from a total of 8000 home-isolated COVID-19 patients during July to October 2020, and were followed by Bahrain International Hospital (BIH). All data were obtained from a live Excel sheet completed by physicians covering BIH during the study period. Data analysis included Chi-square test to determine significant association between categorical variable, Pearson correlation, and logistic regression analysis. RESULTS: Of the 394 home-isolated patients followed, 18 patients with missing data were excluded. The overall admission rate was 50% for ≥50 age group compared to 13.3% for 18-49 age group, while only 2.8% in <18 age group. Moreover, Intensive Care Unit (ICU) admissions were significantly higher in the older age group: 15.2% for ≥50 age group (P < 0.001). About 14% of the patients with comorbidities needed ICU admission, compared with 1.8% of those without comorbidities (P < 0.001). Of the home-isolated patients, 6.3% were diagnosed with pneumonia and 9.9% of those presenting had low oxygen saturation. The CT value was significantly correlated with the severity of symptoms and the need for admission. CONCLUSION: Home isolation of low-risk patients with monitoring and follow-up was a safe and necessary step in dealing with the COVID-19 pandemic.

Home-Isolation Care in Newly COVID-19-Positive Elderly Patients: A Caregiver-Centric Explanatory Framework.

Objectives: This community-based study aimed to identify the effect of different behavioral factors of family caregivers on the decision for home-isolation-based treatment of a new COVID-19-diagnosed elderly individual. It also explored the facilitators and barriers contributing to the decision-making process. Methods: A mixed-methods design was adopted to study the role of behavioral constructs such as risk tolerance, risk aversion, regret aversion, loss aversion, self-efficacy, and risk perception in healthcare-seeking decisions. By integrating the findings from the quantitative and qualitative parts, a framework was developed. Results: Self-efficacy, risk perception, and risk tolerance related to different issues were crucial factors behind the healthcare decision. However, regarding the various issues under consideration, risk perception followed by risk tolerance were the significant predictors for decision-making. Conclusion: To enhance appropriateness and equity in emergency healthcare-seeking, interventions should target risk tolerance and risk perception, taking into account the awareness levels of caregivers and the target population's risk and regret aversion. Such integrated approaches can improve the quality of care for elderly patients in home-based settings.

Are COVID-19 patients given adequate instructions about toothbrush hygiene? A cross-sectional study.

OBJECTIVE: The aim of this study was to evaluate toothbrush hygienic practices, whether subjects with a positive COVID-19 test received instructions about toothbrush hygiene, and to determine if carriers of SARS CoV-2 were assigned separate bathrooms during home isolation. METHODS: Data were collected by an anonymous online questionnaire. Variables of interest included toothbrush hygiene practices, receiving instructions on toothbrush handling if tested positive for COVID-19, and being assigned separate bathrooms during home isolation. RESULTS: From November 2020 through April 2021; 755 responded (472 [62.5%] females, 269 [35.6%] males, 14 [1.85%] did not specify their gender). 14 (4.1%) of 341 respondents who reported a positive result of a COVID-19 test received instructions about how to maintain their toothbrush during home isolation. The majority of subjects (74.4%) reported the use of water to wet their toothbrush before brushing, this practice was significantly more common among young subjects (p < 0.001). 58.6% wash all parts of the toothbrush after use while 38.8% wash the head of the toothbrush, and 1.6% place the toothbrush in an antiseptic. 53% used separate bathrooms during isolation, this was significantly associated with age group (p = 0.006) and higher monthly income (p = 0.02). CONCLUSIONS: The majority of participants with a positive result of the COVID-19 test were not given explicit instructions about toothbrush handling. Less than half reported good toothbrush hygienic practices. Higher monthly income was significantly associated with using a separate bathroom during home isolation. Providing explicit instructions about toothbrush hygiene is recommended to reduce the spread of contagious diseases such as COVID-19.

Health Status and Management Practices of Home Isolated COVID-19 Adult Patients.

BACKGROUND: The worldwide containment strategy for COVID-19 outbreak includes laboratory-confirmed cases, and their isolation and management in health care institutions or at home. The spread of the COVID-19 virus has mandated home isolation for mild cases, as recommended by the Government of Nepal. Isolation is a situation that can have a substantial influence on physical and mental health of isolated people. This study is aimed to assess physical and mental well-being of COVID-19 home isolated patients, and their home management practices. METHODS: A descriptive cross-sectional research using quantitative methods was carried out. Purposive sampling was used to select COVID-19 patients. Total 536 COVID-19 home isolated patients were included in this study. Telephonic interview was conducted to obtain the data. Descriptive analysis was done and interpreted. RESULTS: About 34 % of the participants were symptomatic. The most common symptoms experienced were fever (22.6%), followed by cough (19.4%) and cold (16.1%). About 20 % indicated having difficulties isolating at home due to lack of separate room. Furthermore, 4 percent of the participants didn't have anyone to take care of them at home. Also almost 2 percent of participants didn't get family support when infected. Moreover, majorities of individuals had normal stress, depression and anxiety level. CONCLUSIONS: Most of the participants' physical and mental health was found to be normal though some of them experienced difficulties for management during home isolation. Hence, Interventions should focus resilience building by improving communication to address fears and concerns, encouraging routines and physical activities, and taking measures to reduce loneliness.

Depression and the risk factors for isolated infectious disease fever patients in the hospital during the COVID-19.

Objectives: To compare and analyze the incidence of anxiety and depression of infectious disease fever patients in hospitalized isolation and home isolation during the COVID-19 pandemic, as well as the risk factors for the negative emotions of hospitalized isolation patients. Methods: Forty isolated infectious disease fever patients in Baoding No.1 Hospital were randomly selected as the study group, and the other 40 isolated infectious disease fever patients at home were randomly selected as the control group from March 2020 to August 2020. The scores and prevalence of depression and anxiety between the two groups were compared and analyzed. The logistic regression analysis was used to judge and analyze the negative psychological factors of hospitalized isolation patients such as depression and anxiety. Result: The HAMA and HAMD-17 scores of study group are significantly higher than those of control group (HAMA, p=0.00; HAMD-17, p=0.01). The prevalence of anxiety and depression in the study group was significantly higher than that in the control group (p=0.03, p=0.04). The gender (p=0.002), economic status (p=0.004) and isolation attitude (p=0.023) are the related factors of anxiety, among which economic status is the protective factor, while women and resistant attitude are the risk factors. Economic status (p=0.003) and isolation attitude (p=0.001) are the related factors of depression, among which economic status is the protective factor, and resistant attitude is the risk factor. Conclusion: The prevalence and severity of anxiety and depression in hospitalized isolation patients due to infectious disease fever are significantly higher than those of home isolation patients. The focus groups are women, with bad economic status and poor isolation attitude. Necessary psychological counseling and social support should be provided to these groups to reduce negative emotions and increase the experience of isolated patients.

Telepharmacy during home isolation: drug-related problems and pharmaceutical care in COVID-19 patients receiving antiviral therapy in Thailand.

BACKGROUND: Home isolation has been proposed for coronavirus disease 2019 (COVID-19) patients with mild symptoms to avoid hospital overcrowding. This study aimed to describe the drug-related problems (DRPs) and the pharmaceutical care of home-isolating COVID-19 patients in Thailand. METHODS: Our cross-sectional study was undertaken from July 1 to September 30, 2021, at the King Chulalongkorn Memorial Hospital, Thailand. Patients who were ≥ 18 years old, were diagnosed with mild COVID-19 by real-time polymerase chain reaction (RT-PCR), and were able to isolate at home while receiving an antiviral agent and standard symptomatic treatment were enrolled. Infectious disease pharmacists provided a telepharmacy service on days 1 and 3 after the COVID-19 diagnosis. RESULTS: A total of 197 patients met the study criteria. Their median age was 45 years, and their most common underlying disease was hypertension (44.29%). All patients exhibited excellent anti-COVID-19 drug adherence. We identified 125 DRPs, including adverse reactions (68%), and the unnecessary use of products (62.40%). Moreover, 91 patients (46.19%) reported the use of supplements or herbs, with vitamin C being the main supplement (37.36%). Pharmacists provided 36 recommendations and received 33 questions from COVID-19 patients. CONCLUSIONS: Our study demonstrates that telepharmacy is an essential service for detecting and preventing DRPs in home-isolating COVID-19 patients.

Prevalence and factors associated with depression, anxiety, and stress symptoms among home isolated COVID-19 patients in Western Nepal.

Introduction: Globally, COVID-19 pandemic has a significant impact on mental health. In Nepal, COVID-19 positive cases have to self-isolate at home in multi-generational and multi-family households. This could be strongly associated with depression, anxiety, and stress-related health outcomes. Additionally, COVID-19 related stigma and fear of transmission may intensify depression, anxiety, and stress symptoms. This study determined the prevalence of depression, anxiety, and stress symptoms and their association with presence of COVID-19 symptoms and comorbid conditions among home isolated COVID-19 positives in the Karnali province, Nepal. Methods: We conducted a cross-sectional study to assess depression, anxiety, and stress symptoms among 402 home isolated COVID-19 patients of Karnali province from January to May 2021 using "Depression, Anxiety and Stress Scale-21 (DASS-21)". We interviewed patients to collect socio-demographic, DASS-21, COVID-19 symptoms, comorbid conditions, and self-treatment. We conducted a telephonic interview using a standardized questionnaire using Kobotoolbox. We calculated the prevalence of depression, anxiety, and stress symptoms. We utilized univariate and multivariate logistic regression to determine their association with the presence of COVID-19 symptoms and comorbid conditions. In multivariate logistic regression, we adjusted sociodemographic factors (age, gender, ethnicity, marital status, monthly family income, education level), smoking status and history of self-treatment. We reported adjusted odds ratios (aOR) with 95% confidence intervals. All analyses were conducted in R (version: 4.0.3). Results: The prevalence of depression, anxiety and stress symptoms among home isolated COVID-19 patients were 8.0% (95% CI: 5.5 to 11.1), 11.2% (95% CI: 8.3 to 14.7), and 4.0% (95% CI: 2.3 to 6.4) respectively. Higher odds of depression symptoms (aOR: 2.86; 95% CI: 1.10-7.44, p = 0.03), anxiety symptoms (aOR: 3.81; 95% CI: 1.62 to 8.93; p = <0.01) and stress symptoms (aOR: 7.78; 95% CI: 1.43 to 42.28; p = 0.02) were associated significantly with presence of COVID-19 symptoms in past week. Higher odds of anxiety symptoms were associated with the presence of comorbid conditions (aOR = 2.92; 95% CI: 1.09 to 7.80; p = 0.03). Conclusion: Depression, anxiety, and stress symptoms were present in a significant proportion of home isolated COVID-19 patients in western Nepal and positively associated with the presence of COVID-19 symptoms. In this global COVID-19 pandemic, it is important to provide timely counseling to high-risk groups like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.

The association of self-control, self-efficacy, and demographic characteristics with home-based E-learning behavior in nursing and midwifery undergraduates: A cross-sectional study under the COVID-19 epidemic.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, nursing and midwifery undergraduate students' time spent in home isolation and being engaged in home-based e-learning was extended. Limited research has been conducted on home-based e-learning behavior during home isolation, and the relationships between individual factors, such as self-control, self-efficacy, and other demographic characteristics, and home-based e-learning behavior are unclear. OBJECTIVES: This study aimed to explore the associations between self-control, self-efficacy, and demographic information with home-based e-learning behavior among nursing and midwifery undergraduates during the COVID-19 pandemic. DESIGN AND METHODS: A cross-sectional study was employed, and an online survey was conducted with 3733 nursing and midwifery undergraduates across seven provinces and cities in mainland China. Data were collected using the Brief Self-control Scale, General Self-efficacy Scale, Undergraduate Home-based E-learning Behavior Questionnaire, and Demographic Information Questionnaire. A multiple linear regression analysis using the stepwise method was conducted to identify predictors of home-based e-learning behavior. RESULTS: Undergraduates achieved an overall mean score of 26.02 (SD = 4.20) for home-based e-learning behavior and an overall mean score of 42.54 (SD = 6.22) and 27.59 (SD = 3.89) for self-control and self-efficacy, respectively. Better self-control (ß = 0.250, P < 0.001), higher self-efficacy (ß = 0.169, P < 0.001), universities being located in non-Hainan provinces (ß = 0.249, P < 0.001), being a sophomore or freshman (ß = -0.255, P < 0.001), and good perceived health status (ß = -0.044, P = 0.003) were identified as the predictors of better home-based e-learning behavior among nursing and midwifery undergraduates. CONCLUSION: Self-control, self-efficacy, and demographic characteristics including the province of the university, grade level, and personal perceived health status were associated with home-based e-learning behavior. Universities should help nursing and midwifery undergraduates improve self-control and enhance self-efficacy while taking measures to decrease the impact caused by demographic characteristic differences.

PA during the COVID-19 outbreak in China: a cross-sectional study.

COVID-19 has undergone several mutations and is still spreading in most countries now. PA has positive benefits in the prevention of COVID-19 infection and counteracting the negative physical and mental effects caused by COVID-19. However, relevant evidence has indicated a high prevalence of physical inactivity among the general population, which has worsened due to the outbreak of the pandemic, and there is a severe lack of exercise guidance and mitigation strategies to advance the knowledge and role of PA to improve physical and mental health in most countries during the epidemic. This study surveyed the effects of COVID-19 on PA in Chinese residents during the pandemic and provided important reference and evidence to inform policymakers and formulate policies and planning for health promotion and strengthening residents' PA during periods of public health emergencies. ANOVA, Kolmogorov-Smirnov, the chi-square test and Spearman correlation analysis were used for statistical analysis. A total of 14,715 participants were included. The results show that nearly 70% of Chinese residents had inadequate PA (95%CI 58.0%-82.19%) during the COVID-19 outbreak, which was more than double the global level (27.5%, 95%CI 25.0%-32.2%). The content, intensity, duration, and frequency of PA were all affected during the period of home isolation, and the types of PA may vary among different ages. The lack of physical facilities and cultural environment is the main factor affecting PA. However, there was no significant correlation between insufficient PA and the infection rate. During the period of home isolation and social distance of epidemic prevention, it is necessary to strengthen the scientific remote network monitoring and guidance for the process of PA in China.

COVID-19 isolation/quarantine rules in home care patients.

The spread of Severe Acute Respiratory Syndrome Coronavirus 2 new variants increased the number of subjects in home isolation and quarantine. The aim of this study was to assess the compliance with coronavirus disease 2019 home isolation rules for 32 subjects in home care in Marche Region, Italy. The results showed that subjects in home isolation were better informed about isolation rules (P = 0.007) than those who were in quarantine. They had lower educational level (P < 0.001) and none/single income (P < 0.001) and higher rate of clinical manifestation. The education for a safe quarantine should be strengthened widely, especially among disadvantaged subjects.

Home care in COVID-19 patients with the home-quarantined condition: A study from Iran.

Objectives: During the COVID-19 home-quarantines, home care services may act as an auxiliary component of health care system, which reduces the burden on the formal health care system. This study aimed to investigate the status of informal home care provided for home quarantined patients with COVID-19 in southwest Iran. Methods: This descriptive study was conducted on 288 patients with COVID-19 in Ahvaz (southwest Iran). Inclusion criteria included a known case of COVID-19, willingness to participate in the study, recommendation of home quarantine from a health center, having a smartphone, and fluency in reading and writing in Persian, and the exclusion criterion was a history of COVID-19 longer than 3 months. The data collection method was structured interviews based on a questionnaire (face-to-face-telephone calls-video call). SPSS software was used for the analysis of data. Results: 45.5% of the participants in the study were women with a mean age of 37.82 (10.48%) and 55.5% were men with a mean age of 36.12 (11.93%). Findings showed that in most cases, the spouse (61.4) is responsible for the care of the patient, and in other cases, parents are responsible for this duty. 57.3% of the patients stated that they themselves had to leave home to provide for necessities of life, and 37.2% stated that they were in charge of cooking. 47.9% of the patients evaluated the quality of quality of care provided at home as good. Most of patients and caregivers referred to hospital for getting information (35.8% patients and 34% caregivers). Most of patients recovered from diseases (60.8%) and 39.2% were hospitalized. Although 43.9% of men and 33.6% of women were hospitalized and a there was a significant difference between men and women (P < 0.04). Conclusion: During COVID-19 pandemic home care to reduce the burden on the health system are very important. We must also know that this type of care requires informed and planned support and sufficient community education. The health care system needs to put self-care and family care among its top priorities. The focus should be on educational and mental support of informal caregivers along with measures that protect their relatives from COVID-19.

COVID's collateral damage: likelihood of measles resurgence in the United States.

BACKGROUND: Lockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that post-lockdown, these reduced MMR rates will lead to a resurgence of measles. METHODS: To measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed. RESULTS: Results show that a decrease in vaccination rate [Formula: see text] has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold [Formula: see text]. At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate. CONCLUSIONS: At low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions.

Effectiveness of a monitored home isolation program for COVID-19 infection during the second wave of the pandemic.

Background: The rapidity of spread of COVID-19 infection during the second wave of the pandemic placed tremendous stress on healthcare resources. This study evaluated the effectiveness of a monitored home isolation (HI) program. Methods: In this descriptive longitudinal study, symptomatic patients were screened in the HI clinic and eligible patients were followed up at home using tele-consultation, until recovery or hospitalization. HI failure was defined as need for hospitalization. Factors associated with HI failure were assessed using logistic regression analysis and expressed as odds ratio (OR) with 95% confidence interval (CI). Results: During April and May 2021, 1957 RT-PCR confirmed patients (984 male) with mean (SD) age 40 (13.5) years were enrolled; 93.3% (n = 1825) were successfully managed at home. Of the 132 patients (6.7%) who failed HI, 57 (43.2%) required oxygen therapy and 23 needed intensive care admissions. Overall mortality was 0.4% (7/1957). On adjusted analysis, factors associated with HI failure were age ≥60 years (OR 2.24; 95%CI 1.26-3.99), male gender (OR 2.26; 95%CI 1.44-3.57), subjective reporting of breathing difficulty (OR 3.64; 95%CI 2.08-6.37), history of cough (OR 2.08; 95%CI 1.37-3.17), and higher heart rate (OR 1.04; 95%CI 1.02-1.05). Although patient status (non-healthcare workers), no prior vaccination and ≥2 comorbidities were associated with HI failure on unadjusted analysis, these were non-significant on adjusted analysis. Conclusion: Monitored HI program can be used successfully during a pandemic wave to judicially use scare hospital resources. Older male patients presenting with breathlessness or cough may warrant closer monitoring.