COVID-19 Plus: Addressing Food Security (SDG 2) and Malnutrition Within a Web of Disasters in the SADC Region

Despite the progress made to attain the Sustainable Development Goal (SDG) 2: zero hunger in other regions of the world, the UN Food and Agricultural Organisation notes that Asia and Africa are still lagging in this regard. The advent of COVID-19 is exacerbating the situation. This study examines how the impact of natural disasters compounded by COVID-19 (COVID-19 plus) affected the state of food security and nutritional status of the populace in the Southern African Development Community (SADC) and the consequences of these on development. The study used secondary and archival data from field assessments conducted by SADC member countries and other critical secondary data sources. The study found that extreme weather patterns, such as droughts, flooding and intense rainfall, coupled with sociopolitical instability and the outbreak of COVID-19 would further limit the region's ability to meet targets set under SDG 2 (zero hunger) and other SDG targets it has synergies with, particularly those related to health (SDG3). Increased food insecurity is a threat to the health, social and economic well-being of the region's population, with detrimental implications for the present and future security of the region. The study calls for support, such as extended social safety net programmes to deal with food insecurity challenges in the short to medium term, if the situation is to be harnessed from further deterioration. There is also a need to put in place measures to address increasing poverty and inequality meted on the populations by COVID-19 induced lockdowns. Such interventions must be sensitive to gender and prioritise the needs of the youth population. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

COVID-19 and Its Implications on Agriculture, Environment, and Water Sectors

The advent of COVID-19 had implications for various sectors of the economy, compounding the challenges set in motion by climate change. Whilst the dawn of 2021 came with hope for recovery from the pandemic, the beginning of 2022 came with another complexity of the Russia-Ukraine war, which hampered recovery efforts. This book examines the trends, dynamics, and implications of COVID-19 for agriculture, environment, and water sectors within the broader context of Sustainable Development Goals using a cocktail of primary and secondary research techniques. The book adopts the quantitative, qualitative, and multi-methods of enquiry. Findings show the increasing temporal trend of COVID-19 cases following periodic waves and spatially variable distribution of cases, with more cases in densely populated urban areas. These trends and dynamics, influenced by a web of intermingling factors, have had ramifications on the agricultural, environmental, and water sectors and subsectors with consequent negative outcomes on virtually all facets of life. The recovery process is being hampered by several factors ranging from poor governance, which results in policy distortions and other global factors. Climate change and the Russia- Ukraine war have complicated the COVID-19 recovery process by pushing up oil and food prices, rendering the poor more vulnerable to food insecurity and increased poverty, challenging Zimbabwe's economic resilience. Social safety nets and tackling climate change and other policy distortions are critical to ensure a sustainable future. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Conclusions and Policy Recommendations: The Emerging COVID-19 Trends, Dynamics and Implications

This chapter presents the key findings from the book and outlines the key policy interventions recommended. Issues examined in the book include the ramifications of the COVID-19 pandemic on agricultural production, food systems, nutrition, informality, water, education, sanitation and livelihoods. The Sustainable Development Goal (SDG) framework was used in the analysis of impacts. The findings show that the pandemic had mostly negative impacts on the systems studied and the most vulnerable members of society got the biggest knock on their livelihoods especially those in the informal sector. Access to key resources like water, municipal services and food was not equal, and the gap in deprivation widened during this period. Post COVID-19 recovery needs to be guided by how well it addresses progress towards SDG indicators. Government stimulus packages for recovery need to consider increasing social safety nets and the most vulnerable members of society. There is a need to support local food systems and vulnerable livelihoods to build back better and become resilient to future shocks that are similar to the COVID-19 pandemic. Authorities need to improve their communication with communities during disaster periods and strengthen their resilience. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

COVID-19 in Zimbabwe: Trends, Dynamics and Implications in the Agricultural, Environmental and Water Sectors

This contributed volume, based on papers presented at a conference held in Zimbabwe in mid-2021, interrogates solutions to COVID-19-related problems and issues across agricultural, environmental and water sectors in Zimbabwe and assesses their scientific, economic and practical validity. Across 19 chapters, this volume unpacks the science, economics and politics of the pandemic with a focus on understanding its secondary and tertiary impact on Zimbabwe's population. The volume is also dedicated to understanding the practical and policy-oriented approaches in tackling the pandemic and confronting the "new normal” of COVID-19. It brings together researchers, development practitioners and policy makers from various disciplines in an endeavour to understand COVID-19 trends and analyse the scientific options for mitigation, containment, innovation and ultimately pre-empt the possible emergence and impacts of other pandemics in the future. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

COVID-19 and the global cruise ship industry: Potential recovery and reformation pathways

Th e cruise ship industry was one of the fastest growing subsectors of the tourism industry before the advent of COVID-19. Th is paper examines the prospects and recovery of the cruise ship industry from the devastating impacts of COVID-19 on the industry. Th e study relied mostly on event study and secondary data, including survey data from authoritative sources, data from representative organisations, news reports and academic literature. Th e results show that the industry exhibited high levels of customer loyalty and resilience to the COVID-19-induced downturn. Th e industry also adopted additional protocols to improve public health on board and protect the health and safety of customers, crews and visited communities. However, continued travel restrictions at both source and destination markets, as well as the continued resurgence of the virus and related uncertainties, threaten the recovery of the industry. Mandatory vaccination of both crew and passengers needs to be considered. © 2022 Sciendo. All rights reserved.

Evaluation of rocuronium in critically ill patients during the COVID-19 pandemic

INTRODUCTION: Limited data exist to support the use of rocuronium continuous infusions in the intensive care unit (ICU). Due to a shortage of cisatracurium, our Pharmacy and Therapeutics committee approved the use of rocuronium as a therapeutic alternative. The objective of this study was to evaluate the dosing and monitoring of adult patients who received rocuronium for hypoxemic respiratory failure during the COVID-19 pandemic. METHODS: This was a prospective, single-center study from March 1, 2020 to May 31, 2020. We identified all adult patients admitted to any ICU who received rocuronium via continuous infusion. Patients were excluded if they received rocuronium for < 6 hours. Study subjects could have multiple paralysis infusions during the same admission. Each rocuronium infusion was separated by at least 24 hours. The main outcome of this study was the relationship between the hourly administration rate of rocuronium and TOF assessment by using Pearson correlation coefficient. Secondary outcomes of this study included median rocuronium dose at initiation, duration of infusion, and median rate of infusion. TOF results were classified as over-paralyzed (TOF = 0), wellparalyzed (TOF = 1-2), or under-paralyzed (TOF = 3-4). RESULTS: Seventy-one patients and 97 paralysis infusions were included. Fifty-nine patients (83%) were positive for SARS CoV-2. There was a negligible correlation between the dose of rocuronium and the TOF results (r = 0.04). Of the 97 paralysis infusions, the median dose at initiation was 3 [3-5] mcg/kg/min and duration of infusion was 45 [23.6-92.5] hours. The median rate of infusion was 4.3 [2.8-7.2] mcg/kg/ min. A total of 1775 TOFs were assessed, of which 46.2% were over-paralyzed, 35.7% well-paralyzed, and 18.1% under-paralyzed. CONCLUSIONS: We found no correlation between rocuronium dose and TOF assessments. The initial and maintenance infusion doses in our analysis were lower than what have been previously referenced. As TOF is unpredictable, patients initiated on continuous infusion rocuronium may be started at lower doses while being titrated to ventilator synchrony to avoid over-paralysis.

Evaluation of inhaled epoprostenol and nitric oxide for refractory hypoxemia in COVID-19

INTRODUCTION: Inhaled epoprostenol (iEPO) and nitric oxide (iNO), have been shown to improve oxygenation in patients with refractory hypoxemia and ARDS. The purpose of this analysis was to evaluate the efficacy and safety of iEPO and iNO in patients with COVID-19 and refractory hypoxemia. METHODS: This retrospective cohort study evaluated critically ill patients admitted to the ICU with respiratory failure secondary to COVID-19 from March to June 2020. Patients were included if they received at least one hour of iEPO or iNO for refractory hypoxemia. The primary outcome was the change in the partial pressure of oxygen [PaO2]/fractional concentration of oxygen [FiO2] ratio following initiation of iEPO or iNO. Secondary outcomes included changes in PaO2 and pulse oxygen saturation (SpO2), percentage of patients classified as ?responders? (increase PaO2/FiO2 > 10%), differences between responders and non-responders, and adverse events. Logistic regression was used to determine predictors of responsiveness to iEPO. RESULTS: Of 93 patients screened, 38 were included in the analysis, with mild (4, 10.5%), moderate (24, 63.2%) or severe (10, 26.3%) ARDS. All patients were initiated on iEPO as the initial pulmonary vasodilator and the median time from intubation to initiation was 137 (68 to 228) hours. The median change in PaO2/FiO2 was 0 (-12.8 to 31.6) immediately following administration of iEPO. Sixteen patients (42.1%) were classified as responders with a median increase in PaO2/FiO2 of 34.1 (24.3 to 53.9) with iEPO. The mean change in PaO2 and SpO2 was -0.55 ± 41.8 and -0.6 ± 4.7, respectively. Eleven patients transitioned to iNO with a median change of 11 (3.6 to 24.8) in PaO2/FiO2. No differences in outcomes or characteristics were seen between responders and non-responders. Minimal adverse events were seen in patients who received either iEPO or iNO. CONCLUSIONS: We found that the initiation of iEPO and iNO in patients with refractory hypoxemia secondary to COVID-19, on average, did not produce significant increases in oxygenation metrics. However, a small group of patients had significant improvement with iEPO and iNO.

Evaluation of hypertriglyceridemia in critically ill patients with COVID-19 receiving propofol

INTRODUCTION: Propofol 1%, available as an oilin- water emulsion, is an attractive sedative option in patients with COVID-19 since it is rapid acting and easily titratable. Previous studies have shown approximately 18% to 45% of patients who receive propofol in the ICU develop hypertriglyceridemia, depending on the definition. Additionally, various reports have recently described hypertriglyceridemia without a clear etiology in patients infected with SARS-CoV-2. The objective of this analysis was to report the incidence of, and evaluate risk factors for, hypertriglyceridemia in patients with COVID-19 who received propofol. METHODS: This was a retrospective, observational analysis in SARS-CoV-2 positive patients who received propofol for at least four hours from March 1, 2020 to April 20, 2020. Patients were excluded if transferred from an outside hospital with propofol administered for > 24 hours, had zero triglyceride levels drawn during admission, or had acute pancreatitis on admission. Hypertriglyceridemia was defined as any triglyceride level ≥ 400 mg/dL. Univariate and multivariate analyses were performed to evaluate risk factors for hypertriglyceridemia. RESULTS: A total of 128 patients were screened, of which 106 patients were included in the analysis. Sixty patients (56.6%) met criteria for hypertriglyceridemia, with a median time to development of 46 hours. A total of five patients had clinical suspicion of acute pancreatitis, with one patient having confirmatory imaging. There was no difference in the dose (8.1 g vs. 6.8 g;p = 0.2) or duration (171 hr vs. 162 hr;p = 0.7) of propofol in patients who developed hypertriglyceridemia. Patients who developed hypertriglyceridemia had significantly increased levels of ferritin, CRP, and d-dimer compared to those who did not develop hypertriglyceridemia. CONCLUSIONS: Hypertriglyceridemia was commonly observed in critically ill patients with COVID-19 who received propofol. Neither the cumulative dose nor duration of propofol were identified as a risk factor for the development of hypertriglyceridemia. Due to the incidence of hypertriglyceridemia in this patient population, monitoring of serum triglyceride levels should be done frequently in patients who require more than 24 hours of propofol.

COVID-19 cripples global restaurant and hospitality industry

The restaurant and hospitality industries are crucial socio-economic sectors that contribute immensely to the global economy. However, these sectors are vulnerable and sensitive to natural hazards such as the COVID-19 pandemic and any resultant economic downturns. This study investigates the impact of COVID-19 on the global restaurant industry using data from OpenTable and other sources. The study found that sit-in guests dropped to zero in many countries as governments across the world instituted social distancing initiatives, movement restrictions and lockdowns. COVID-19 also led to an unprecedented loss of employment and revenue, resulting in millions of jobs and billions of dollars in potential revenue lost. The work recommends extra-ordinary financial and other support measures for the sector. It further recommends a raft of safety and health protocols as the industry gradually reopens.