Heterologous vaccination with inactivated vaccine and mRNA vaccine augments antibodies against both spike and nucleocapsid proteins of SARS-CoV-2: a local study in Macao.

The mRNA vaccines (RVs) can reduce the severity and mortality of severe acute respiratory syndrome coronavirus (SARS-CoV-2). However, almost only the inactivated vaccines (IVs) but no RVs had been used in mainland China until most recently, and the relaxing of its anti-pandemic strategies in December 2022 increased concerns about new outbreaks. In comparison, many of the citizens in Macao Special Administrative Region of China received three doses of IV (3IV) or RV (3RV), or 2 doses of IV plus one booster of RV (2IV+1RV). By the end of 2022, we recruited 147 participants with various vaccinations in Macao and detected antibodies (Abs) against the spike (S) protein and nucleocapsid (N) protein of the virus as well as neutralizing antibodies (NAb) in their serum. We observed that the level of anti-S Ab or NAb was similarly high with both 3RV and 2IV+1RV but lower with 3IV. In contrast, the level of anti-N Ab was the highest with 3IV like that in convalescents, intermediate with 2IV+1RV, and the lowest with 3RV. Whereas no significant differences in the basal levels of cytokines related to T-cell activation were observed among the various vaccination groups before and after the boosters. No vaccinees reported severe adverse events. Since Macao took one of the most stringent non-pharmaceutical interventions in the world, this study possesses much higher confidence in the vaccination results than many other studies from highly infected regions. Our findings suggest that the heterologous vaccination 2IV+1RV outperforms the homologous vaccinations 3IV and 3RV as it induces not only anti-S Ab (to the level as with 3RV) but also anti-N antibodies (via the IV). It combines the advantages of both RV (to block the viral entry) and IV (to also intervene the subsequent pathological processes such as intracellular viral replication and interference with the signal transduction and hence the biological functions of host cells).

Burnout among healthcare providers: Its prevalence and association with anxiety and depression during the COVID-19 pandemic in Macao, China.

INTRODUCTION: Burnout in healthcare providers (HPs) might lead to negative consequences at personal, patient-care and healthcare system levels especially during the COVID-19 pandemic. This study aimed to investigate the prevalence of burnout and the contributing variables, and to explore how, from health workforce management perspective, HPs' experiences related to carrying out COVID-19 duties would be associated with their burnout. METHODS: A cross-sectional, open online survey, informed by physical and psychological attributes reportedly related to burnout, the Copenhagen Burnout Inventory (CBI) and the Hospital Anxiety and Depression Scale (HADS), was completed by HPs in Macau, China during October and December 2021. Factors associated with burnout were analysed using multiple logistic regressions. RESULTS: Among the 498 valid responses, the participants included doctors (37.5%), nurses (27.1%), medical laboratory technologist (11.4%) and pharmacy professionals (10.8%), with the majority being female (66.1%), aged between 25-44years (66.0%), and participated in the COVID-19 duties (82.9%). High levels of burnout (personal (60.4%), work-related (50.6%) and client-related (31.5%)), anxiety (60.6%), and depression (63.4%) were identified. Anxiety and depression remained significantly and positively associated with all types of burnout after controlling for the strong effects of demographic and work factors (e.g. working in the public sector or hospital, or having COVID-19 duties). HPs participated in COVID-19 duties were more vulnerable to burnout than their counterparts and were mostly dissatisfied with the accessibility of psychological support at workplace (62.6%), workforce distribution for COVID-19 duties (50.0%), ability to rest and recover (46.2%), and remuneration (44.7%), all of which were associated with the occurrence of burnout. CONCLUSIONS: Personal, professional and health management factors were found attributable to the burnout experienced by HPs during the COVID-19 pandemic, requiring actions from individual and organizational level. Longitudinal studies are needed to monitor the trend of burnout and to inform effective strategies of this occupational phenomenon.

Omicron subvariant BA.5 is highly contagious but containable: Successful experience from Macau.

Introduction: Due to its high transmissibility and immune escape, Omicron subvariant BA.5 has become the dominant strain of the SARS-CoV-2 virus and led to escalating COVID-19 cases, how to cope with it becomes an urgent issue. A BA.5 infection surge burst out on 18 June 2022 and brought an unprecedented challenge to Macau, the most densely populated region worldwide. This study aimed to analyze the characteristics of this outbreak and summarize the useful anti-epidemic measures and experiences during this outbreak. Methods: All data were obtained from the Government Portal of Macao SAR (https://www.gov.mo), and the Special Webpage Against Epidemics, the Macao Health Bureau (www.ssm.gov.mo). An epidemiologic study was performed to analyze epidemic outcomes, including the infection rate, the proportion of symptomatic cases, the case fatality ratio (CFR), etc. Data were analyzed using SPSS Version 20. A p-value <0.05 was considered statistically significant. The anti-epidemic measures and experience were reviewed and summarized. Results: The BA.5 outbreak resulted in 1,821 new cases, which was significantly more than the cumulative cases of the previous variants of COVID-19 in Macau. The symptomatic cases accounted for 38.71% of the total cases, which was higher than that of the previous variants. After 6-week concerted efforts, Macau effectively controlled the outbreak, with an infection rate of 0.27%, which was much lower than many BA.5-attacked regions. The CFR was approximately 0.86%, which was not statistically different from that of previous variants. Six victims were chronically ill senior elders and their vaccination rate was much lower than the average level. Macau took a comprehensive anti-epidemic strategy to win a quick victory against BA.5, especially the "relatively static" strategy that was first formulated and applied by Macau for the management of the COVID-19 pandemic. Successful experience showed that although BA.5 was highly contagious, it could be contained by comprehensive anti-epidemic measures, including adequate anti-epidemic preparation, herd immunity through vaccination, repeated mass nucleic acid tests and rapid antigen tests, KN-95 mask mandate, the "relatively static" strategy, precise prevention and control, epidemiological investigation and tracing, and traditional Chinese medicine treatment, etc. Discussion: In Macau, compared with the previous subvariants, BA.5 is associated with increased transmissibility and a higher proportion of symptomatic cases, however, the risk of death remains similar, and the infection rate is much lower than that in many other BA.5-attacked regions. BA.5 is highly contagious but still containable, Macau's experience may offer hints for the regions experiencing the BA.5 waves to choose or adjust a more rational anti-epidemic strategy.

Epidemiology of SARS-CoV-2 Omicron BA.5 Infections, Macau, June-July 2022.

A SARS-CoV-2 Omicron BA.5 outbreak occurred in Macau from mid-June through July 2022. Out of >1,800 laboratory-confirmed cases, most were mild or asymptomatic; only 6 deaths were recorded. The outbreak was controlled through stringent public health and social measures, such as repeated universal testing and a stay-at-home order lasting 2 weeks.

A study on the evolution of economic patterns and urban network system in Guangdong-Hong Kong-Macao greater bay area.

The COVID-19 pandemic has seriously affected China's macroeconomy, industrial transformation, and high-quality development. Research on economic patterns and urban network systems can provide a reference for healthy development of the regional economic system. The evolution of the economic pattern and urban network system of Guangdong-Hong Kong-Macao Greater Bay Area (GBA) from 2010 to 2020 is investigated using methods (e.g., the gravity center model, the gravitational force model, social network analysis, and geographic information system). (1) The gravity center of gross domestic product (GDP) of the GBA is located in Nansha district, Guangzhou, with a skewing direction northwest-east-northwest and a movement rate of "large-small-large." The center of import and export and the center of consumption show a "zigzagging migration" in which the center of investment shows an "irregular (random) migration". (2) The economic connection degree of cities in the GBA exhibits a high ascending velocity, and the whole area tends to be mature, with a significant effect of spatial proximity. With the steady increase in network density, there is significant polarization of network centrality in the region. The four major cohesive subgroups have been relatively stable and consistent with the degree of geographic proximity of the cities. The center-periphery structure is more significant, in which the core area is extended to the cities on the east coast of the Pearl River Estuary, thus forming the core cluster of "Hong Kong-Shenzhen-Guangzhou-Dongguan." In this study, the evolution of economic patterns and urban network systems in the GBA over the past decade is analyzed using multiple methods (i.e., gravity model, urban network system analysis, and geographic information system) based on urban socioeconomic data by starting from various spatial elements (e.g., "points, lines, and networks") to gain insights into and optimize research on regional economic development after the COVID-19 pandemic.

COVID-19 prevention and control strategies: learning from the Macau model.

Background: Macau is a densely populated international tourist city. Compared to most tensely populated countries/territories, the prevalence and mortality of COVID-19 in Macau are lower. The experiences in Macau could be helpful for other areas to combat the COVID-19 pandemic. This article introduced the endeavours and achievements of Macau in combatting the COVID-19 pandemic. Method: Both qualitative and quantitative analysis methods were used to explore the work, measures, and achievements of Macau in dealing with the COVID-19 pandemic. Results: The results revealed that Macau has provided undifferentiated mask purchase reservation services, COVID-19 vaccination services to all residents and non-residents in Macau along with delivering multilingual services, in Chinese, English and Portuguese, to different groups of the population. To facilitate the travels of people, business and trades between Macau and mainland China, the Macau government launched the Macau Health Code System, which uses the health status declaration, residence history declaration, contact history declaration of the declarant to match various relevant backend databases within the health authority and provide a risk-related colour code operations. The Macau Health Code System connects to the Chinese mainland's own propriety health code system seamlessly, whilst effectively protecting the privacy of the residents. Macau has also developed the COVID-19 Vaccination Appointment system, the Nucleic Acid Test Appointment system, the Port and Entry/Exit Quarantine system, the medical and other supporting systems. Conclusion: The efforts in Macau have achieved remarkable results in COVID-19 prevention and control, effectively safeguarding the lives and health of the people and manifesting the core principle of "serving the public". The measures used are sustainable and can serve as an important reference for other countries/regions.

An empirical analysis of social public resources digital sharing system: Dissipative structure theory.

The development of the social public resource digital sharing system (SPRDSS) has been accelerated with the evolution of digital information and communication technologies (ICTs). This paper analyzes the dissipative structure features and formation process of SPRDSS in China. Combined with the Brusselator model and its transformation, this paper empirically analyzes the dissipative structure of SPRDSS using panel data collected from 30 Chinese provinces (excluding Tibet, Hong Kong, Macao, and Taiwan) from 2015 to 2019. The results show that the SPRDSS in China has pre-conditions to form a dissipative structure. At present, the SPRDSSs in most Chinese provinces have not yet formed the dissipative structure, but they are gradually evolving into it. The global orderliness of the sharing system is greater in eastern China than in central China and greater in central China than in western China. The potential for improving global orderliness is greater in western China than in central China and is greater in central China than in eastern China. Therefore, proper policies and measures should be adopted to accelerate the construction of SPRDSS based on the evolution of dissipative structure and to promote the sustainable development of the digital sharing economy.

Social Media Engagement in Two Governmental Schemes during the COVID-19 Pandemic in Macao.

Social media engagement is a vehicle for effective communication and engagement between governments and individuals, especially in crises such as the COVID-19 pandemic. Additionally, it can be used to communicate resilience measures and receive feedback. This research aims to investigate public social media engagement with resilience measures related to COVID-19 in Macao. We examined 1107 posts and 791 comments about the government's face mask supply and consumption voucher schemes on Facebook. Using the Crisis Lifecycle model, we partitioned the data and analyzed the content and engagement of related posts, as well as the word semantics in user comments. Our findings show that social media engagement in these resilience measures is high and positive in the early stages of the pandemic, suggesting social media's potential in mobilizing society, preserving social resilience, and serving as a two-way communication tool in public health emergencies.

Network analysis of depression, anxiety, insomnia and quality of life among Macau residents during the COVID-19 pandemic.

BACKGROUND: Although the Coronavirus Disease 2019 (COVID-19) has greatly impacted individuals' mental health and quality of life, network analysis studies of associations between symptoms of common syndromes during the pandemic are lacking, particularly among Macau residents. This study investigated the network structure of insomnia, anxiety, and depression and explored their associations with quality of life in this population. METHOD: This online survey was conducted in Macau between August 18 and November 9, 2020. Insomnia, anxiety, depressive symptoms, and quality of life were assessed with the Insomnia Severity Index, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and World Health Organization Quality of Life-brief version, respectively. Analyses were performed to identify central symptoms and bridge symptoms of this network and their links to quality of life. RESULTS: 975 participants enrolled in this survey. The prevalence of depressive, anxiety and insomnia symptoms were 38.5% (95% confidence interval (CI): 35.5%-41.5%), 28.8% (95%CI: 26.0%-31.7%), and 27.6% (95% CI: 24.8%-30.4%), respectively. "Sleep maintenance" had the highest expected influence centrality, followed by "Trouble relaxing", "Interference with daytime functioning", "Irritability", and "Fatigue". Five bridge symptoms were identified: "Sleep problems", "Restlessness", "Irritability", "Severity of sleep onset", and "Motor activity". The insomnia symptom, "Sleep dissatisfaction", had the strongest direct relation to quality of life. CONCLUSION: Insomnia symptoms played a critical role in the distress symptom network regarding node and bridge centrality as well as associations with quality of life among Macau residents. Close attention to these symptoms may be critical to reducing risk and preventing exacerbations in common forms of distress in this population.

Will Macau's Restaurants Survive or Thrive after Entering the O2O Food Delivery Platform in the COVID-19 Pandemic?

COVID-19 presents a formidable challenge to global tourism. One of the emergency measures adopted by the Macau restaurant industry has been to increase its revenue by joining an online-to-offline (O2O) platform. Nevertheless, are there any risks that follow these opportunities? This article aims to explore whether any risks follow these opportunities, which could extend the literature. Study 1 explores the key factors that customers focus on by analyzing the content of customer reviews published on the Aomi platform through Python. Results show that brand credibility, freshness, and taste remained prominent in the customers' dining experience. Packaging, delivery quality, and hygiene emerged as new factors due to the COVID-19 pandemic and the popularity of the O2O platform. Customers and staff continued to participate in service interactions through these online channels. Meanwhile, Study 2 contributes to the present understanding of O2O services in restaurants by interviewing catering professionals, and the results highlight how restaurateurs adopt their strategies on O2O platforms.

Investigating the intention to receive the COVID-19 vaccination in Macao: implications for vaccination strategies.

BACKGROUND: Understanding the intention of receiving COVID-19 vaccines is important to inform effective vaccination strategies. This study aimed to investigate such intention, identify the key influencing factors, and determine the most important intention predictors using a theoretically principled model. METHODS: An online, cross-sectional survey method was implemented in Macao in May 2021. People aged 18 years or above and residing in Macao for 12 months prior to the study were recruited through social media. Intention to receive COVID-19 vaccines and the main constructs of the protection motivation theory and the health belief model were the main measures encompassing threat appraisal, intrapersonal characteristics, cues to action, coping appraisal, past experiences and information seeking behavior. Descriptive statistics, Pearson correlation and multiple linear regression were used for data analysis. RESULTS: A total of 552 valid responses were received. Among the respondents, 79.5% aged between 25 and 54 years old, 59.4% were female, and 88% had a bachelor degree or above; 62.3% of the respondents indicated their intention to receive COVID-19 vaccination while 19.2% were hesitant and 18.5% did not have any intention. While 67.0% believed COVID-19 infection was life-threatening, only 19.0% thought they were at risk of getting infected. Control variables such as age, gender, education level, and having travel plans were significantly correlated with intention. Significant associations between intention with perceived severity, perceived susceptibility, maladaptive response reward, self-efficacy, response-efficacy, response cost, social attitude, social norm, past experience and information seeking behavior were identified (P < 0.05). The most important positive predictors of intention were "being able to make arrangement to receive the vaccine" (ß = 0.333, P < 0.001), "a sense of social responsibility" (ß = 0.326, P < 0.001), and "time off from work after vaccination" (ß = 0.169, P < 0.001), whereas "concerns over vaccine safety" (ß = - 0.124, P < 0.001) and "relying on online resources for vaccine information" (ß = - 0.065, P < 0.05) were negative predictors. Perceived severity in terms of COVID-19 being a life threatening illness was not a predictor of intention. CONCLUSION: This study reaffirmed that intention to receive COVID-19 vaccination is an ongoing concern in the combat of the pandemic. Multi-component strategies to enhance health literacy that supports well-informed decision-making, increase vaccination convenience, promote social responsibility, and provide time-off incentives are among the key considerations in designing and improve vaccination campaigns in Macao.

Nurses Who Are More Willing to Participate in the Fight against COVID-19: Evidence from China.

When facing an infectious disease disaster, nurses' willingness to work is critical. Nurses' lack of willingness to work during a pandemic may worsen the shortage of health care personnel. The purpose of this study is to assess the willingness of nurses to participate in the fight against COVID-19 in China and to identify factors associated therewith. This cross-sectional study examines nurses working in 11 Chinese cities including Macau, Hong Kong, Shenzhen, Dongguan, Huizhou, Guangzhou, Zhaoqing, Foshan, Jiangmen, Zhongshan, and Zhuhai. Questionnaires were collected from 19 May to 7 August 2020. A total of 8065 questionnaires were received, of which 8030 valid questionnaires were included for analysis. A total of 53.4% of participants reported that they had signed up to support the COVID-19 pandemic response. Multivariate logistic regression analysis revealed that being single (OR = 0.72, 95% CI: 0.60-0.87), having no children (OR = 0.81, 95% CI: 0.68-0.97), possessing higher professional qualifications (OR = 1.25, 95% CI: 1.14-1.37), having a more prestigious professional title (OR = 1.68, 95%CI: 1.50-1.90), being an administrative supervisor (OR = 0.53, 95% CI: 0.45-0.63), having a higher caring dimensions inventory score (OR = 1.01, 95% CI: 1.01-1.01), working in a hospital (OR = 0.53, 95% CI: 0.39-0.72), and receiving employer-provided care training (OR = 0.77, 95% CI: 0.68-0.87) were predictive of nurses' willingness to participate in the fight against COVID-19. We suggest that unmarried nurses should be given priority when recruiting to fight an epidemic and, for married nurses with children who are recruited to fight an epidemic, supporting measures should be provided for childcare. We suggest strengthening workplace training of caring for nurses in order to better retain and recruit qualified support for an epidemic outbreak of infectious diseases.

Problematic Smartphone Use during the COVID-19 Pandemic: Its Association with Pandemic-Related and Generalized Beliefs.

Smartphone technologies have played a crucial role in the fight against the COVID-19 pandemic; however, the increased use of smartphones during the pandemic period may expose the general public to a higher risk of problematic smartphone use (PSU). This study aimed to estimate the prevalence of PSU among Chinese community adults and adopted a social-cognitive theory and social axiom framework to evaluate the effects of beliefs on PSU. A Chinese adult sample (N = 616) was obtained through probability sampling via a telephone survey from Macao, China and included 591 smartphone users' data (39.4% men) for formal analysis. The prevalence of PSU was 43.3% in the overall sample, with 41.9% in women, and 45.5% in men. Two types of beliefs derived from the social-cognitive theory, pandemic-related self-efficacy and government efficacy, both showed significant and negative correlations with PSU (r = -0.13 and -0.10, p < 0.05). As for the two beliefs from the social axiom framework, reward for application was negatively correlated with PSU (r = -0.10, p < 0.05), whereas social cynicism was positively associated with PSU (r = 0.25, p < 0.001). Among those four beliefs, social cynicism exerted the most substantial effect on PSU when controlling for demographics. Our findings enriched the understanding of PSU during the pandemic and provided empirical direction regarding cognition-based intervention strategies for reducing PSU.

An Overview of Epidemiology of COVID-19 in Macau S.A.R.

The Greater Bay Area of southern China has a population of over 71 million people. The area is well-connected with Hubei province, the epicenter of the COVID-19 outbreak. Macau, as the most densely populated city in the world, is very vulnerable to infectious disease outbreaks. Since its return to the sovereignty of China 20 years ago, the city has experienced outbreaks such as severe acute respiratory syndrome (SARS), Swine flu, and COVID-19. At the time of writing, 10 confirmed imported/local transmission cases were recorded. The government undertook measures to attain and then maintain 40 days without new cases. In this article, we report on the 10 confirmed cases and discuss the measures that the Macau Special Administrative Region (S.A.R.) government undertook during the COVID-19 pandemic.

Engagement of Government Social Media on Facebook during the COVID-19 Pandemic in Macao.

Government social media is widely used for providing updates to and engaging with the public in the COVID-19 pandemic. While Facebook is one of the popular social media used by governments, there is only a scant of research on this platform. This paper aims to understand how government social media should be used and how its engagement changes in prodromal, acute and chronic stages of the pandemic. We collected 1664 posts and 10,805 comments from the Facebook pages of the Macao government from 1 January to 31 October 2020. Using word frequency and content analysis, the results suggest that the engagement was relatively low at the beginning and then surged in the acute stage, with a decreasing trend in the chronic stage. Information about public health measures maintained their engagement in all stages, whereas the engagement of other information was dropping over time. Government social media can be used for increasing vigilance and awareness in the prodromal stage; disseminating information and increasing transparency in the acute stage; and focusing on mental health support and recovery policies in the chronic stage. Additionally, it can be a tool for controlling rumors, providing regular updates and fostering community cohesion in public health crises.

Spatiotemporal spread pattern of the COVID-19 cases in China.

The COVID-19 pandemic is currently spreading widely around the world, causing huge threats to public safety and global society. This study analyzes the spatiotemporal pattern of the COVID-19 pandemic in China, reveals China's epicenters of the pandemic through spatial clustering, and delineates the substantial effect of distance to Wuhan on the pandemic spread. The results show that the daily new COVID-19 cases mostly occurred in and around Wuhan before March 6, and then moved to the Grand Bay Area (Shenzhen, Hong Kong and Macau). The total COVID-19 cases in China were mainly distributed in the east of the Huhuanyong Line, where the epicenters accounted for more than 60% of the country's total in/on 24 January and 7 February, half in/on 31 January, and more than 70% from 14 February. The total cases finally stabilized at approximately 84,000, and the inflection point for Wuhan was on 14 February, one week later than those of Hubei (outside Wuhan) and China (outside Hubei). The generalized additive model-based analysis shows that population density and distance to provincial cities were significantly associated with the total number of the cases, while distances to prefecture cities and intercity traffic stations, and population inflow from Wuhan after 24 January, had no strong relationships with the total number of cases. The results and findings should provide valuable insights for understanding the changes in the COVID-19 transmission as well as implications for controlling the global COVID-19 pandemic spread.

Adherence to COVID-19 Precautionary Measures: Applying the Health Belief Model and Generalised Social Beliefs to a Probability Community Sample.

BACKGROUND: In the face of the global pandemic of coronavirus disease-2019 (COVID-19), people's adherence to precautionary behavioral measures (e.g. social distancing) largely influences the effectiveness of those measures in containing the spread of the coronavirus. The present study aims at testing the applicability of the health belief model (HBM) and generalised social beliefs (i.e. social axioms) to explore strategies for promoting adherence to COVID-19 precautionary measures. METHODS: We conducted a telephone survey with a two-step stratified random sampling method and obtained a probability sample of 616 adults in Macao, China (18-87 years old; 60.9% women) in April 2020. RESULTS: Our participants showed stronger adherence to some COVID-19 precautionary measures (e.g. face mask wearing; 96.4%) but not others (e.g. social distancing; 42.3%). Their adherence to those measures was found to be significantly associated with four HBM factors and two social axioms, after controlling for gender, age, and years of education. CONCLUSIONS: The HBM and the generalised social beliefs of social cynicism and reward for application can be applied to understanding adherence to precautionary measures against COVID-19. Strategies based on beliefs were proposed to facilitate the promotion of precautionary measures.

Quarantine measures for coronavirus disease 2019 on a cruise ship, Taiwan, February 2020.

To early detect coronavirus disease 2019 on an international cruise ship and prevent its spread, Taiwan's Central Epidemic Command Center implemented on-board quarantine measures on a cruise ship docked at the Port of Keelung, Taiwan, on February 8, 2020. Quarantine officers, medical professionals, and administrative staff from competent authorities conducted fever screening and investigated the present illness and travel history of 1738 passengers and 776 crew members on the ship. Throat swabs were collected from 128 (5.1%) passengers and crew members with fever or respiratory symptoms during the past 14 days or travel history to China, Hong Kong, or Macao within 30 days. All swabs tested negative for severe acute respiratory syndrome coronavirus 2 at the national reference laboratory. The whole process, from on-board preparation to the completion of testing, took 9 h. All passengers and crew were permitted to disembark and were required to take 14-day self-health management measures. No cases were reported by the end of the self-health management period.