The possible onset of fibromyalgia following acute COVID-19 infection.

INTRODUCTION: The exact pathogenesis of fibromyalgia (FM) syndrome is unclear. However, various infectious have been implicated with the development of FM after their acute phase. We aimed to investigate the incidence of FM syndrome among convalesced individuals following hospitalization for Acute Coronavirus Disease-2019 (COVID-19). METHODS: We performed a cross-sectional study on patients who were discharged after COVID-19 hospitalization from the Sheba Medical Center, Israel, between July 2020 to November 2020. A phone interview was performed consisting of the following questionnaires: the Fibromyalgia Survey Diagnostic Criteria Questionnaire, Sense of Coherence Questionnaire to evaluate resilience, and the Subjective Traumatic Outlook Questionnaire to assess the associated psychological aspects of the trauma. The incidence of post-COVID FM was calculated and regression models were performed to identify predictors. RESULTS: The study population consisted of 198 eligible patients who completed the phone interview. The median age was 64 (52-72) and 37% were women. The median follow-up was 5.2 months (IQR 4.4-5.8). The incidence of FM was 15% (30 patients) and 87% (172 patients) had at least one FM-related symptom. Female gender was significantly associated with post-COVID FM (OR 3.65, p = 0.002). In addition, high median Subjective Traumatic Outlook scores and low median Sense of Coherence scores were both significantly associated with post-COVID FM (OR 1.19, p<0.001 and OR 0.92, p<0.001, respectively). CONCLUSIONS: FM is highly prevalent among COVID-19 convalescent patients. Our finding suggests that a significant subjective traumatic experience and a low resilience are highly associated with post-COVID FM.

Public conformism with health regulation is crumbling as COVID-19 becomes a chronic threat: Repeated Cross-sectional Studies.

BACKGROUND: The purpose of this study is to analyze the long terms trends in public attitudes toward the COVID-19 pandemic and compliance with self-quarantine regulations. METHODS: Repeated cross-sectional studies looking into data collected from nationally representative samples (N = 2568) of the adult population in Israel at five points in time representing the five morbidity waves of the COVID-19 pandemic. This study examined public trust in Israeli health regulations, levels of public panic, feelings of personal worry, and compliance with health regulations, specifically self-quarantine. RESULTS: Public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value of nearly 75% measured in March 2020. While reported worry is steadily reducing, the perception of public panic is increasing. In earlier rounds, public compliance with self-quarantine was reported close to 100%; however, it has dropped to 38% by January 2022 when compensation is not assumed. Regression analysis suggests that trust is a major predictor of compliance with health regulations. CONCLUSIONS: The "fifth wave" of the COVID-19 pandemic brought about an all-time low in public trust in health regulations. The Israeli public, normally a highly compliant one, is showing signs of crumbling conformity.

"Let me touch him": Perceptions and experiences of family caregivers of nursing home residents during the COVID-19 outbreak in Israel.

Older adults in nursing homes were particularly vulnerable to COVID-19 morbidity and mortality worldwide. Due to the COVID-19 pandemic, visitations in nursing homes were restricted. The present study examined the perceptions and experiences of family caregivers of nursing home residents during the COVID-19 crisis in Israel and their coping strategies. Online focus group interviews were held with 16 family caregivers of nursing home residents. Three main categories were identified through Grounded Theory techniques: (a) Anger and decreased trust in nursing homes; (b) Perception of the residents as victims of the nursing home policy; (c) Coping strategies at different levels. The outbreak redefined family caregivers' understanding of their role. Practical implications include making the voice of the family caregivers heard, identifying effective coping strategies, and creating a dialogue between family caregivers, nursing home managements, and staff.

Continuous Exposure to Terrorism during the COVID-19 Pandemic: A Moderated Mediation Model in the Israeli Context.

This study tested the role of perceived social support as a moderating factor in the mediation of COVID-19-related concerns in the association between continuous traumatic stress (CTS) and depression. The study participants were 499 college students who responded to an anonymous online questionnaire. Measures included the assessment of prior continuous exposure to threats of terrorism, COVID-19-related distress, perceived social support and depressive symptoms. The results demonstrated that COVID-19-related concerns mediated the relationship between continuous exposure to threats of terrorism and depression symptoms, and that perceived social support moderated the association between COVID-19-related concerns and depression. The implications of the study highlight the role of prior exposure to traumatic stress as a risk factor for depression and the role of social support as a protective factor. These results point to the need to develop accessible and non-stigmatic mental health services for populations exposed to other types of continuous traumatic stress.

Perceived partial social integration, levels of distress and resilience, and COVID-19 vaccine rejection of Jewish and Arab citizens of Israel.

Introduction: The present study examines the role of perceived partial social integration (PPSI) in determining the rejection of the COVID-19 vaccine of Jewish and Arab citizens of Israel. Methods: The research hypotheses are examined using a relatively large sample of the Israeli public, including 208 Arab and 600 Jewish adults, who have responded to an anonymous questionnaire pertaining, among other issues, to partial social integration and the individual level of vaccine uptake. Results: Higher levels of PPSI were found to be associated with higher levels of vaccine rejection, in both Jewish and Arab samples. The Arab minority group regards themselves as less socially integrated into the Israeli society and therefore rejects the COVID-19 vaccine to a greater extent than the majority group. The Arab respondents expressed a higher level of psychological distress and a lower level of resilience compared with the Jewish participants. The perceived partial social integration score significantly predicted the levels of distress and resilience of the Jewish but not the Arab sample. Discussion: The study indicates that increasing the vaccination rates depends more substantially on trust in the authorities than on leveraging greater pressure on individuals that reject the vaccine. Increased trust in the authorities and regarding oneself as an integral component of society are two vital conditions for vaccine acquiescence. Insufficient social integration is a major reason for vaccine rejection.

The role of biostatistics in the response to COVID-19: a Belgian and international perspective.

In this commentary to Dattner et al. (Israel J Health Policy Res. 11:22, 2022), we highlight similarities and differences in the role that biostatistics and biostatisticians have been playing in the COVID-19 response in Belgium and Israel. We bring out implications and opportunities for our field and for science. We argue that biostatistics has an important place in the multidisciplinary COVID-19 response, in terms of research, policy advice, and science and public communication. In Belgium, biostatisticians located in various institutes, collaborated with epidemiologists, vaccinologists, infectiologists, immunologists, social scientists, and government policy makers to provide rapid and science-informed policy advice. Biostatisticians, who can easily be mobilized to work together in pandemic response, also played a role in public communication.

Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices.

BACKGROUND: Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making. METHODS: PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed. RESULTS: Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location. CONCLUSIONS: Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.

'Women in the front': Psychological impact of the COVID-19 pandemic: Depression, anxiety, loneliness, and somatization in the Israel population.

The COVID-19 pandemic has generated a high level of psychological distress in the general population. The aims of this study were to examine the mental health of men and women in the general population in Israel during the first lockdown. The sample comprised 587 participants (426 females and 161 males), whose age ranged between 16 and 85. They completed the Patient Health Questionnaire-4 (PHQ-4), the Psychosomatic Symptoms Scale, and the Connor-Davidson Resilience Scale (CD-RISC2). Psychological distress was expressed in our measures of depression, anxiety, loneliness, and somatization, in conjunction with high resilience. Women exhibited higher levels of these symptoms than men-but this fluctuates with age, and can match the levels of these symptoms reported by men. Specifically, no difference between the genders was found for loneliness, in age groups 24-39 and 56-85; and for depression, in age groups 40-55 and 56-85. For somatization, the difference is reversed for age group 56-85. In contrast, while women generally scored lower than the men for resilience, this was specifically for age group 16-23. Our findings suggest that young women report more mental health problems, and that men and women may be differentially vulnerable to disaster-related stressors, such as experienced during the pandemic.

Gastroenterologists attitude in various clinical settings in the era of COVID-19 pandemic: An online Uni-National Israeli Survey.

ABSTRACT: Coronavirus disease 2019 (COVID-19) pandemic has impacted our clinical practice. Many gastroenterologists have changed their attitudes toward various gastroenterological clinical settings. The aim of the present study is to explore the gastroenterologist's attitudes in several clinical settings encountered in the clinical practice.An online based survey was completed by 101 of 250 Israeli gastroenterologists (40.5%).Most of the participants were males (76.2%), and most of them were in the age range of 40 to 50 (37.6%). For all questionnaire components, the 2 most common chosen options were "I perform endoscopy with N95 mask, gloves and gown protection in a standard endoscopy room without preendoscopy severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing" and "Tend to postpone endoscopy until SARS-CoV-2 test is performed because of fear from being infected, or virus spreading in the endoscopy suite." Notably, 12 (11.9%) gastroenterologists were infected by Coronavirus disease 2019 during their work. Classifying the clinical settings to either elective and non-elective, most gastroenterologists (77.4%) chose the attitude of "I perform endoscopy with N95 mask, gloves and gown protection in a standard endoscopy room without SARS-COV-2 testing" in the nonelective settings as compared to 54.2% for the elective settings, (P < .00001), whereas 32.9% of the responders chose the attitude of "Tend to postpone endoscopy until SARS-COV-2 test is performed because of fear from being infected, or virus spreading in the endoscopy suite" in the elective settings (P < .00001).Gastroenterologists' attitude in various gastroenterological settings was based on the clinical indication. Further studies are needed to assess the long-term consequences of the different attitudes.

Anosmia, ageusia, and other COVID-19-like symptoms in association with a positive SARS-CoV-2 test, across six national digital surveillance platforms: an observational study.

BACKGROUND: Multiple voluntary surveillance platforms were developed across the world in response to the COVID-19 pandemic, providing a real-time understanding of population-based COVID-19 epidemiology. During this time, testing criteria broadened and health-care policies matured. We aimed to test whether there were consistent associations of symptoms with SARS-CoV-2 test status across three surveillance platforms in three countries (two platforms per country), during periods of testing and policy changes. METHODS: For this observational study, we used data of observations from three volunteer COVID-19 digital surveillance platforms (Carnegie Mellon University and University of Maryland Facebook COVID-19 Symptom Survey, ZOE COVID Symptom Study app, and the Corona Israel study) targeting communities in three countries (Israel, the UK, and the USA; two platforms per country). The study population included adult respondents (age 18-100 years at baseline) who were not health-care workers. We did logistic regression of self-reported symptoms on self-reported SARS-CoV-2 test status (positive or negative), adjusted for age and sex, in each of the study cohorts. We compared odds ratios (ORs) across platforms and countries, and we did meta-analyses assuming a random effects model. We also evaluated testing policy changes, COVID-19 incidence, and time scales of duration of symptoms and symptom-to-test time. FINDINGS: Between April 1 and July 31, 2020, 514 459 tests from over 10 million respondents were recorded in the six surveillance platform datasets. Anosmia-ageusia was the strongest, most consistent symptom associated with a positive COVID-19 test (robust aggregated rank one, meta-analysed random effects OR 16·96, 95% CI 13·13-21·92). Fever (rank two, 6·45, 4·25-9·81), shortness of breath (rank three, 4·69, 3·14-7·01), and cough (rank four, 4·29, 3·13-5·88) were also highly associated with test positivity. The association of symptoms with test status varied by duration of illness, timing of the test, and broader test criteria, as well as over time, by country, and by platform. INTERPRETATION: The strong association of anosmia-ageusia with self-reported positive SARS-CoV-2 test was consistently observed, supporting its validity as a reliable COVID-19 signal, regardless of the participatory surveillance platform, country, phase of illness, or testing policy. These findings show that associations between COVID-19 symptoms and test positivity ranked similarly in a wide range of scenarios. Anosmia, fever, and respiratory symptoms consistently had the strongest effect estimates and were the most appropriate empirical signals for symptom-based public health surveillance in areas with insufficient testing or benchmarking capacity. Collaborative syndromic surveillance could enhance real-time epidemiological investigations and public health utility globally. FUNDING: National Institutes of Health, National Institute for Health Research, Alzheimer's Society, Wellcome Trust, and Massachusetts Consortium on Pathogen Readiness.

The impact of Muslim and Christian religious leaders responding to COVID-19 in Israel.

Background: The COVID-19 pandemic is one of the most significant public health emergencies in decades and has affected all countries worldwide. Religious leaders have been recognized as playing a pivotal role in health promotion during times of crisis. This study explored the role that Muslim and Christian religious leaders played in Israel during the pandemic, and the impact that their activities had on the community. Methods: A qualitative study involving semi-structured interviews was conducted with Muslim and Christian religious leaders and health policy makers from the Arab community. Intensive purposeful sampling was used to locate the two target audiences. Interview protocols were developed and included questions about the role they played during the pandemic, challenges they faced, and dialogue and partnerships they had. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis. Results: Ten Muslim Sheikhs, three Christian clergy, and four health policy makers were interviewed. Religious leaders played a predominant role in promoting health during the COVID-19 crisis. Both religious leaders and health policy makers reported similar challenges including dealing with fake news and the conspiracy theory, social events and gatherings, frustrations about gaps in policy toward religious institutions, and lack of trust toward State. Health policy makers recognized the key role religious leaders played and emphasized the importance of engaging religious leaders. Conclusion: The COVID-19 pandemic has been a catalyst for partnership between health policy makers and religious leaders. Religious leaders should play an integral and integrated role in promoting health during future health crises, not only in implementation of guidelines but also in development of policy so that the guidelines are tailored and sensitive to specific communities to avoid conflicts. As trusted authorities, religious leaders serve as a bridge between health authorities and communities and can be mediators who reconcile science, policy and religious perspectives. The routine cooperation between decision makers, opinion leaders, and religious leaders as social gatekeepers can increase the public's level of trust in the system.

The role of models as a decision-making support tool rather than a guiding light in managing the COVID-19 pandemic.

Reference scenarios based on mathematical models are used by public health experts to study infectious diseases. To gain insight into modeling assumptions, we analyzed the three major models that served as the basis for policy making in Israel during the COVID-19 pandemic and compared them to independently collected data. The number of confirmed patients, the number of patients in critical condition and the number of COVID-19 deaths predicted by the models were compared to actual data collected and published in the Israeli Ministry of Health's dashboard. Our analysis showed that the models succeeded in predicting the number of COVID-19 cases but failed to deliver an appropriate prediction of the number of critically ill and deceased persons. Inherent uncertainty and a multiplicity of assumptions that were not based on reliable information have led to significant variability among models, and between the models and real-world data. Although models improve policy leaders' ability to act rationally despite great uncertainty, there is an inherent difficulty in relying on mathematical models as reliable tools for predicting and formulating a strategy for dealing with the spread of an unknown disease.

Fluctuations in Pediatric Acute Otitis Media Burden During the First Two COVID-19 Years in Israel.

BACKGROUND: To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. METHODS: This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017-February 29, 2020) and the first two COVID years (March 1, 2020-February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel's largest healthcare maintenance organization. Children 0-15 years with AOM and UTI episodes were categorized according to age (1>, 1-4, 5-15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). RESULTS: We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1-4.1). Male predominance, age at presentation, and the dominant age group of 1-4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68-0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34-0.63, P < 0.001). The largest decrease was observed among children 1-4 years old during the first COVID year (ß=-1,938 AOM episodes/100,00 children, 95% CI, -2,038 to -1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05-0.05, P < 0.001). CONCLUSIONS: AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.

Associations between reported post-COVID-19 symptoms and subjective well-being, Israel, July 2021 - April 2022.

The impact of individual symptoms reported post-COVID-19 on subjective well-being (SWB) is unknown. We described associations between SWB and selected reported symptoms following SARS-CoV-2 infection. We analysed reported symptoms and subjective well being from 2295 participants (of which 576 reporting previous infection) in an ongoing longitudinal cohort study taking place in Israel. We estimated changes in SWB associated with reported selected symptoms at three follow-up time points (3-6, 6-12 and 12-18 months post infection) among participants reporting previous SARS-CoV-2 infection, adjusted for key demographic variables, using linear regression. Our results suggest that the biggest and most sustained changes in SWB stems from non-specific symptoms (fatigue -7.7 percentage points (pp), confusion/ lack of concentration -10.7 pp, and sleep disorders -11.5pp, P < 0.005), whereas the effect of system-specific symptoms, such as musculoskeletal symptoms (weakness in muscles and muscle pain) on SWB, are less profound and more transient. Taking a similar approach for other symptoms and following individuals over time to describe trends in SWB changes attributable to specific symptoms will help understand the post-acute phase of COVID-19 and how it should be defined and better managed. Post-acute COVID19 symptoms were associated with a significant decrease in subjective well being up to 18 months after initial infection.

COVID-19 vaccine hesitancy scale and its association with actual COVID-19 vaccine uptake in Israel.

BACKGROUND: The public's willingness to get vaccinated continues to be a source of concern. In this study we assessed the psychometric properties of the COVID-19 vaccine hesitancy scale (C19-VHS) as well as the association between the scale and self-reported past COVID-19 vaccination, approximately two weeks after the national vaccine distribution plan was launched in Israel. METHODS: Participants were recruited via an online survey distributed through social media platforms and mailing lists. A total of 650 individuals completed the C19-VHS, the general vaccine hesitancy scale, and the fear of COVID-19 scale, and reported on demographic and pandemic-related characteristics. Principal component and Cronbach's alpha analyses were performed to assess the factor structure and reliability of the scale. Logistic regressions were employed to assess the scale's convergent and discriminative validity. RESULTS: Two factors pertaining to "lack of confidence" (Factor 1) and "risk perception" (Factor 2) emerged. Cronbach's alpha indicated good reliability of Factor 1 (0.93), with lower reliability of Factor 2 (0.72). Younger age was associated with higher risk perception, with women showing less confidence and perceiving greater risks. Lower hesitancy significantly predicted actual COVID-19 vaccine uptake after adjusting for demographic and pandemic-related factors (OR = 1.16, 95%CI 1.11-1.21, p <.001). Older age, being a woman, and receiving the flu vaccine in the past year were also predictive of COVID-19 vaccine uptake. DISCUSSION: The C19-VHS measure shows robust psychometric properties and is associated with actual vaccine uptake. Future studies assessing COVID-19 vaccination attitudes may utilize this scale to assess current COVID-19 vaccine hesitancy in different contexts and cultures.

"A breath of fresh air": mindfulness training for early-career mental health social workers in Israel during COVID-19.

The present study examined the effectiveness of participation in a mindfulness group for Israeli early career social workers during the COVID-19 period. Eleven participants conducting fieldwork in a mental health rehabilitation center were interviewed. The participants described a variety of benefits from their mindfulness training, in three main areas: (1) Personal: applying mindfulness in their daily life; (2) Family: improved work-life balance and family relationships; and (3) Professional: applying mindfulness in their work with mental health clients. Mental support and self-care tools provided to early-career social workers were perceived by the participants as helping them overcome uncertainty, fatigue, and overwork.

Trends in Burn Injuries in Northern Israel During the COVID-19 Lockdown.

Coronavirus disease 2019 obliged many countries to apply lockdown policies to contain the spread of infection. The restrictions in Israel included limitations on movement, reduction of working capacity, and closure of the educational system. The present study focused on patients treated at a referral center for burns in northern Israel. Their goal was to investigate temporal variations in burn injuries during this period. Data were retrospectively extracted from the medical records of burn patients treated at our hospital between March 14, 2020 and April 20, 2020 (ie, the period of aggravated lockdown). Data from this period were compared with that from paralleling periods between 2017 and 2019. During the lockdown and paralleling periods, 178 patients were treated for burn injuries, of whom 44% were under 18. Although no restrictions were enforced during the virus outbreak period with regard to seeking medical care, we noticed a decrease in the number of patients admitted to the emergency room for all reasons. Of particular interest was a 66% decrease in the number of adult burn patients (P < .0001). Meanwhile, among the pediatric population, no significant decrease was observed. Nonetheless, subgroups with higher susceptibility to burn injuries included children aged 2 to 5 years (56.3% vs 23.8%, P = .016) and female patients from all pediatric age groups (57.1% vs 25%, P = .027). These findings may be explained by the presumably busier kitchen and dining areas during the lockdown. Overall, the study results can assist with building a stronger understanding of varying burn injuries and with developing educational and preventive strategies.

COVID-19 restrictions and visitations to an Israeli psychiatric emergency department: A four-lockdowns retrospective study.

We examine the volume and characteristics of psychiatric ED visitations through a perspective of four COVID-19 lockdowns. All adult visitations to the ED of Shalvata Mental Healthcare center (Israel) during 2020-2021 were retrieved and statistically analysed and data from 2017 to 2019 was considered as control. Voluntary and involuntary ED visitations were considered, separately and combined. We find that the significant decrease in the volume of voluntary ED visitations during the 1st lockdown was quickly overturned, roughly returning to the pre-pandemic state following its conclusion. In parallel, the volume of involuntary ED visitations has dramatically increased, with the most striking levels observed during the second and third lockdowns. Elapsed time since the first occurrence of COVID-19 in Israel and the level of governmental restrictions is significantly associated with the increase in the volume of ED visits and admissions, the admission rate and the rate of involuntary visits. The prolonged consequences associated with the pandemic and the measures taken to control it suggest that it is unreasonable to expect a return to normal ED utilization in the near future. As such, alternatives to strict lockdowns should be favored when possible and urgent strengthening of psychiatric care is warranted.