The Paradox of ‘Water Is Life' in a Water Rationed City During the COVID-19 Pandemic

In this chapter, we use the concept of everyday practice to highlight the plight of urban residents and what it means/takes to survive the ongoing COVID-19 pandemic in a water-insecure city. We use data from four Wards on differentiated locations relative to storage tanks supplying water and different water rationing zones. The data was collected from 2020 to 2021 (2 years). A stratified random sampling technique was used to select a study sample of 303 respondents. Of these, 200 household heads were interviewed at their place of residency, while the remaining 103 respondents gave interviews while waiting to draw water from boreholes dotted around the four residential areas. Our results suggest that the policies for managing the pandemic paid less attention to everyday practices of getting around the more than two-decade-old water challenges in the urban areas. The water challenges in the urban areas further exposed the residents to COVID-19 infection, and the pandemic widened the gendered and spatial inequalities to access to water. We conclude that the search for and concerted efforts to access water to manage and prevent COVID-19 infection were equally associated with high chances of being infected and/or spreading COVID-19. The ongoing COVID-19 pandemic is not the last water-demanding crisis we will experience. This calls for a paradigm shift in urban water and sanitation access planning to include alternative water sources - groundwater - at the initial stages of residential planning. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Integrated surveillance and early warning system for emerging infectious diseases based on One Health concept: Structures and innovations.

One Health is an upgrade and optimization of health concepts, which recognizes the integrated health of the human-animal-environment. It emphasizes the use of interdisciplinary collaboration, multi-sectoral coordination, and multi-organizational One Health approaches to solve scientific questions. The surveillance and early warning system is the basis of public health emergency prevention and control. The COVID-19 pandemic and the emerging infectious disease (EID) have put great challenges on the existing surveillance and early warning systems worldwide. Guided by the concept of One Health, we attempt to build a new pattern of integrated surveillance and early warning system for EID. We will detail the system including the One Health-based organizational structure, zoonotic and environmental science surveillance network, EID reporting process, and support and guarantee from education and policy. The integrated surveillance and early warning system for EID constructed here has practical and application prospects, and will provide guidance for the prevention and control of COVID-19 and the possible EID in the future.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.

[Establishment of early warning indicators of SARS-CoV-2 Omicron variant in Tianjin].

In this study, Delphi method was used to conduct a questionnaire survey on 12 experts to determine the indicators system and the corresponding weight for early warning features of SARS-CoV-2 Omicron in Tianjin.The positive indexes of experts in three rounds of consultations were both 100%. The experts' authority coefficient was 0.79. The Kendall's W coordination coefficients were 0.375, 0.356 and 0.385 respectively (all P<0.05). The indicators system for early warning features of 2019-nCoV Omicron variant had 5 first-level indicators, 10 second-level indicators and 52 third-level indicators. The weight of each indicator was also determined.

[Analysis on the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors].

Objective: To evaluate the household secondary attack rates of the SARS-CoV-2 Delta variant and the associated factors. Methods: A COVID-19 outbreak caused by the Delta variant occurred in Nanjing in July 2021. A total of 235 cases with current addresses in Nanjing were reported from 171 households. The subjects in this study were selected from household close contact(s) of infected cases. The information on household index cases and their contacts were collected, and the household secondary attack rate (HSAR) and the risk factors were analyzed by the multi-factor logistic regression model. Results: A total of 234 cases of household close contacts and 64 household secondary cases were reported from 103 households, and the HSAR was 27.4% (64/234, 95%CI:22.0% to 33.4%). The proportions of household size for 2 to 3, 4 to 5, and 6 to 9 were 64.1% (66), 26.2% (27) and 9.7% (10), respectively. A total of 35 cases of household cluster outbreaks were reported (35/103, 34.0%). The number of the first case in the household (FCH) was 103 and males accounted for 27.2% (28 cases), with the median age (Q1, Q3) of 49 (9, 56). The number of household close contacts was 234 and males accounted for 59.0% (138 cases), with the median age (Q1, Q3) of 42 (20, 55) and the median exposure period (Q1, Q3) of 3 (1, 3) days. The multi-factor logistic regression model showed that the higher HSAR was observed in the FCH with the features of airport staff (OR=2.913, 95%CI:1.469-5.774), detection from home quarantine screening (OR=6.795, 95%CI:1.761-26.219) and detection from mass screening (OR=4.239, 95%CI:1.098-16.368). Meanwhile, higher HSAR was observed in cases with longer household exposure (OR=1.221, 95%CI:1.040-1.432), non-vaccination (OR=2.963, 95%CI:1.288-6.813) and incomplete vaccinations (OR=2.842, 95%CI:0.925-8.731). Conclusion: The generation interval of the Delta variant is shortened, and the ability of transmission within the household is enhanced. In the outbreak in Nanjing, the associated factors of HSAR are occupation, detection route, vaccination and exposure period.

Predicting Oxygen Utilization & Nurse Staffing Needs For COVID-19

Supplemental oxygen is an essential part of in-hospital care for most patients hospitalized with SARS-CoV-2 pneumonia. This study seeks to identify hospitalized patients who will require advanced oxygen support (high flow oxygen, CPAP, BiPAP, or mechanical ventilation) within 96 hours of admission using a machine learning model. This information can be useful for hospitals to plan for nurse staffing, as patients will consume more resources and will need more staff assistance.Data from 302 SARS-CoV-2 patients was used to create a classifier to predict whether or not patients would require advanced oxygen support within 96 hours of admission. Of the 302 cases, 211 were randomly selected to train the model, and 91 were randomly selected for testing. Through a labeled dataset, we performed supervised learning by using a random forest ensemble model which included demographic, clinical comorbidities, vitals, and laboratory values. We used 5-fold cross-validation to evaluate our trained model and employed a majority vote decision across the five trained models in order to produce the final prediction for a given patient. Through the models, we yielded results through sensitivity, specificity, positive predictive value, negative predictive value, and F1 score with the 91 cases of training data.An additional 24 cases were used to test the validity of the ensemble consensus model. Approximately 40% of all patients progressed to require advanced oxygen support 96 hours after the initial presentation.Although the insight gained from the model may not definitively predict the course of an individual patient, this model may help hospital administrators plan for staffing needs with a 48-hour lead time. Patients on high oxygen support require high acuity beds, which have increased nurse-to-patient ratios. Additional samples may increase its statistical significance. Nevertheless, this model demonstrates the potential and viability of using data science to help manage hospital resources. © 2022 IEEE.

Integrated surveillance and early warning system for emerging infectious diseases based on One Health concept: Structures and innovations

One Health is an upgrade and optimization of health concepts, which recognizes the integrated health of the human-animal-environment. It emphasizes the use of interdisciplinary collaboration, multi-sectoral coordination, and multi-organizational One Health approaches to solve scientific questions. The surveillance and early warning system is the basis of public health emergency prevention and control. The COVID-19 pandemic and the emerging infectious disease (EID) have put great challenges on the existing surveillance and early warning systems worldwide. Guided by the concept of One Health, we attempt to build a new pattern of integrated surveillance and early warning system for EID. We will detail the system including the One Health-based organizational structure, zoonotic and environmental science surveillance network, EID reporting process, and support and guarantee from education and policy. The integrated surveillance and early warning system for EID constructed here has practical and application prospects, and will provide guidance for the prevention and control of COVID-19 and the possible EID in the future. © 2022, National Institute of Parasitic Diseases. All rights reserved.

Wearable Optical Sensing in the Medical Internet of Things (MIoT) for Pervasive Medicine: Opportunities and Challenges

Recent advances in the Medical Internet of Things (MIoT) and big data enable a prospering platform for pervasive healthcare and facilitate the transformation from hospital-centered to human-centered healthcare. Wearable devices as human interfaces provide first-hand data and real-time monitoring, which are key technologies in the MIoT. Several remarkable surveys have been conducted to summarize the recent progress in wearable sensors and systems for the MIoT and pervasive medicine. However, few have focused on wearable optical sensing (WOS) technologies, which is an emerging sensing modality in wearable devices. WOS can achieve high precision, high compatibility, high anti-interference, and low motion artifacts for human vital signal acquisition, which are particularly useful in special scenarios such as intensive care units (ICUs). These technologies can also be integrated with smart fabrics or mobile computing for out-of-hospital healthcare. This work provides the first literature review of WOS for pervasive medicine. We aim to systematically summarize the emerging WOS technologies in the MIoT for disease diagnosis and health monitoring. Specifically, this review covers the technical bases and design principles of major WOS technologies and their application domains for monitoring and treatment. We also discuss the opportunities and challenges, especially in the COVID-19 outbreak.

Expanding Family-based Obesity Treatment Interventions for Children in Emerging Latinx Communities: A Qualitative Evaluation

Background: Latinx children have the highest childhood overweight and obesity rates out of any United States racial and ethnic group. The United States Preventative Task Force recommends pediatric obesity screening and referral to comprehensive, intensive behavioral interventions. However, there is a lack of data for obesity treatment programs for newly developing (emerging) Latinx communities that often have fewer social supports in place compared to more established Latinx communities. Qualitative evaluations of obesity treatment programs for Latinx youth are also limited. Methods: Forty Latinx children aged 5-12 years old who were overweight or obese were recruited into a community-based, family-oriented obesity treatment program in an emerging Latinx community. The program was based on the Active and Healthy Families (AHF) intervention initially implemented in California. Our program, which ran from September 2017 to September 2019, consisted of eight in-person group sessions over sixteen weeks led by a nutritionist, pediatrician, and promotora. All the parents who participated with their children in the intervention were invited to be interviewed. For those parents who consented, interviews were conducted from December 2020 to February 2021 to explore their experience during and post intervention as well as the impact of the COVID-19 pandemic on family behaviors. Transcripts were recorded, transcribed, and analyzed for thematic content. Transcripts were coded independently using Dedoose and subsequently reconciled with a second coder. The coding team reviewed the codes and selected the themes through group consensus. This project was approved by our institutional IRB (IRB00136080). Results: We interviewed 14 mothers. Four major themes emerged: 1) mothers' felt a sense of responsibility and desire to learn how to improve the health of their child, 2) families acquired new knowledge that they applied to change household habits, 3) parents felt solidarity with other parents in the program by sharing struggles and common experiences, and 4) the COVID-19 pandemic made it difficult to maintain dietary changes and active lifestyles. Further, parents were open to a virtual format for the intervention. Conclusion: The family intervention was well received and created a supportive environment for parents. Based on the knowledge they gained through the intervention, parents endorsed behavior change at both the child and parent level following the program. However, social distancing measures as part of the COVID-19 pandemic response often reversed many of these behavior changes. These findings support the use of community-based, family-oriented pediatric obesity treatment programs in emerging Latinx communities. Additional quantitative analysis of this project to review intervention effectiveness is underway. Booster sessions may be needed to support families and provide strategies when new stressors and barriers arise such as such as those that occurred during the COVID-19 pandemic. Future studies could also investigate the acceptability and effectiveness of a virtual format for the intervention. Associations of Childhood Obesity Google Trends Scores with the USA's 2011-2018 Annual Prevalence of Childhood Obesity & Pediatric Type 2 Diabetes Mellitus Red: Childhood Obesity Blue: Pediatric Type II Diabetes Mellitus.

Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective cross-sectional study.

Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severity is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity-based on hospital or intensive care unit (ICU) admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days-were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. Only LSAT was found to be significantly associated with the COVID-19 severity (p<0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA-based on AHI, ODI, and RDI-and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days.

Fatigue status and influencing factors of officers and soldiers during closed management of coronavirus disease 2019

Objective To explore the characteristics and influencing factors of fatigue in officers and soldiers during the closed management of coronavirus disease 2019 (COVID-19), so as to provide evidence for developing specific strategies on psychological assistance in major public health emergencies. Methods The fatigue status and stress level were evaluated by multidimensional fatigue inventory, military personnel psychological self-evaluation test and self-designed epidemic effect questionnaire in 199 officers and soldiers from an army unit, and the relevant data were analyzed by SPSS 21.0 softwase. Results The total fatigue score was 47.96±12.52, with power loss (50.25%) as the main manifestation, and the stress rate was 7.54% (15/199). There were significant differences in the total fatigue scores concerning gender, job title, service age, educational background, number of closed days, and the impact of the epidemic on themselves (all P<0.05). The total fatigue score and the 3 factors (physical fatigue, mental fatigue and power loss) were positively correlated with the stress level (P<0.05 or P<0.01). Multiple linear regression analysis showed that the number of closed days, job title, stress level and whether being the only child or not were included in the regression equation. Conclusion The main influencing factors of fatigue in officers and soldiers during the COVID-19 epidemic include gender, job title, service age, educational background, stress level, number of closed days, and the impact of the epidemic on themselves. The number of closed days, job title, stress level and whether being the only child or not can effectively predict the fatigue status of officers and soldiers during closed management.

Expert consensus on emergency medicine procedure optimization guided by routine prevention and control strategy for COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 31 January 2020. Emergency medicine procedures in Emergency Department should be optimized to cope with the current COVID-19 pandemic by providing subspecialty services, reducing the spread of nosocomial infections, and promoting its capabilities to handle emerging diseases. Thus, the Chinese Society of Emergency Medicine and Wuhan Society of Emergency Medicine drafted this consensus together to address concerns of medical staffs who work in Emergency Department. Based on in-depth review of COVID-19 diagnosis and treatment plans, literatures, as well as management approval, this consensus proposes recommendations for improving the rationalization and efficiency of emergency processes, reducing the risk of nosocomial infections, preventing hospital viral transmission, and ensuring patient safety. © 2021 Asian Pacific Journal of Tropical Medicine Produced by Wolters KluwerMedknow. All rights reserved.

Review and Prospects of Pathogen Detection Related to Autopsy of Coronavirus Infectious Diseases.

ABSTRACT: In the past, coronavirus caused two serious human-to-human pandemics in the world, including severe acute respiratory syndrome （SARS） and Middle East respiratory syndrome （MERS）. In late 2019, coronavirus disease 2019 （COVID-19） caused another major global public health event. Due to the strong infectivity of novel coronavirus, it is difficult to carry out the autopsy of related death cases widely. This paper reviews the previous status of the pathogen detection related to the autopsy of coronavirus infection diseases, and introduces the ongoing detection methods of novel coronavirus in clinical practice, in order to provide reference for the pathogen detection and study related to autopsy of COVID-19.

Exploration of a new way of drug accessibility for patients with rare diseases in China: the system of compassionate use under the epidemic situation

Under the outbreak of COVID-19, the unapproved experimental drug remdesivir was used by the US in order to treat the first diagnosed COVID-19 patient, following the principle of compassionate use. The application of compassionate use also provides a new way of drug accessibility for patients with rare diseases. By analyzing the relevant official websites, laws and regulations, guidelines and domestic and foreign literature of the US, the European Union, France and the UK, this paper focused on the analysis of the use of compassionate use system in the US, the UK and France, so as to provide reference for the application of compassionate use of drugs under clinical trials for patients with rare diseases in China. Both the Expanded Access (EA) and the Right To Try system in the US provide patients with access to experimental drugs in advance. French Autorisation Temporaire D'utilisation (ATU) shortens the waiting time of patients to obtain drugs and accelerates the treatment of more than 20 000 patients (rare and non-rare diseases) within three years. The UK's Early Access to Medicines Scheme (EAMS) combined with subsequent drug marketing and reimbursement, shortens the corresponding approval time for drugs. It is suggested that when implementing the compassionate use system for rare diseases in line with the national conditions of China, such important aspects be fully considered as simple and flexible methods, procedures for quick approval, reasonable cost-sharing mechanism, and system to ensure drug safety. Meanwhile, ensuring patients' right to know about drug use, opening and sharing information platform, effective incentive policy and other important aspects should be noted.

Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 （COVID-19） （Trial Draft）.

Abstract: Autopsy is of great significance to the elucidation of the pathological changes, pathogeneses and causes of death of corona virus disease 2019 （COVID-19） and can provide theoretical basis for more scientific and accurate prevention and control of the outbreak. Based on related laws and regulations, such as the Law of the People's Republic of China on Prevention and Control of Infectious Diseases, the clinical manifestations and epidemiological characteristics of COVID-19, and the related guidelines on the prevention and control of the outbreak, combined with the practical work of forensic pathology examination, the Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 （COVID-19） （Trial Draft） has been developed. This guide includes information on the background investigation of the cases, autopsy room requirements, personal prevention and protections, external examinations, autopsy, auxiliary examinations, and so on. This guide can be used as a reference by forensic and pathological examination institutions, as well as examination staff.

[Epidemiological investigation on a cluster epidemic of COVID-19 in a collective workplace in Tianjin].

Objective: To investigate and analysis the epidemiological characteristics of a cluster epidemic of COIVD-19 in a collective workplace in Tianjin, evduate the prevention and control measures based on limited evidence and experience in early period of COVID-19 epidemic. Methods: Descriptive research method was used to describe the distribution and other epidemiological characteristics of the cluster cases of COVID-19. Results: Since the onset of the first index case on January 15, ten confirmed COVID-19 cases had occurred in the workplace, and the epidemic had spread from the workplace to 4 families, infecting 7 family members. The median age of 17 cases was 55 (19-79) years. All the 10 employee cases were males, and in the family cases, 3 were males and 4 were females. Of the employee cases, 8 worked in CW workshop and 2 worked in administrative office building. The median exposure-onset interval of all the cases was 4 days, and the median exposure-onset interval was 4.5 days in the employee cases and 4 days in the family cases. The median onset-medical care seeking interval was 4 days in the non-isolated cases, 2.5 days in the cases with home isolation after onset, and 0.5 day in the cases with home isolation before onset. Conclusions: The clustering of COVID-19 cases was observed in this workplace in Tianjin, which affected 4 families. In the early stage of the epidemic, accurate and rapid blocking and control measures can completely prevent the large-scale spread of COVID-19.

[Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19].

Objective: To evaluate the cardiovascular damage of patients with COVID-19, and determine the correlation of serum N-terminal pro B-type natriuretic peptide (NT-proBNP） and cardiac troponin-I (cTnI） with the severity of COVID-19, and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated. Methods: A cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January 19 to February 13 in 2020, including 126 mild cases and 24 cases in critical care. Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension, diabetes and coronary heart disease (CHD）, as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients. Results: Age, hypersensitive C-reactive protein(hs-CRP) and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05). Prevalence of male, elevated NT-proBNP and cTnI, hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05). Univariate logistic regression analysis showed that age, male, elevated NT-proBNP, elevated cTnI, elevated hs-CRP, elevated serum creatinine, hypertension, and CHD were significantly correlated with critical disease status(all P<0.05). Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909，95%CI 4.086-177.226，P=0.001) and CHD (OR=16.609，95%CI 2.288-120.577，P=0.005) were the independent risk factors of critical disease status. Conclusions: COVID-19 can significantly affect the heart function and lead to myocardial injury. The past medical history of CHD and increased level of cTnI are 2 independent determinants of clinical disease status in patients with COVID-19.