Rare predicted loss-of-function variants of type I IFN immunity genes are associated with critical COVID-19

BackgroundWe previously reported inborn errors of TLR3- and TLR7-dependent type I interferon (IFN) immunity in 1-5% of unvaccinated patients with life-threatening COVID-19, and auto-antibodies against type I IFN in another 15-20% of cases. MethodsWe report here a genome-wide rare variant burden association analysis in 3,269 unvaccinated patients with life-threatening COVID-19 (1,301 previously reported and 1,968 new patients), and 1,373 unvaccinated SARS-CoV-2-infected individuals without pneumonia. A quarter of the patients tested had antibodies against type I IFN (234 of 928) and were excluded from the analysis. ResultsNo gene reached genome-wide significance. Under a recessive model, the most significant gene with at-risk variants was TLR7, with an OR of 27.68 (95%CI:1.5-528.7, P=1.1x10-4), in analyses restricted to biochemically loss-of-function (bLOF) variants. We replicated the enrichment in rare predicted LOF (pLOF) variants at 13 influenza susceptibility loci involved in TLR3-dependent type I IFN immunity (OR=3.70 [95%CI:1.3-8.2], P=2.1x10-4). Adding the recently reported TYK2 COVID-19 locus strengthened this enrichment, particularly under a recessive model (OR=19.65 [95%CI:2.1-2635.4]; P=3.4x10-3). When these 14 loci and TLR7 were considered, all individuals hemizygous (n=20) or homozygous (n=5) for pLOF or bLOF variants were patients (OR=39.19 [95%CI:5.2-5037.0], P=4.7x10-7), who also showed an enrichment in heterozygous variants (OR=2.36 [95%CI:1.0-5.9], P=0.02). Finally, the patients with pLOF or bLOF variants at these 15 loci were significantly younger (mean age [SD]=43.3 [20.3] years) than the other patients (56.0 [17.3] years; P=1.68x10-5). ConclusionsRare variants of TLR3- and TLR7-dependent type I IFN immunity genes can underlie life-threatening COVID-19, particularly with recessive inheritance, in patients under 60 years old.

Healthcare workers' worries and Monkeypox vaccine advocacy during the first month of the WHO Monkeypox alert: Cross-sectional survey in Saudi Arabia

BackgroundMonkeypox virus re-surged in May 2022 as a new potential global health threat with outbreaks bursting in multiple countries across different continents. This study was conducted during the first month of the WHO announcement to assess the healthcare workers (HCWs) within Saudi Arabia, exploring their perception, worries, and vaccine acceptance for Monkeypox in-line with the resolving COVID-19 pandemic. MethodsA national cross-sectional survey was conducted between May 27 and June 10, 2022, in Saudi Arabia. Data were collected on the sociodemographic and job-related characteristics, COVID-19 infection status, HCWs worry levels of Monkeypox compared to COVID-19 and its sources, their perceptions, awareness, and HCWs Monkeypox vaccination advocacy. ResultsAmong the 1130 HCWs who completed survey, 41.6% already developed COVID-19. Still, 56.5% were more worried from COVID-19 compared to Monkeypox, while the rest were more worried of Monkeypox disease. The main reason for their worry among 68.8% of the participants was development of another worldwide pandemic post COVID-19, followed by their worry of acquiring the infection themselves or their families (49.6%). Most HCWs (60%) rated their self-awareness of Monkeypox disease as moderate to high. Males and those who previously developed COVID-19 were significantly less likely to worry about Monkeypox. The worry about Monkeypox developing into a pandemic and the perception of Monkeypox being a severe disease correlated significantly positively with the odds of high worry from the disease. Regarding participants advocacy for HCWs vaccination against Monkeypox disease, those who developed COVID-19 previously and those who supported application of tighter infection control measures compared to the current ones to combat the disease were significantly predicted to agree for vaccination. 74.2% of the surveyed HCWs perceived that they need to read more about the Monkeypox disease after the survey. ConclusionDuring the first month of the WHOs Monkeypox international alert, about half of HCWs in this study were more worried about Monkeypox disease as compared to COVID-19, and its possible progression into another pandemic. In addition, the majority were in favor of applying tighter infection prevention measures to combat the disease. The current study highlights areas needed for healthcare administrative about the HCWs perceptions and readiness for Monkeypox especially in the event of any occurrence of local or international pandemic.

Monkeypox caused less worry than COVID-19 among the general population during the first month of the WHO Monkeypox alert

BackgroundMonkeypox re-emerged in May 2022 as another global health threat. This study assessed the publics perception, worries, and vaccine acceptance for Monkeypox and COVID-19 during the first month of WHO announcement. MethodsA national cross-sectional survey was conducted between May 27 and June 5, 2022, in Saudi Arabia. Data were collected on sociodemographic characteristics, previous infection with COVID-19, worry levels regarding Monkeypox compared to COVID-19, awareness, and perceptions of Monkeypox, and vaccine acceptance. ResultsAmong the 1546 participants, most respondents (62%) were more worried about COVID-19 than Monkeypox. Respondents aged 45 years and above and those with a university degree or higher had lower odds of agreement with Monkeypox vaccination (OR .871, p-value .006, OR .719, p-value <0.001), respectively. Respondents with moderate to a high level of self and family commitment to infection control precautionary measures and those who expressed self and family worry of Monkeypox infection had significantly higher odds of vaccination agreement (OR 1.089 p-value=0.047, OR1.395 p-value=0.003) respectively. On the other hand, respondents who previously developed COVID-19 were significantly more worried about the Monkeypox disease (1.30 times more, p-value=0.020). ConclusionWorry levels amongst the public are higher from COVID-19 than Monkeypox. Perception of Monkeypox as a dangerous and virulent disease, worry from contracting the disease, and high commitment to infection precautionary measures were predictors of agreement with Monkeypox vaccination. While advanced age and high education level are predictors of low agreement with vaccination.

SARS-CoV-2 Omicron variant: healthcare workers' perceptions and beliefs of vaccine effectiveness and advocacy: a national survey during the first week of the World Health Organization variant alert

BackgroundAs the SARS-CoV2 Omicron variant spreads in several countries, healthcare workers (HCWs) perceptions and worries regarding vaccine effectiveness and boosters warrant reassessment. MethodsAn online questionnaire among HCWs in Saudi Arabia (KSA) was distributed from Dec 1st to 6th 2021 to assess their perceptions, vaccine advocacy to the Omicron variant, and their perception of the effectivness of infection prevention measures and vaccination to prevent its spread, their Omicron variant related worries in comparison to the other variants, and their agreement with mandatory vaccination in general for adults. ResultsAmong the 1285 HCW participants, two-thirds were female, 49.8 % were nurses, 46.4% were physicians, and 50.0% worked in tertiary care hospitals. 66.9% considered vaccination to be the most effective way to prevent the spread of the Omicron variant and future variants. The respondents however perceived social distancing (78.0%), universal masking (77.8%), and avoiding unnecessary travel (71.4%) as slightly superior to vaccination to prevent the spread of SARS-CoV-2 variants. HCWs aging 55 or older agreed singficanlty with vaccine ineffictivness to control Omicron spread, while those who believed in non-pharmacolgical infection prevention measures agreed signifcantly with vaccination for that purpose. Male HCWs had a significant agreement with mandatory vaccination of all eligible adult populations. On the other hand, unwilling HCWs to receive the vaccine had strong disagreements with mandatory vaccination. ConclusionsThe current study in the first week of Omicron showed that only two-thirds of HCWs felt that vaccination was the best option to prevent the spread of the Omicron variant, indicating the need for further motivation campaigns for vaccination and booster dose. HCWs had a strong belief in infection prevention measures to contain the spread of SARS-CoV-2 variants that should be encouraged and augmented.

Healthcare workers' COVID-19 Omicron variant uncertainty-related stress, resilience, and coping strategies during the first week of World Health Organization alert

BackgroundAs the COVID-19 Omicron variant emerged and spread globally at an alarming speed, healthcare workers (HCWs) uncertainties, worries, resilience, and coping strategies warrant assessment. The COVID-19 pandemic had a severe psychological impact on HCWs, including the development of Post-Traumatic Stress symptoms. Specific subgroups of HCWs, such as front-line and female workers, were more prone to poor mental health outcomes and difficulties facing stress. MethodsThe responses to an online questionnaire among HCWs in Saudi Arabia (KSA) were collected December 1-5, 2021, aiming to assess their Omicron variants uncertainties, worries, resilience, and coping strategies. Three validated instruments were used to achieve the studys goals: the Brief Resilient Coping Scale, the Standard Stress Scale (SSS), and the Intolerance of Uncertainty Scale (IUS) - Short Form. ResultsThe online survey was completed by 1285 HCWs. Females made up the majority (64%). The BRCS score of resilient coping was negatively and substantially linked with the SSS score of stress (r=-0.313, p = 0.010). Furthermore, the IUS had a positive and significant relationship with stress (r=0.326, p= 0.010). Increased stress levels were linked to a considerable drop in resilient coping scores. Furthermore, being a Saudi HCW or a nurse was linked to a significant reduction in resilient coping ratings. Coping by following healthcare authorities preventative instructions and using the WHO website as a source of information was linked to a considerable rise in resilient coping. ConclusionsFollowing the emergence of the Omicron variant of SARS-CoV-2 in late 2021, a rapid investigation into the correlates of stress and resilient coping among the HCWs in KSA was conducted. The negative association between resilient coping and stress was clearly shown, as well as how underlying intolerance of uncertainty is linked to higher stress among HCWs quickly following the development of a new infectious threat. The study provides early insights to develop and promote coping strategies for emerging SARS-CoV-2 variants.

Induction of soluble platelet activation markers and FXIII deficiency promote COVID-19 severity

IntroductionCoagulation dysfunction and thromboembolism emerge as strong comorbidity factors in severe COVID-19. However, it is unclear when particularly platelet activation markers and coagulation factors dysregulated during the pathogenesis of COVID-19. Here, we sought to assess the levels of coagulation and platelet activation markers at moderate and severe stages of COVID-19 to understand the pathogenesis. MethodsTo understand this, hospitalized COVID-19 patients with (severe cases that required intensive care) or without pneumonia (moderate cases) were recruited. Phenotypic and molecular characterizations were performed employing basic coagulation tests including PT, APTT, D-Dimer and TFPI. The flow cytometry-based multiplex assays were performed to assess FXI, anti-thrombin, prothrombin, fibrinogen, FXIII, P-selectin, sCD40L, plasminogen, tissue-plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and D-Dimer. ResultsThe investigations revealed induction of plasma P-selectin and CD40 ligand (sCD40L) in moderate COVID-19 cases which were significantly abolished with the progression of COVID-19 severity. Moreover, a profound reduction in plasma tissue factor pathway inhibitor (TFPI) and FXIII were identified particularly in the severe COVID-19. Further analysis revealed fibrinogen induction in both moderate and severe patients. Interestingly, an elevated PAI-1 more prominently in moderate, and tPA particularly in severe COVID-19 cases were observed. Particularly, the levels of fibrinogen and tPA directly correlated with the severity of the disease. ConclusionsIn summary, induction of soluble P-selectin, sCD40L, fibrinogen and PAI-1 in moderate COVID-19 cases suggests the activation of platelets and coagulation system before patients require intensive care. These findings would help in designing better thromboprophylaxis to limit the COVID-19 severity.

Pediatric intensive care hybrid-style clinical round during COVID-19 pandemic: A pilot study

BackgroundWith the evolving COVID-19 pandemic and the emphasis on social distancing to decrease the spread of SARS-CoV-2 among healthcare workers (HCWs), our pediatric intensive care unit (PICU) piloted utilization of Zoom online into the clinical rounds to enhance communication among the treating team. We aimed to explore the feasibility of these hybrid virtual and physical clinical rounds for PICU patients from the HCWs perspective. MethodsA mixed quantitative and qualitative deductive thematic content analysis of narrative responses from pediatric intensive care HCWs were analyzed, descriptive statistics were used ResultsA total of 31 HCW were included in the analysis; the mean time of the virtual round was 72.45 minutes vs. 34.68 for physical rounds, the most shared component in the virtual round was CXR (93.5%). Some of the HCWs perceived advantages of the hybrid rounds were enabling the multidisciplinary discussions, lesser round interruptions, and practicality of the virtual discussions. The perceived challenges were the difficulty of the bedside nurse to attend the virtual round, decreased teaching opportunities for the trainees, and decreased interactions among the team members, especially if the video streaming was not utilized. ConclusionHybrid virtual and physical clinical rounds in PICU were perceived as feasible by HCWs. The virtual rounds decreased the physical contact between the HCWs, which could decrease the possibility of SARS-CoV-2 spread among the treating team. Still, several components of the hybrid round could be optimized to facilitate the virtual team-members interactions and enhance the teaching experience.

Virtual handover of patients in the pediatric intensive care unit during COVID-19 crisis

ObjectivesA key measure to mitigate coronavirus disease 2019 (COVID-19) has been social distancing. Incorporating video-conferencing applications in the patient handover process between healthcare workers can enhance social distancing while maintaining handover elements. This study describes pediatric intensive care unit (PICU) physicians experience of using an online video-conferencing application for handover during the COVID-19 pandemic. Design: qualitative content analysis SettingPICU at a university hospital in Riyadh, Saudi Arabia Subjects: PICU Physicians InterventionsDue to the pandemic, the hospitals PICU used Zoom(R) as a remote conferencing application, instead of a face-to-face handover. Following institutional review board approval, data were collected over two weeks (July 1, 2020 to July 14, 2020). Measurements: Demographic data and narrative descriptions of the perceived efficacy of remote handover were collected using open-ended questions through a created online link. The analysis process included open coding, creating categories, and abstraction. Main ResultsAll 37 PICU physicians who participated in the handover completed the survey. The participants comprised six attendings, nine specialists, and 22 residents. They had variable previous teleconferencing experiences. Most physicians (78.4%) were comfortable conducting a remote endorsement. Most found that Situation-Background- Assessment-Recommendation handover elements were properly achieved through this remote handover process. The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing. The perceived disadvantages were the paucity of nonverbal communication and teaching during virtual meetings. ConclusionsVideo-conferencing applications used for online handovers could supplement traditional face-to-face intensive care unit patient endorsement during outbreaks of infectious diseases. The use of video streaming and more emphasis on teaching should be encouraged to optimize the users experience.

COVID-19 vaccine uptake among healthcare workers in the fourth country to authorize BNT162b2 during the first month of rollout

BackgroundThe Kingdom of Saudi Arabia (KSA) was the fourth country in the world to authorize the BNT162b2 coronavirus disease 2019 (COVID-19) vaccine, which it rolled out on December 17, 2020 and first targeted at healthcare workers (HCWs). This study assesses vaccine uptake among this group during the first month of its availability. MethodsA national cross-sectional, pilot-validated, self-administered survey was conducted among HCWs in the KSA between December 27, 2020 and January 3, 2021. The survey included sociodemographic details, previous contact with COVID-19 patients, previous infection with COVID-19, receiving (or registering with the Ministry of Health website to receive) the COVID-19 vaccine, sources of HCWs information on vaccines, awareness of emerging variants of concern, and anxiety level using the 7-item Generalized Anxiety Disorder assessment. A descriptive bivariate analysis and multivariate logistic binary regression analysis were performed. The primary evaluated outcome was vaccine uptake. ResultsOf the 1,058 participants who completed the survey, 704 (66.5%) were female, and 626 (59.2%) were nurses. Of all the respondents, 352 (33.27%) were enrolled to receive or had already received the vaccine, while 706 (66.73%) had not registered. In a bivariate analysis, not enrolling for vaccination was more likely in females than males (78.5% vs. 21.5%, P < 0.001), HCWs between the ages of 20 and 40 years than those > 40 years (70.4% vs. 29.6%, P = 0.005), Saudi HCWs than expatriates (78% vs 22%, P < 0.001), and among HCWs who used social media as a source of information than those who did not (69.8% vs. 38.6%, P < 0.001). In a multivariate analysis, independent factors for not enrolling to receive the vaccine included being female (aOR = 0.287, 95%CI = 0.206-0.401, P < 0.001), being less than 40 years of age (aOR = 1.021, 95%CI = 1.002-1.040, P = 0.032), and using social media as a source of information (aOR = 0.207, 95%CI = 0.132-1.354, P = 0.001). Factors associated with uptake were being a Saudi national (aOR = 1.918, 95%CI = 1.363-2.698, P < 0.001), working in an intensive care unit (aOR = 1.495, 95%CI = 1.083-2.063, P = 0.014), and working at a university hospital (aOR = 1.867, 95%CI = 1.380-2.525, P < 0.001). ConclusionsA low level of vaccine uptake was observed especially in female HCWs, those younger than 40 years old, and those who used social media as their source of vaccine information. This survey provides important information for public health authorities in order to scale up vaccination campaigns targeting these HCWs to increase vaccine enrollment and uptake.

Changes in healthcare workers' knowledge, attitudes, practices, and stress during the COVID-19 pandemic

IntroductionCoronavirus disease 2019 (COVID-19) has caused an unprecedented health crisis around the world, not least because of its heterogeneous clinical presentation and course. The new information on the pandemic emerging daily has made it challenging for healthcare workers (HCWs) to stay current with the latest knowledge, which could influence their attitudes and practices during patient care. MethodsThis study is a follow-up evaluation of changes in HCWs knowledge, attitudes, and practices as well as anxiety levels regarding COVID-19 since the beginning of the pandemic. Data were collected through an anonymous, predesigned, self-administered questionnaire that was sent online to HCWs in Saudi Arabia. ResultsThe questionnaire was sent to 1500 HCWs, with a 63.8% response rate (N=957). The majority of respondents were female (83%), and the most common age group was 31-40 years (52.2%). Nurses constituted 86.3% of the respondents. HCWs reported higher anxiety during the COVID-19 pandemic which increased from 4.91{+/-}2.84 to 8.6{+/-}2.27 on an 11-point Likert scale compared to other viral outbreaks. HCWs believed that their own preparedness as well as that of their hospitals intensive care unit (ICU) or emergency room (ER) was higher during the COVID-19 pandemic than during the Middle East respiratory syndrome coronavirus pandemic (2012-2015). About 58% of HCWs attended one or more simulations concerning the management of COVID-19 patients in their ICU/ER, and nearly all had undergone N95 mask fit testing. The mean score of HCWs knowledge of COVID-19 was 9.89/12. For most respondents (94.6%), the perception of being at increased risk of infection was the main cause of anxiety related to COVID-19; the mean score of anxiety over COVID-19 increased from 4.91{+/-}2.84 before to 8.6{+/-}2.27 during the pandemic in Saudi Arabia. ConclusionsHCWs anxiety levels regarding COVID-19 have increased since a pandemic was declared. It is vital that healthcare facilities provide more emotional and psychological support for all HCWs.

SARS-CoV-2 B.1.1.7 lineage-related perceptions and travel worry among healthcare workers

BackgroundHealthcare workers (HCWs) travel-related anxiety needs to be assessed in light of the emergence of SARS-CoV-2 mutations. MethodsAn online, cross-sectional questionnaire among HCWs between December 21, 2020 to January 7, 2021. The outcome variables were HCWs knowledge and awareness of the SARS-CoV-2 B.1.1.7 lineage, and its associated travel worry and Generalized Anxiety Disorder (GAD-7) score. ResultsA total of 1,058 HCWs completed the survey; 66.5% were female, 59.0% were nurses. 9.0% indicated they had been previously diagnosed with COVID-19. Regarding the B.1.1.7 lineage, almost all (97.3%) were aware of its emergence, 73.8% were aware that it is more infectious, 78.0% thought it causes more severe disease, and only 50.0% knew that current COVID-19 vaccines are effective in preventing it. Despite this, 66.7% of HCWs were not registered to receive the vaccine. HCWs most common source of information about the new variant was social media platforms (67%), and this subgroup was significantly more worried about traveling. Nurses were more worried than physicians (P=0.001). ConclusionsMost HCWs were aware of the emergence of SARS-CoV-2 B.1.1.7 variant and expressed substantial travel worries. Increased worry levels were found among HCWs who used social media as their main source of information, those with lower levels of COVID-19 vaccine uptake, and those with higher GAD-7 scores. The utilization of official social media platforms could improve accurate information dissemination among HCWs regarding the pandemics evolving mutations. Targeted vaccine campaigns are warranted to assure HCWs about the efficacy of COVID-19 vaccines toward SARS-CoV-2 variants.

Adenovirus and RNA-based COVID-19 vaccines: perceptions and acceptance among healthcare workers

ObjectivesThe aim of this study was to compare the perception, confidence, hesitancy, and acceptance rate of various COVID-19 vaccine types among healthcare workers (HCWs) in Saudi Arabia, a nation with MERS-CoV experience. DesignNational cross-sectional, pilot-validated questionnaire. SettingOnline, self-administered questionnaire among HCWs. ParticipantsA total of 2,007 HCWs working in the Kingdom of Saudi Arabia participated; 75.3% completed the survey and were included in the analysis. InterventionData were collected through an online survey sent to HCWs during November 1-15, 2020. The main outcome measure was HCW acceptance of COVID-19 candidate vaccines. The associated factors of vaccination acceptance were identified through a logistic regression analysis and via measurement of the level of anxiety, using the generalized anxiety disorder 7 (GAD7) scale. ResultsAmong the 1512 HCWs who were included, 62.4% were women, 70.3% were between 21 and 40 years of age, and the majority (62.2%) were from tertiary hospitals. In addition, 59.5% reported knowing about at least one vaccine; 24.4% of the participants were sure about their willingness to receive the ChAdOx1 nCoV-19 vaccine, and 20.9% were willing to receive the RNA BNT162b2 vaccine. However, 18.3% reported that they would refuse to receive the Ad5-vectored vaccine, and 17.9% would refuse the Gam-COVID-Vac vaccine. Factors that influenced the differential readiness of HCWs included their perceptions of the vaccines efficiency in preventing the infection (33%), their personal preferences (29%), and the vaccines manufacturing country (28.6%). ConclusionsAwareness by HCWs of the several COVID-19 candidate vaccines could improve their perceptions and acceptance of vaccination. Reliable sources on vaccine efficiency could improve vaccine uptake, so healthcare authorities should use reliable information to decrease vaccine hesitancy among frontline healthcare providers.

COVID-19 vaccine confidence and hesitancy among healthcare workers: a cross-sectional survey from a MERS-CoV experienced nation

ObjectivesThis study aimed to identify COVID-19 vaccine perception, acceptance, confidence, hesitancy, and barriers among healthcare workers (HCW). MethodsAn online national cross-sectional pilot-validated questionnaire was self-administered by HCW in Saudi Arabia, a nation with MERS-CoV experience. The main outcome variable was HCWs acceptance of COVID-19 vaccine candidates. The associated factors of vaccination acceptance were identified through a logistic regression analysis and the level of anxiety using generalized anxiety disorder 7. ResultOut of 1512 HCWs who completed the study questionnaire--944 (62.4%) women and 568 (37.6%) men--1058 (70%) were willing to receive COVID-19 vaccines. Logistic regression analysis revealed that male HCWs (ORa=1.551, 95% CI: 1.122-2.144), HCWs who believe in vaccine safety (ORa=2.151; 95% CI:1.708-2.708), HCWs who believe that COVID vaccines are the most likely way to stop the pandemic (ORa=1.539; 95% CI: 1.259-1.881), and HCWs who rely on Centers for Disease Control and Prevention website for COVID 19 updates (ORa=1.505, 95% CI: 1.125-2.013) were significantly associated with reporting willingness to be vaccinated. However, HCWs who believed vaccines were rushed without evidence-informed testing were found to be 60% less inclined to accept COVID-19 vaccines (ORa=0.394, 95% CI: 0.298- 0.522). ConclusionMost HCWs are willing to receive COVID-19 vaccines once available; yet, satisfactoriness of COVID-19 vaccination among HCWs is crucial because health professionals knowledge and confidence toward vaccines are important determining factors for their own vaccine acceptance and recommendation to their patients.

Assessing the influence of parental anxiety on childhood anxiety during the COVID-19 pandemic in the United Arab Emirates

The COVID-19 pandemic originated in Wuhan, China on December 31st and spread into international borders, leading to a public health crisis and complete shutdown of countries. The strict quarantine measures taken by governments kept a large number of people, around the world, in isolation and affected many aspects of peoples lives. These unprecedented changes triggered a wide variety of psychological problems ranging from panic disorders, anxiety and depression. In this study, we aim to explore anxiety levels among parents, teachers and the general community amid the COVID-19 pandemic in the UAE, as well as identify emotional and anxiety disorders in children. Using a web-based cross-sectional survey we collected data from 2,200 self-selected assessed volunteers. Demographic information, knowledge and beliefs about COVID-19, generalized anxiety disorder (GAD) using the (GAD-7) scale, emotional problems in children using the strengths and difficulties questionnaire (SDQ), worry and fear about COVID-19, coping mechanisms and general health information were collected. The overall prevalence of GAD in the general population was 71% with younger people (59.8%) and females (51.7%) reporting the highest levels of anxiety. Parents who were teachers reported the highest percentage of emotional problems in children (26.7%) compared to parents only (14.6%) or teachers only (4.7%). Multivariate logistic regression for GAD-7 score showed that females, participants who felt public fear was justifiable, persons who worried about COVID-19, persons who intended to take the COVID-19 vaccine and smokers were all associated with anxiety. Multivariate logistic regression for SDQ showed parents who had severe anxiety levels were 7 times more likely to report more emotional problems in their children (OR=7.00, 95% CI, 3.45 to 14.0) than less anxious parents. Findings suggest the urgency of policy makers to develop effective screening and coping strategies for parents and teachers and more specifically for vulnerable children.

Whole genome and phylogenetic analysis of SARS-CoV-2 strains from the index and early patients with COVID-19 in Dubai, United Arab Emirates, 29 January to 18 March 2020

International travel played a significant role in the early global spread of SARS-CoV-2. Understanding transmission patterns from different regions of the world will further inform global dynamics of the pandemic. Using data from Dubai in the United Arab Emirates (UAE), a major international travel hub in the Middle East, we establish SARS-CoV-2 full genome sequences from the index and early COVID-19 patients in the UAE. The genome sequences are analysed in the context of virus introductions, chain of transmissions, and possible links to earlier strains from other regions of the world. Phylogenetic analysis showed multiple spatiotemporal introductions of SARS-CoV-2 into the UAE from Asia, Europe, and the Middle East during the early phase of the pandemic. We also provide evidence for early community-based transmission and catalogue new mutations in SARS-CoV-2 strains in the UAE. Our findings contribute to the understanding of the global transmission network of SARS-CoV-2.

Increased levels of anxiety among medical and non-medical university students during the COVID-19 pandemic in the United Arab Emirates.

IntroductionThe COVID-19 pandemic is likely to increase anxiety levels within the community and in particular medical students who are already considered psychologically vulnerable groups. Since the COVID-19 outbreak, no study has yet estimated the effect of this pandemic on university students in the UAE or its impact on the psychological well-being of medical students. MethodsIn this study, we surveyed 1485 medical (comprising medical and dental) and non-medical university students across 4 emirates within the UAE. We used an online platform to assess knowledge, sources of information, changes in hygienic behavior, perceptions of fear and worry and anxiety levels using the generalized anxiety disorder 7 (GAD-7) scale. The GAD-7 score was measured at three time points; during hospital visits for medical/dental students, before the introduction of online learning and after online learning for all students. ResultsThe majority of students demonstrated high levels of knowledge and utilized reliable sources of information. Non-medical students exercised higher compliance with social restrictions, while medical students practiced better hand hygiene. Almost half of students reported anxiety levels ranging from mild to severe with females reporting higher anxiety scores during hospital visits (OR=2.02, 95% CI, 1.41 to 2.91) and medical students reporting lower anxiety levels in comparison to dental students (OR=0.61, 95% CI, 0.45 to 0.84). Medical students reported higher levels of anxiety during their clinical rotations which decreased with the introduction of online learning, yet, non-medical students anxiety levels increased with online learning. ConclusionsThis is the first study to provide important information on the initial response and anxiety levels in university students across the UAE. The findings from our study can be used to support the development of effective screening strategies and interventions to build psychological resilience among university students during the COVID-19 pandemic or any other public health emergencies in the future.

A novel anti-IL4Rα nanoparticle efficiently controls lung inflammation during asthma

Drug resistance and the harmful side effects accompanying the prolonged corticosteroid treatment of chronic pulmonary diseases prompted the development of more specific anti-inflammatory approaches. Several strategies aiming to block IL4Rα, the receptor for a key pro-inflammatory pathway, were investigated. However, their efficiency was limited, mostly due to the systemic or subcutaneous route of administrations. In this paper, we examined the ability of an intranasal treatment with biocompatible nanoparticles targeting IL4Rα to control lung inflammation in ovalbumin (OVA)-sensitized mice. OVA-sensitized mice were treated with anti-IL4Rα-conjugated nanoparticles. The levels of pro-inflammatory cytokines in the lungs and broncho-alveolar lavage fluid (BALF) were determined using a cytokine array assay. The effects of nanoparticle treatment on the activation of lung inflammatory cells and their ability to proliferate and produce cytokines were determined using fluorescence-activated cell sorting (FACS) analysis. Lung inflammation was also monitored using immunohistochemical staining. Treatment with the anti-IL4Rα nanoparticles significantly decreased pro-inflammatory cytokine expression and release in BALF and airway lung tissue in mice. The numbers of lung tissue lymphocytes, neutrophils and eosinophils were also decreased. Interestingly, anti-IL4Rα nanoparticles deactivated CD4 and CD8 T cells in lung tissue and inhibited their ability to produce pro-inflammatory cytokines to a significantly lower level than the treatment with free anti-IL4Rα. Moreover, they induced a sustained low level of lung inflammation for 1 week following the last instillation compared with the treatment with free anti-IL4Rα antibodies. Together, this data suggested that the enhanced tissue penetrability and sustainability of these nanoparticles improved the strength and durability of the immunosuppressive effects of anti-IL4Rα.