Living through the COVID-19 Pandemic: Impact and Lessons on Dietary Behavior and Physical Well-Being

The aim of this review is to highlight the spectrum on which human behavior has been affected by blanket restriction measures and on a wider scale, the COVID-19 pandemic. Some of the human behaviors that have been impacted by the COVID-19 lockdown are dietary behavior and nutrition, food options and food delivery usage, physical activity and sedentary behaviors. This is important in planning effective public health strategies with minimal detriment to all subsets of society as well as improving the distribution of government aid to populations that are more severely affected. Our main purpose is to present the literature from a rapidly growing pool of scientific research to hopefully enable a better and more comprehensive understanding of the effects of this pandemic and the lessons learnt from the accompanying restrictions, as well as policy recommendations that can be made in national pandemic responses in the future.

Estimating the Proportion of Asymptomatic COVID-19 Cases in an Italian Region with Intermediate Incidence during the First Pandemic Wave: An Observational Retrospective Study

Early in the COVID-19 pandemic, asymptomatic transmission represented an important challenge for controlling the spread of SARS-CoV-2 through the traditional public health strategies. Further understanding of the contribution of asymptomatic infections to SARS-CoV-2 transmission has been of crucial importance for pandemic control. We conducted a retrospective epidemiological study to characterize asymptomatic COVID-19 cases occurred in the Apulia region, Italy, during the first epidemic wave of COVID-19 outbreak (February 29-July 7, 2020). We analyzed data collected in a regional platform developed to manage surveillance activities, namely, investigation and follow-up of cases and contacts, contact tracing, and laboratory and clinical data collection. We included all asymptomatic cases that were laboratory-confirmed during the appropriate follow-up, defined as persons infected with SARS-CoV-2 who did not develop symptoms/clinical signs of the disease. Between February 29 and July 7, 2020, a total of 4,536 cases were diagnosed with COVID-19 among 193,757 tests performed. The group of persons with asymptomatic SARS-CoV-2 infection consisted of 903 cases; the asymptomatic proportion was 19.9% (95% CI: 18.8-21.1%); this decreased with increasing age (OR: 0.89, 95% CI: 0.83-0.96; p = 0.001 ), in individuals with underlying comorbidities (OR: 0.55, 95% CI: 0.41-0.73; p < 0.001 ), and in males (OR: 0.69, 95% CI: 0.54-0.87; p = 0.002 ). The median asymptomatic SARS-CoV-2 RNA positive period was 19 days (IQR: 14-31) and the cumulative proportion of persons with resolution of infection 14 days after the first positive PCR test was 74%. As the public health community is debating the question of whether asymptomatic and late spreaders could sustain virus transmission in the communities, such cases present unique opportunities to gain insight into SARS-CoV-2 adaptation to human host. This has important implications for future COVID-19 surveillance and prevention.

Sampling bias in Brazilian studies on transgender and gender diverse populations: the two-step measure for assessing gender identity in surveys

Correctly recognizing gender identity in population-based surveys is essential to develop effective public health strategies to improve the living conditions of transgender and gender-diverse populations, as well as to adequately collect data on cisgender individuals. This study aims to present the two-step measure as the best strategy for assessing gender identity in Brazilian surveys, thus we performed two separate analyses. Firstly, we conducted a systematic review concerning HIV-related care among Brazilian transgender and gender-diverse populations to assess the strategy used to identify participants’ gender identity. Secondly, we re-analyzed data from a recent survey that included Brazilian transgender populations, comparing characteristics and health outcomes from the sample identified by single-item and by the two-step measure. Concerning the systematic review, from 6,585 references, Brazilian research teams published seven articles, and only one study used the two-step measure. Regarding this survey, the two-step measure recognized 567 cisgender and 773 transgender and gender diverse participants among the 1,340 participants who answered the questionnaire, whereas the single-item measure was able to recognize only 540 transgender and gender diverse people. Furthermore, 31 transgender women self-identified as “transgender men” on the single-item measure. Therefore, although scarcely used in Brazil, the two-step measure is a more accurate strategy to recognize gender identity.

Symptom cluster analysis of long COVID-19 in patients discharged from the Temporary COVID-19 Hospital in Mexico City

Introduction: Several reports have emerged describing the long-term consequences of COVID-19 and its effects on multiple systems. Methods: As further research is needed, we conducted a longitudinal observational study to report the prevalence and associated risk factors of the long-term health consequences of COVID-19 by symptom clusters in patients discharged from the Temporary COVID-19 Hospital (TCH) in Mexico City. Self-reported clinical symptom data were collected via telephone calls over 90 days post-discharge. Among 4670 patients, we identified 45 symptoms across eight symptom clusters (neurological; mood disorders; systemic; respiratory; musculoskeletal; ear, nose, and throat; dermatological; and gastrointestinal). Results: We observed that the neurological, dermatological, and mood disorder symptom clusters persisted in >30% of patients at 90 days post-discharge. Although most symptoms decreased in frequency between day 30 and 90, alopecia and the dermatological symptom cluster significantly increased ( p < 0.00001). Women were more prone than men to develop long-term symptoms, and invasive mechanical ventilation also increased the frequency of symptoms at 30 days post-discharge. Conclusion: Overall, we observed that symptoms often persisted regardless of disease severity. We hope these findings will help promote public health strategies that ensure equity in the access to solutions focused on the long-term consequences of COVID-19.

Are ‘Behaviour Change’ Approaches to Obesity and Health Effective? A case Study from Samoa

‘Behaviour Change’ approaches in public health strategies have been used in Pacific Island countries to address the problem of dietary and lifestyle changes that are believed to be the cause of rising rates of obesity and associated NCDS. We consider the limitations of this approach in the context of Samoa’s socioeconomic situation and public health policy and propose that an ‘obesogenic’ environment and structural factors are causational and require policy measures that go beyond the scope of responsibilities of the Samoa Ministry of Health

Perception and preventive behavior during COVID-19 pandemic among urban residents in Banda Aceh, Indonesia: a cross-sectional study

BACKGROUND It is critical to evaluate the perception and preventive behavior of COVID-19 to formulate the optimal public health strategies for tackling the ongoing pandemic. This study aimed to enhance knowledge on the perception and preventive behavior toward COVID-19 among urban residents in Banda Aceh, Indonesia. METHODS A cross-sectional population-based survey was conducted from September to October 2020 using a structured questionnaire for the attendants of the six public health centers in Banda Aceh. Information about sociodemographic, perception, and preventive behavior toward COVID-19 were collected. The data were analyzed to find the association between the level of preventive behavior and covariates. RESULTS Among 1,067 respondents, 71.1% were female, 52.5% were aged between 40 and 60 years, 31.2% were university graduates, and >60% were unemployed with underlying diseases such as diabetes, hypertension, and cardiopulmonary diseases. The responses of each statement toward COVID-19 were varied. The multivariable model of covariates showed that females had good preventive behavior toward COVID-19 (adjusted OR: 1.849, 95% CI: 1.359–2.515). Urban residents in Banda Aceh with the underlying diseases had poor preventive behavior, while those with higher educational level and perception scores were more inclined to engage in good preventive behavior. CONCLUSIONS Most urban residents in Banda Aceh showed positive perception and propensity for adopting preventive measures. Health education is necessary for susceptible residents, such as males, less educated people, and people with underlying diseases. It should be stressed on specific practices and knowledge.

Which Vaccine? The Cost of Religious Freedom in Vaccination Policy

We discuss whether and under what conditions people should be allowed to choose which COVID-19 vaccine to receive on the basis of personal ethical views. The problem arises primarily with regard to some religious groups’ concerns about the connection between certain COVID-19 vaccines and abortion. Vaccines currently approved in Western countries make use of foetal cell lines obtained from aborted foetuses either at the testing stage (Pfizer/BioNTech and Moderna vaccines) or at the development stage (Oxford/AstraZeneca vaccine). The Catholic Church’s position is that, if there are alternatives, Catholic people have a moral obligation to request the vaccine whose link with abortion is more remote, which at present means that they should refuse the Oxford/AstraZeneca vaccine. We argue that any consideration regarding free choice of the vaccine should apply to religious and non-religious claims alike, in order to avoid religion-based discrimination. However, we also argue that, in a context of limited availability, considering the significant differences in costs and effectiveness profile of the vaccines available, people should only be allowed to choose the preferred vaccine if: 1) this does not risk compromising vaccination strategies; and 2) they internalize any additional cost that their choice might entail. The State should only subsidize the vaccine that is more cost-effective for any demographic group from the point of view of public health strategies.

Spatiotemporal patterns and progression of the Delta variant of COVID-19 and their health intervention linkages in Southeast Asia

The global pandemic of COVID-19 presented an unprecedented challenge to all countries in the world, among which Southeast Asia (SEA) countries managed to maintain and mitigate the first wave of COVID-19 in 2020. However, these countries were caught in the crisis after the Delta variant was introduced to SEA, though many countries had immediately implemented non-pharmaceutical intervention (NPI) measures along with vaccination in order to contain the disease spread. To investigate the potential linkages between epidemic dynamics and public health interventions, we adopted a prospective space-time scan method to conduct spatiotemporal analysis at the district level in the seven selected countries in SEA from June 2021 to October 2021. Results reveal the spatial and temporal propagation and progression of COVID-19 risks relative to public health measures implemented by different countries. Our research benefits continuous improvements of public health strategies in preventing and containing this pandemic.

Adverse events related to unapproved stem cell products and other regenerative interventions: recommendations for more robust regulation of the direct-to-consumer marketplace

Tweetable abstract Adverse events continue to occur in the direct-to-consumer market for unapproved regenerative interventions and US FDA alone cannot adequately address the problem. Other public health strategies are needed to provide better patient protection.