Nothing is Simple

The emergence of the coronavirus disease-2019 (COVID-19) pandemic has given an unrequested, rare, and prominent moment to the discipline of Epidemiology. The rigors and tools of epidemiology are critical in such situations, as public health threats progress from misunderstood or poorly understood to managed to possible eradication. Those trained well can hold the dual levers of scientific knowledge and public office at the same moment and steer societies from fear and suspicion when outbreaks occur to a sense of calm accomplishment and resumption of “life as normal.” In these moments epidemiology’s true influence over the last 200 years is evident. However, no force can act alone.

A Review of the Antiviral Activity of Ivermectin and Its Use in the Treatment of Coronavirus Disease-2019

Background The coronavirus disease-2019 (COVID-19) originated in China and was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. Since its emergence in December 2019, there have been challenges in developing drugs that are effective against the virus. Currently, COVID-19 is managed using symptomatic and supportive therapies, antiviral agents, cellular and immunotherapy. Besides, most of the treatment modalities are still under investigation and treatment guidelines vary from one country to another. Ivermectin is among the drugs that are being used as part of treatment guidelines in certain countries like the Republic of Peru. However, the WHO recommends that ivermectin only be used in clinical trials. Aim The authors conducted this review to explore published studies on the possible therapeutic effects of ivermectin against active infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a causative agent of COVID-19. Methods A literature search was conducted using Google Scholar, PubMed and EMBASE for articles published from 2016 to 2021. Search words used included ivermectin, antiviral, COVID-19, efficacy, safety, dosing, lower mortality rate, hospitalised patients and the Boolean operator ‘AND’. Results A few clinical trials have shown that ivermectin is safe for use in humans at specific doses and reduces the severity of the infection. Ivermectin was seen to reduce the signs and symptoms associated with COVID-19 in some studies while others showed no significant reduction. However, more studies must be conducted to ascertain its use in treating COVID-19. Conclusion Since many clinical trials are being conducted on the use of ivermectin to treat COVID-19, full evidence will be used to support its use in humans. Currently, some countries that are using ivermectin for treating COVID-19 have reported it to be effective and reduces morbidity and mortality associated with the disease. Therefore, countries should collaborate and provide full evidence for the use of ivermectin in humans to manage COVID-19.

Factors Affecting Access to E-Learning during the Coronavirus Disease 2019 Pandemic Among Rural-Based Pharmacy Students in Zambia: A Qualitative Study

Background The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the education sector globally. This has resulted in learning institutions adopting e-learning techniques. E-learning implementation in higher education continues to gain prominence in both developed and developing countries. Most universities are exploring different ways of using information and communications technology (ICT). However, ICT remains a challenge more especially for students who come from rural areas. Aim This study was aimed at exploring the factors that affect access to e-learning among rural-based pharmacy students in Zambia. Methods A qualitative case study was conducted among ten (10) purposively sampled pharmacy students at the University of Zambia. The study participants were from the Manying, a district of North-Western Province, the Sinda district of Eastern Province, the Nalolo district of Western Province, the Chipili district of Luapula Province and the Mbala district of Northern Province. Semistructured interviews were used to collect data from the respondents. Data were analyzed using the framework analysis. The sociodemographic characteristics indicate that ten (10) respondents were drawn from Zambia’s five (5) provinces. Six qualitative themes were generated these included devices used for e-learning; the effectiveness of the devices; student performance; internet connectivity; and electrification of the houses. Key findings suggest that the most commonly used device was a smartphone, which posed challenges to effective learner participation in e-learning. Poor internet connectivity, non-electrification of students’ houses, electricity outages, and costs-associated with internet use negatively affected students in accessing online learning and could adversely affect their academic activities and performance. Conclusion The COVID-19 pandemic has negatively affected access to e-learning among rural pharmacy students in Zambia. The implications of the challenges faced by the rural pharmacy students are that their academic activities and performance were negatively affected. Therefore, this posed a threat to the rights to universal access to education of the rural students who were mostly venerable.

Using MapMCDA Tool for the Spatial Epidemiology of Animal Rabies in Morocco: How to Improve the Rationality of a Qualitative Risk Assessment

Objective The objective behind this article is to better characterize spatial distribution of animal rabies in Morocco through qualitative risk assessment framework. In Morocco, the occurrence of the disease is neither clearly distributed nor complete. Therefore, risk assessment methods become strongly recommended to cope with distorted geographic patterns. Methods Based on data collection set from 168 counties, qualitative changes on spatial epidemiology of rabies were analysed by mapMCDA tool covering a period from 2004 to 2017 and including information on determinants of the geographic distribution of animal rabies in Morocco defined in previous work. Results To validate the risk assessment model, the results were compared to rabies cases reported during the study period. The clustering of the rabies risk estimates is decisive and highly reliable. A significant alignment was shown between the very high and high-risk estimates. Conclusion This study is the first attempt that has been made for using MapMCDA for rabies. For a normative process aiming to avoid subjectivity related to expert-opinions, authors suggest conducting initially a statistical multiple component analysis that will provide quantified estimates of risk factors. It would be an advisable decision-making tool that helps to design oriented surveillance and allows better referral of actions to control the disease.

Strategies and Challenges in the Development of Coronavirus Disease-2019 Vaccine

The novel coronavirus infection (coronavirus disease-2019 (COVID-19)) emerged from Wuhan in the Hubei Province of China in late 2019. Millions of people were infected with COVID-19 pandemic due to the long incubation period of the virus inside the human body and the dearth of available treatments or vaccines. High transmission rates created havoc, which highlighted the urgent need for effective interventions to stop the spread and clinical impact of the virus on patients and populations. Previous research on severe acute respiratory syndrome coronavirus (SARS-CoV) provides information on vaccination strategies that could inform how governments approach the elimination of this novel coronavirus. Numerous efforts have been made to develop vaccines against Middle East respiratory syndrome (MERS) and SARS. The spike glycoprotein or S protein is the critical target for most of the drugs and vaccines against coronavirus. The virus uses the spike (S) protein for entering the host cell, by interacting with the receptor called angiotensin converting enzyme-2 (ACE2). Various vaccine platforms are available such as nucleic acid vaccine, protein-based vaccines, virus-vectored vaccines and live or attenuated vaccines, with each having their advantages and disadvantages. This review focuses on the overview of different vaccine candidates used, those currently in development, and the challenges encountered while developing effective vaccines.

The Potential of Amniotic Fluid-Derived Extracellular Vesicles to Treat Severe Acute Respiratory Syndrome Coronavirus 2 Infection Versus Hydroxychloroquine in Human Patients

Recently a lot of attention has been focused on fast-tracking repurposed drugs for the treatment of a novel coronavirus; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent leading to the devastating coronavirus disease-2019 (Covid-19). One of the first and most well-known examples is hydroxychloroquine (HCQ), which has been used for years as a treatment for malaria, rheumatoid arthritis and lupus. HCQ was rolled out as a miracle treatment for Covid-19, which was inexpensive, effective and causing few side-effects. However, its effectiveness in treating Covid-19 has recently been questioned leaving doctors and patients confused and desperate. Here the proposed mechanisms of action of HCQ are discussed and compared with an inexpensive, safe and effective alternative, which is derived from natural, healthy amniotic fluid.

Challenges Related to Antimalarial Abuse in Coronavirus Disease-2019 Treatment in the Democratic Republic of Congo

Malaria is endemic to many African countries and geographies and remains the leading cause of morbidity and mortality on the continent. Ongoing efforts by health authorities to reverse the scale of malaria are often faced to the challenges of drug resistance often generated by therapeutic abuses relating to self-medication, sub-therapeutic under dosages and poor storage and handling of drugs throughout the pharmacy supply chain system.

Better Together: Evolving Social Process between Bystanders and First Responders is a Force Multiplier for Effective Emergency Response

Bystanders are an integral part of an emergency scene. Their presence on site makes them the immediate potential responders, who can provide life-saving assistance as well as various rescue actions. Research has shown that bystanders are willing to and are capable of helping, especially (but not limited to) when a leader emerges, as the help is rooted in a collective action. In this article, we suggest a new framework for understanding the effectiveness of bystanders help, based on the evolving social process between bystanders and first responders. As we show, the transition from no help, at the very first moment right after the emergency has occurred, to an effective coordinated response where first responders and bystanders act together, goes through engagement of bystanders. Further, first responders should acknowledge the social organization of bystanders, utilize and leverage it in order to optimize their efforts. This framework has important insights for policy makers when managing emergency and disaster situations with limited resources.

Halting Coronavirus Replication

Sirtuin 1 (SIRT1) inhibitors can reduce replication of many viruses with certain characteristics similar to those of coronaviruses, while the p53 protein is another important factor in the down-regulation of viral growth. Tenovin is a class of small molecules that inhibit Sirtuin 1 and 2, in addition to activating the p53 protein, by means of regulating the interactions used by coronaviruses as a self-defense mechanism. By blocking virus growth and continuous replication, with already tested antiviral medicines, the promise of coronavirus disease 2019 (COVID-19) eradication exists.