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Journal Description

JMIR Public Health & Surveillance (JPHS, Editor-in-chief: Travis Sanchez, Emory University/Rollins School of Public Health) is a PubMed- and MEDLINE-indexed, peer-reviewed international multidisciplinary journal with a unique focus on the intersection of innovation and technology in public health, and includes topics like public health informatics, surveillance (surveillance systems and rapid reports), participatory epidemiology, infodemiology and infoveillance, digital disease detection, digital epidemiology, electronic public health interventions, mass media/social media campaigns, health communication, and emerging population health analysis systems and tools. 

JPHS has an international author- and readership and welcomes submissions from around the world.

We publish regular articles, reviews, protocols/system descriptions and viewpoint papers on all aspects of public health, with a focus on innovation and technology in public health. The main themes/topics covered by this journal can be found here.

Apart from publishing traditional public health research and viewpoint papers as well as reports from traditional surveillance systems, JPH was one of the first (if not the only) peer-reviewed journals to publish papers with surveillance or pharmacovigilance data from non-traditional, unstructured big data and text sources such as social media and the Internet (infoveillance, digital disease detection), or reports on novel participatory epidemiology projects, where observations are solicited from the public.  

Among other innovations, JPHS is also dedicated to support rapid open data sharing and rapid open access to surveillance and outbreak data. As one of the novel features we plan to publish rapid or even real-time surveillance reports and open data. The methods and description of the surveillance system may be peer-reviewed and published only once in detail, in a  "baseline report" (in a JMIR Res Protoc or a JMIR Public Health & Surveill paper), and authors then have the possibility to publish data and reports in frequent intervals rapidly and with only minimal additional peer-review (we call this article type "Rapid Surveillance Reports"). JMIR Publications may even work with authors/researchers and developers of selected surveillance systems on APIs for semi-automated reports (e.g. weekly reports to be automatically published in JPHS and indexed in PubMed, based on data-feeds from surveillance systems and minimal narratives and abstracts).

Furthermore, during epidemics and public health emergencies, submissions with critical data will be processed with expedited peer-review to enable publication within days or even in real-time.

We also publish descriptions of open data resources and open source software. Where possible, we can and want to publish or even host the actual software or dataset on the journal website.

 

Recent Articles:

  • Source: Flickr; Copyright: David Stanley; URL: https://www.flickr.com/photos/davidstanleytravel/30582479662/in/album-72157675875661396/; License: Creative Commons Attribution (CC-BY).
    Editorial

    Apr 8, 2020

    Iraq Mass Gathering Preparedness and Public Health Recommendations

    Authors List:

    Abstract:

  • Source: Pexels; Copyright: Anna Shvets; URL: https://www.pexels.com/photo/woman-in-brown-jacket-using-smartphone-3943954/; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 7, 2020

    Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital...

    Authors List:

    Abstract:

    Background: As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation’s health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic. Objective: We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states. Methods: We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities. Results: We found that US population–level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation (r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth (r=0.055, P=.70) nor hospitals having tele-ICU capability (r=–0.073, P=.61). Conclusions: As the number of COVID-19 cases increases, so does the US population’s interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge.

  • Source: Unsplash; Copyright: Kyle Dias; URL: https://unsplash.com/photos/ZIoi-47zV88; License: Creative Commons Attribution (CC-BY).
    Participatory Epidemiology and...

    Apr 7, 2020

    Participatory Surveillance Based on Crowdsourcing During the Rio 2016 Olympic Games Using the Guardians of Health Platform: Descriptive Study

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    Abstract:

    Background: With the evolution of digital media, areas such as public health are adding new platforms to complement traditional systems of epidemiological surveillance. Participatory surveillance and digital epidemiology have become innovative tools for the construction of epidemiological landscapes with citizens’ participation, improving traditional sources of information. Strategies such as these promote the timely detection of warning signs for outbreaks and epidemics in the region. Objective: This study aims to describe the participatory surveillance platform Guardians of Health, which was used in a project conducted during the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil, and officially used by the Brazilian Ministry of Health for the monitoring of outbreaks and epidemics. Methods: This is a descriptive study carried out using secondary data from Guardians of Health available in a public digital repository. Based on syndromic signals, the information subsidy for decision making by policy makers and health managers becomes more dynamic and assertive. This type of information source can be used as an early route to understand the epidemiological scenario. Results: The main result of this research was demonstrating the use of the participatory surveillance platform as an additional source of information for the epidemiological surveillance performed in Brazil during a mass gathering. The platform Guardians of Health had 7848 users who generated 12,746 reports about their health status. Among these reports, the following were identified: 161 users with diarrheal syndrome, 68 users with respiratory syndrome, and 145 users with rash syndrome. Conclusions: It is hoped that epidemiological surveillance professionals, researchers, managers, and workers become aware of, and allow themselves to use, new tools that improve information management for decision making and knowledge production. This way, we may follow the path for a more intelligent, efficient, and pragmatic disease control system.

  • Source: The Authors/Placeit; Copyright: The Authors/Placeit; URL: https://placeit.net/c/mockups/stages/mockup-of-a-macbook-pro-on-a-rustic-desk-2311-el1?customG_0=q883wo75c6; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 6, 2020

    Novel Coronavirus in Cape Town Informal Settlements: Feasibility of Using Informal Dwelling Outlines to Identify High Risk Areas for COVID-19 Transmission...

    Authors List:

    Abstract:

    Background: The challenges faced by the Global South during the coronavirus disease (COVID-19) pandemic are compounded by the presence of informal settlements, which are typically densely populated and lacking in formalized sanitation infrastructure. Social distancing measures in informal settlements may be difficult to implement due to the density and layout of settlements. This study measures the distance between dwellings in informal settlements in Cape Town to identify the risk of COVID-19 transmission. Objective: The aim of this paper is to determine if social distancing measures are achievable in informal settlements in Cape Town, using two settlements as an example. We will first examine the distance between dwellings and their first, second, and third nearest neighbors and then identify clusters of dwellings in which residents would be unable to effectively practice social isolation due to the close proximity of their homes. Methods: Dwellings in the settlements of Masiphumelele and Klipfontein Glebe were extracted from a geographic information system data set of outlines of all informal dwellings in Cape Town. The distance to each dwelling’s first, second, and third nearest neighbors was calculated for each settlement. A social distance measure of 2 m was used (buffer of 1 m, as dwellings less than 2 m apart are joined) to identify clusters of dwellings that are unable to effectively practice social distancing in each settlement. Results: The distance to each dwelling’s first 3 nearest neighbors illustrates that the settlement of Masiphumelele is constructed in a denser fashion as compared to the Klipfontein Glebe settlement. This implies that implementing social distancing will likely be more challenging in Masiphumelele than in Klipfontein Glebe. However, using a 2-m social distancing measure, it was demonstrated that large portions of Klipfontein Glebe would also be unable to effectively implement social distancing. Conclusions: Effectively implementing social distancing may be a challenge in informal settlements due to their density. This paper uses dwelling outlines for informal settlements in the city of Cape Town to demonstrate that with a 2 m measure, effective social distancing will be challenging.

  • Source: Freepik; Copyright: pressfoto; URL: https://www.freepik.com/free-photo/studying-results-conducted-experiment_5576477.htm; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 6, 2020

    Conducting Clinical Research During the COVID-19 Pandemic: Investigator and Participant Perspectives

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    Abstract:

    As the medical landscape changes daily with the coronavirus disease (COVID-19) pandemic, clinical researchers are caught off-guard and are forced to make decisions on research visits in their ongoing clinical trials. Although there is some guidance from local and national organizations, the principal investigator (PI) is ultimately responsible for determining the risk-benefit ratio of conducting, rescheduling, or cancelling each research visit. The PI should take into consideration the ethical principles of research, local/national guidance, the community risk of the pandemic in their locale, staffing strain, and the risk involved to each participant, to ultimately decide on the course of action. While balancing the rights and protection of the human subject, we seldom examine patients’ views and opinions about their scheduled research visit(s). This article discusses the ethical principles of beneficence and autonomy in helping the decision-making process. We discuss ways to weigh-in local and national guidance, staffing strain, and institutional support into the decision-making process and outline potential changes needed for regulatory bodies depending on the decision. Further, we discuss the need to weigh-in the individual risk-benefit ratio for each participant and present a decision tree to navigate this complex process. Finally, we examine participant and caregiver perspectives on their fears, sense of preparedness, and factors that they consider before deciding whether to keep or postpone the research appointments. This entry also provides PIs ways to support their research participants in both scenarios, including provision of psychological support.

  • Source: Unsplash; Copyright: Marcus Spiske; URL: https://unsplash.com/photos/11bjTWQ9mV0; License: Licensed by JMIR.
    Editorial

    Apr 6, 2020

    The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will

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    The world is experiencing the expansive spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in a global pandemic that is placing strain on health care, economic, and social systems. Commitment to implementing proven public health strategies will require bold public health leadership and courageous acts by politicians. Developing new innovative communication, mitigation, and health care approaches, particularly in the era of social media, is also clearly warranted. We believe that the best public health evidence must inform activities in three priority areas to stop this pandemic: (1) coordinated and consistent stay-at-home orders across multiple jurisdictions, including potential nationwide mandates; (2) rapid scale-up of SARS-CoV-2 testing; and (3) improved health care capacity to respond. This editorial outlines those areas, the rationale behind them, and the call for innovation and engagement of bold public health leadership to empower courageous political action to reduce the number of deaths during this pandemic.

  • Source: freepik; Copyright: prostooleh; URL: https://www.freepik.com/free-photo/elegant-old-couple-sitting-home-using-laptop_7376583.htm#page=3&query=person+using+laptop&position=14; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 2, 2020

    Preventive Behaviors Conveyed on YouTube to Mitigate Transmission of COVID-19: Cross-Sectional Study

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    Background: Accurate information and guidance about personal behaviors that can reduce exposure to severe acute respiratory syndrome coronavirus 2 are among the most important elements in mitigating the spread of coronavirus disease 2019 (COVID-19). With over 2 billion users, YouTube is a media channel that millions turn to when seeking information. Objective: At the time of this study, there were no published studies investigating the content of YouTube videos related to COVID-19. This study aims to address this gap in the current knowledge. Methods: The 100 most widely viewed YouTube videos uploaded throughout the month of January 2020 were reviewed and the content covered was described. Collectively, these videos were viewed over 125 million times. Results: Fewer than one-third of the videos covered any of the seven key prevention behaviors listed on the US Centers for Disease Control and Prevention website. Conclusions: These results represent an important missed opportunity for disease prevention.

  • Source: Freepik; Copyright: prostooleh; URL: https://www.freepik.com/free-photo/scientist-coverall-clothing-is-examining-coronavirus-sample-laboratory_7282313.htm#page=1&query=flu%20sample&position=8; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 2, 2020

    Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance...

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    Abstract:

    Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. Objective: The aim of this study is the surveillance of COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections to ascertain both the rate and pattern of COVID-19 spread and to assess the effectiveness of the containment policy. Methods: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. Results: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. Conclusions: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning.

  • Source: Freepik / Placeit; Copyright: Freepik; URL: https://www.freepik.com/free-photo/doctor-desk-holding-out-his-hand_5480783.htm; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 2, 2020

    Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action

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    On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine.

  • Source: Pixabay; Copyright: Gerd Altmann; URL: https://pixabay.com/photos/mobile-phone-smartphone-keyboard-1917737/; License: Licensed by the authors.
    Infoveillance, Infodemiology and...

    Apr 1, 2020

    Classification of Health-Related Social Media Posts: Evaluation of Post Content–Classifier Models and Analysis of User Demographics

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    Background: The increasing volume of health-related social media activity, where users connect, collaborate, and engage, has increased the significance of analyzing how people use health-related social media. Objective: The aim of this study was to classify the content (eg, posts that share experiences and seek support) of users who write health-related social media posts and study the effect of user demographics on post content. Methods: We analyzed two different types of health-related social media: (1) health-related online forums—WebMD and DailyStrength—and (2) general online social networks—Twitter and Google+. We identified several categories of post content and built classifiers to automatically detect these categories. These classifiers were used to study the distribution of categories for various demographic groups. Results: We achieved an accuracy of at least 84% and a balanced accuracy of at least 0.81 for half of the post content categories in our experiments. In addition, 70.04% (4741/6769) of posts by male WebMD users asked for advice, and male users’ WebMD posts were more likely to ask for medical advice than female users’ posts. The majority of posts on DailyStrength shared experiences, regardless of the gender, age group, or location of their authors. Furthermore, health-related posts on Twitter and Google+ were used to share experiences less frequently than posts on WebMD and DailyStrength. Conclusions: We studied and analyzed the content of health-related social media posts. Our results can guide health advocates and researchers to better target patient populations based on the application type. Given a research question or an outreach goal, our results can be used to choose the best online forums to answer the question or disseminate a message.

  • Source: freepik; Copyright: katemangostar; URL: https://www.freepik.com/free-photo/cropped-view-hands-typing-laptop_1121914.htm#page=1&query=person+using+laptop&position=2; License: Licensed by JMIR.
    Theme Issue 2020: Novel Coronavirus...

    Apr 1, 2020

    Assessment of Health Information About COVID-19 Prevention on the Internet: Infodemiological Study

    Authors List:

    Abstract:

    Background: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods: On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). Conclusions: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

  • Source: freepik; Copyright: peoplecreations; URL: https://www.freepik.com/free-photo/female-doctor-giving-injection-patient_1006306.htm#page=2&query=injection&position=18; License: Licensed by JMIR.
    Theme Issue 2019: The Eastern...

    Mar 31, 2020

    Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana’a, Yemen: Cross-Sectional Study

    Authors List:

    Abstract:

    Background: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. Objective: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana’a, Yemen. Methods: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana’a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. Results: A total of 219/362 (60%) participants had been accidentally injured while working in the laboratory. Of those, 14.6% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). Conclusions: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana’a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen.

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  • Regulation and trust: COVID-19 mortality in 25 European countries

    Date Submitted: Apr 8, 2020

    Open Peer Review Period: Apr 9, 2020 - Jun 9, 2020

    Background The outbreak of COVID-19 has dramatically changed societies in 2020. Since the end of February, Europe has been hit particularly hard by COVID-19, but there are major country differences i...

    Background The outbreak of COVID-19 has dramatically changed societies in 2020. Since the end of February, Europe has been hit particularly hard by COVID-19, but there are major country differences in both the spread of the virus and measures taken to stop the virus. Social psychological factors such as institutional trust could be important in understanding the development of the epidemic. The aim of our study was to examine country-variation in COVID-19 mortality in Europe by analyzing 1) social risk factors explaining the spread of the disease, 2) restrictions and control measures and 3) institutional trust. Methods The present study was based on a background analysis of European Social Survey data on 25 European countries (N = 47,802). Multilevel mixed effects linear regression models focused on 75 days of the COVID-19 epidemic (January 23 – April 7, 2020) and modelled the daily COVID-19 mortality. Analysis focused on the impact of social relations, restrictions and institutional trust within each country. Results The spread of the COVID-19 epidemic has been fast everywhere, but our findings reveal significant differences between countries in COVID-19 mortality. Perceived sociability predicted higher COVID-19 mortality. Major differences between the 25 countries were found in reaction times to the crisis. Late reaction to the crisis predicted later mortality figures. Institutional trust was associated with lower COVID-19 mortality. Increase in mortality was more rapid in countries that reacted late during the 21-day follow-up. Discussion The analyses demonstrated the importance of societal and social psychological factors in the spread of the COVID-19 epidemic. By considering multiple perspectives, our study showed that country differences in Europe are major and this will have an impact on how countries will cope with the ongoing crisis in the following months. Our results indicate the importance of timely restrictions and cooperation with people. Digital technologies are likely to help in achieving these goals.

  • Novel Coronavirus (COVID-19) Knowledge and Perceptions: A Survey of Healthcare Workers

    Date Submitted: Apr 6, 2020

    Open Peer Review Period: Apr 6, 2020 - Apr 20, 2020

    Background: During the first week of March, the surge of coronavirus disease 2019 (COVID-19) cases reached over 100 countries with more than 100,000 cases. Healthcare authorities have already initiate...

    Background: During the first week of March, the surge of coronavirus disease 2019 (COVID-19) cases reached over 100 countries with more than 100,000 cases. Healthcare authorities have already initiated awareness and preparedness activities beyond borders. A poor understanding of the disease among healthcare workers (HCWs) may result in delayed treatment and the rapid spread of infection. Objective: This study aimed to investigate the knowledge and perceptions of HCWs about COVID-19. Methods: A cross-sectional, web-based study was conducted among HCWs about COVID-19 during the first week of March 2020. A 23-item survey instrument was developed and distributed randomly to HCWs using social media; it required 5 minutes to complete. A chi-square test was used to investigate the level of association among variables at the significance level of p<0.05. Results: Of 529 participants, a total of 453 HCWs completed the survey (response rate: 85.6%); 51.6% were males, 32.1% were aged 25-34 years, and most were doctors (30.2%) and medical students (29.6%). Regarding COVID-19, most of the participants used social media to obtain information (61%), and a significant proportion of HCWs had poor knowledge of its transmission (61%) and symptom onset (63.6%) and showed positive perceptions of COVID-19 prevention and control. Factors such as age and profession were associated with inadequate knowledge and poor perception of COVID-19. Conclusions: As the global threat of COVID-19 continues to emerge, it is critical to improve the knowledge and perceptions of HCWs. Educational interventions are urgently needed to reach HCWs beyond borders, and further studies are warranted.

  • Forecasting the dynamics of COVID-19 Pandemic in Top 15 countries in April 2020: ARIMA Model with Machine Learning Approach

    Date Submitted: Apr 3, 2020

    Open Peer Review Period: Apr 3, 2020 - Apr 17, 2020

    Background: Mathematical approaches are widely used to infer critical epidemiological transitions and parameters of COVID-19. Objective: We here predicted some trajectories of COVID-19 in the coming d...

    Background: Mathematical approaches are widely used to infer critical epidemiological transitions and parameters of COVID-19. Objective: We here predicted some trajectories of COVID-19 in the coming days (until April 30, 2020) using the most advanced Auto-Regressive Integrated Moving Average Model (ARIMA). Methods: We used different statistical phenomenological models in the R-language platform to analyze the disease-based trajectories model for prediction purposes Results: Our analysis predicted very frightening outcomes, which defines to worsen the conditions in Iran, entire Europe, especially Italy, Spain, and France. While South Korea, after the initial blast, has come to stability, the same goes for the COVID-19 origin country China with more positive recovery cases and confirm to remain stable. The United States of America (USA) will come as a surprise and going to become the epicenter for new cases during the mid-April 2020. Conclusions: Based on our predictions, public health officials should tailor aggressive interventions to grasp the power exponential growth, and rapid infection control measures at hospital levels are urgently needed to curtail the COVID-19 pandemic.

  • Estimation of the probability of reinfection with COVID-19 coronavirus by the SEIRUS model

    Date Submitted: Apr 3, 2020

    Open Peer Review Period: Apr 3, 2020 - May 29, 2020

    Background: With sensitivity of the Polymerase Chain Reaction (PCR) test used to detect the presence of the virus in the human host, the global health community has been able to record a great number...

    Background: With sensitivity of the Polymerase Chain Reaction (PCR) test used to detect the presence of the virus in the human host, the global health community has been able to record a great number of recovered population. Objective: Therefore, the objective of this study was evaluate the probability of reinfection in the recovered class and the model equations which exhibits the disease-free equilibrium (E_0 ) state for COVID-19 coronavirus. Methods: The model differential equation were evaluated for the disease-free equilibrium for the case of reinfection as well as existence and stability criteria for the disease using the model proportions. This evaluation shows that the criteria for a locally or globally asymptotic stability with a basic reproductive number R_0=0 is satisfied. Hence, there is a chance of no secondary reinfections from the recovered population as the rate of incidence of the recovered population vanishes, that is, B=0. Results: With a total of about 900,000 infected cases worldwide, numerical simulations for this study was carried to complement the analytical results in investigating the effect of the implementation of quarantine and observatory procedures has on the projection of the further spread of the virus globally. Conclusions: As shown by the results, the proportion of infected population in the absence of curative vaccination will continue to grow globally meanwhile the recovery rate will continue slowly which therefore means that the ratio of infection to recovery rate will determine the death rate that is recorded globally and most significant for this study is the rate of reinfection by the recovered population which will decline to zero over time as the virus is cleared clinically from the system of the recovered class.

  • Clinical features, diagnosis, combine medicine treatment, epidemiological characteristics, and the therapy of 26 confirmed 2019 novel coronavirus (COVID-19).

    Date Submitted: Apr 3, 2020

    Open Peer Review Period: Apr 3, 2020 - Apr 17, 2020

    Background: Clinical features, diagnosis, medicine treatment, epidemiological characteristics, and the therapy of 26 confirmed cases were analyzed. Objective: To provide a scientific basis for formula...

    Background: Clinical features, diagnosis, medicine treatment, epidemiological characteristics, and the therapy of 26 confirmed cases were analyzed. Objective: To provide a scientific basis for formulating epidemic prevention with control strategies and measures. Methods: According to the Program of Investigation on Cases of Pneumonia Caused by Novel Coronavirus Infection in the fifth edition National Health Commission release guideline about Prevention, Treatment, and Control of Infection. An epidemiological survey, clinical features, treatment guidelines was conducted for the 26 patients who were diagnosed with COVID-19 and have been treated in The General Hospital since Jan 2020. Results: The ratio of males and females were 3.25∶1. 25 cases of Han nationality of Chinese. 22 cases (84.62%) were more than 18 years old. There were 15 cases from the local area (57.69%), and 6 cases were from Hubei province (23.08%). There were 20(76.92%) cases of fever, 14(53.85%) cases of weakness, and 8(30.77%) cases of dry cough. Progressive muscle relaxation (PMR) therapy could help covid-19 patients overcome anxiety and sleep problems, which may give a boost in their mental strength to fight against this covid-19 during the staying isolation ward. Both the clinical results and quality of evidence will reveal for Ribavirin, Lopinavir/Ritonavir, Moxifloxacin and Arbidol Hydrochloride combination with supportive drugs are probably major effective treatments in this study challenges that face frontline physicians who treat patients in a medical setting and evaluate prophylaxis for novel high-risk environments formed by large quarantined and isolated populations. Conclusions: Most cases are male. The people aged more than 40 years old are the population group at high risk of the disease. Most of the early cases had a history of travel or business trips to Wuhan, and nearly 50% of cases were caused by living together and close contact. Different Combination drugs use for covid-19 are clinically successfully effective in published literature, including this study.

  • Launch and global reach of an online COVID-19 course in multiple languages on OpenWHO in the first quarter of 2020

    Date Submitted: Apr 3, 2020

    Open Peer Review Period: Apr 2, 2020 - Apr 16, 2020

    Background: At the onset of the coronavirus outbreak, the World Health Organization’s (WHO) Health Emergencies Learning and Capacity Development Unit, together with WHO’s health technical lead on...

    Background: At the onset of the coronavirus outbreak, the World Health Organization’s (WHO) Health Emergencies Learning and Capacity Development Unit, together with WHO’s health technical lead on coronaviruses, developed a massive open online course (MOOC) within just three weeks as part of the global response to the emergency. The introductory COVID‑19 course was launched on 26 January 2020 on the health emergencies learning platform OpenWHO.org. Objective: This article investigates geographic reach of different language courses accessed by a global audience seeking information on COVID-19. Users’ professional identities and background are explored to inform course owners on the use case. The course was developed and delivered via the open access learning platform OpenWHO.org. The self-paced resources available in a total of 13 languages were produced between 26 January and 25 March 2020. Methods: Methods: Data was collected from the online courses’ statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analysed based on Google Analytics and the platform's own statistics capabilities, with data sets overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, their top 10 countries and the proportion of use for each language version. Data includes affiliation, gender, age and other parameters for approximately 30% of users who indicated their background. Results: As of 25 March 2020, the introductory COVID-19 course totals 232 890 enrolments across all languages. The Spanish language course comprises more than half (51%) of all course enrolments, while the English language course comprises 37% of enrolments. WHO’s Region of the Americas accounts for most of the course enrolments, with more than 72% across all languages. Other regions are more evenly distributed with less than 10% each. 32.4% of users specified professional affiliation by choosing from the 12 most common backgrounds in OpenWHO’s user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations with small fractions of users identifying themselves as “Other”. With the COVID-19 introductory course, the largest number of users selected “Other” (31.7%) suggesting a large non-health professional and academic user load. The top 10 countries of users across all languages are Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom and the United States of America. Conclusions: The online course has addressed a global learning need by providing WHO technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggests that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform’s aim of providing learning everywhere to anyone interested. User surveys will be carried out to measure real impact.

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