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Background Studies have shown, ambient temperature can affect the transmission and survival of coronaviruses. This study aimed to determine whether the number of COVID-19 cases and 14-day fatality rates (FR) in Berlin are associated with temperature. Methods Within the scope of this study, a total of 240 days of Berlin belonging to the dates 28.08.20- 24.04.21 were examined. Daily highest temperature, lowest temperature, daily average temperature, number of daily cases, number of deaths were accessed free from the berlin.de and weather.com site. In addition, the incubation period of COVID-19 was assumed to be 14 days, and the fatality rates of 14 days and the average temperatures of these days were calculated. The relationship between the data was evaluated with the Spearman correlation test. Results When the 240 days are examined, the average daily temperature varies between -7.5- 23.5 °C, the fatality rates of 14 days vary between 0- 7,3%. The period with the highest fatality rate of 14 days is between 29.1.21-11.2.21 (FR = 7.3%) and the average temperature of this period (-1.8 °C) is the 14 days with the lowest average temperature. Very strongly negative relationship (r = -0.920; p < 0.001) was determined between FR and 14-day average temperature. It was noted that as the daily temperature decreased, the number of deaths per day (r = -0.695; p < 0.001) and the number of daily cases (r = -0.296; p < 0.001) increased. 1 °C decrease in temperature was associated with an increase in daily new deaths by 1.29 (B = -1.29, 95% CI: -1.55, -0.1.09; p < 0.001, Adj. R2 = 0.3). Conclusions Our analysis results showed that the number of COVID-19 daily cases and 14-day fatality rate increased with a low temperature in the Berlin sample. Key messages Temperature showed a negative correlation between COVID-19 fatality rate. Further evaluation may be required globally with more data to determine temperature and COVID-19 cases.

Background Face masks can all be effective means of controlling SARS-CoV-2 transmission. In Poland, obligatory wearing of masks in public spaces was introduced on April 10th, 2020. Objective To assess use of masks in public spaces in Poland during the third wave of SARS-Cov-2 epidemic. Methods A non-participatory covert observational study was conducted during the 3rd wave, on three dates (20.03/27.03/03.04.2021) at public spaces in 12 provinces with different SARS-Cov-2 infection risks according to the R number. Ten consecutive individuals were observed by each of 91 medical students, using a structured checklist. Results Among 3283 observed individuals, the female/male ratios were 1.1/1.1/0.9 on the three dates. Around three quarters were using masks: 76.2% (858/1126) on date 1, 76.3% (867/1137) on date 2; and 79.7% (813/1020) on date 3. Medical masks predominated on all dates (52.4%-50.5%-55.8%), followed by cloth (34.6%-37.6%-33.0%). Location in a closed space (OR = 3.47-2.64-2.84) was associated with higher usage. Participants in sports were about two-three times less likely to use masks (OR = 0.52-0.58-0.34) as compared to other activities. The proportion using masks correctly was as follows: 62.6% (537/858); 63.1% (547/867); 57.7% (469/813) respectively; significant between-gender difference was observed regarding date 1 (date 1: 306/458, 66.8% females vs 231/400, 57.8% males; p = 0.006, date 2: 284/459, 61.9% females vs 263/408, 64.5% males; p = 0.43, and date 3: 232/408, 56.9% females vs 237/405, 58.5% males; p = 0.63). Uncovered noses (55.5%-59.5%) and masks around the neck (18.1%-24.7%) were the most frequent incorrect practices. Conclusions The results show an essential difference between governmental regulations and how the general public responds to the SARS-Cov-2 pandemic in the context of mask usage. Medical masks were predominantly used in public spaces, however, almost every third individual wore masks incorrectly. Key messages Knowledge translation with the use of adequate communication channels, would be helpful to increase compliance and correct usage. This message can be used to target specific practices when developing public health campaigns which should be then rigorously evaluated for their effectiveness.

Background Pandemics, state of emergency, restrictions and new regulations, new ways of thinking, teaching, learning, working and communicating. Transforming social environment, Covid-19 pandemics has greatly affected lifestyle of all people around the globe. In this matter, students are not an exception. The aim of the study was to describe self-reported stress and behaviors of students at the University of Georgia during Covid-19 pandemics. Methods In frame of online survey design, self-administrative semi-structured Questionnaires (Geo/Eng) were disseminated via UG's intranet. Target population was BA, MA and One-Cycle Program students with active status (6545). Questionnaires were available during two weeks. Results In result, 446 (CL = 95%; CI = 5) students participated in online survey. Students reported physiological, emotional, and cognitive symptoms they never noticed before moving to online learning due to Covid-19 pandemics. Both, local and foreign students reported headaches (30%) and Feeling of being depressed (25%). Fatigue (25%) and irritation (28%) was marked by local students, nearly 20% of foreign students marked hardness of dealing with the life problems. Changing of sleep and physical activity patterns were highlighted by both local and international students. In average, 55% students evaluated their sleep as deteriorated or very deteriorated. 60% of students could recall only 3 days or less when they walked for at least 10 minutes without break. 35% noticed increase or significant increase of body weight. Nearly 30% of students evaluated their stress level as 8; 9; or 10 at ten-point scale (0=no stress; 10=high stress level). Conclusions Study hasn't shown significant differences between local and international students. Negative changes were reported in physical and emotional level, physical activity and sleep patterns. Study results underlined importance of Further research and strengthening of supportive services for students during pandemics. Key messages Creating/strengthening of supportive services for students during pandemics. Integrate physical activity training into online lectures.

Introduction Health workers, as the first line of defence during infectious pandemic, are also one of the main vectors of coronavirus transmission. Preventing the spread of infection to and from caregivers relies on the effectiveness of personal protective equipment (PPE). This study aimed at assessing knowledge, attitudes and practices related to PPE use in a healthcare setting in the region of Mahdia (Tunisia). Methods A cross-sectional study was carried out on December 2020 among health care professionals (HCP) in the University Hospital Tahar Sfar Mahdia. The measurement tool was developed by specialists at the Department of Preventive Medicine after reviewing literature then pretested. Results A total of 173 HCP were enrolled with an average age of 35 ±9.3 years. More than half of participants were females (64.7%), 32.9% were doctors and 34.7% were nurses. Among them, 35.8% have worked during a pandemic before. The level of good knowledge was 52%. The main sources of information for HCP were the Ministry of Health (63.6%), social network and media (58.4%). About 25.4% of HCP was satisfied by the preventive measures training received in the hospital. Half of HCP (54.3%) admitted that their knowledge related to the pandemic was not sufficient. While third of the HCP (31.8%) thought that it is necessary to wear the full PPE, 16.8% knew how to put on their PPE and 27.2% knew how to take it off. Conclusions Taking into account knowledge, attitudes and practices related to PPE use allows the implementation of a strategy aimed at mastering the management of this equipment by health care workers. Key messages Assessing the Knowledge, attitudes and practices related to the personal equipment among health care givers: 52%. Implementation of a strategy aimed at mastering the management of this equipment by health care workers.

Healthcare workers (HCWs) are on the frontline fight against the ongoing pandemic with an increased risk of infection from COVID-19. As of December 27, 2020, approximately 89,879 COVID-19 cases had been reported among HCWs in Italy. Vaccination plans recommend that initial supplies of COVID-19 vaccine be allocated to HCWs because their early protection is crucial to preserve capacity to care for patients. The aim of this study is threefold: to investigate the factors influencing the likelihood towards vaccination, to estimate the vaccine efficacy (VE) in a hospital setting and to assess the frequency of adverse reactions (AR). This retrospective study was conducted in an Italian teaching hospital from December 28, 2020 to March 31, 2021 (before the introduction of mandatory vaccination for HCWs). A total of 6,649 individuals was included. HCWs were divided into physicians, nurses and other HCWs. Univariate analyses and a multivariate logistic regression were run with an alpha of 0.05. VE was estimated as the proportionate reduction in disease attack rate between the unvaccinated and vaccinated. Out of 6,649 HCWs, 5,162 were fully vaccinated against COVID-19. Among the selected job categories, 82% of physicians, 79% of nurses and 68% of other HCWs were vaccinated. The findings of the logistic regression depicted that the 41-60 years old age class, compared with the youngest age class, was statistically significant (OR 1.17, 95% CI 1.03-1.33) in influencing vaccination, as well as being nurses (OR 0.80, 95% CI 0.69-0.92) or other HCWs (OR 0.45, 95% CI 0.39-0.52) in comparison with physicians. VE equaled 92.83% (p < 0.05). The frequency of serious and not serious AR was 0.03% and 2.9%, respectively. Sustaining and boosting COVID-19 vaccination campaigns is effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination among HCWs is a critical public health measure to safeguard HCWs themselves, patients and the hospital community. Key messages In light of the encouraging efficacy and safety of COVID-19 vaccination, it represents an essential strategy to protect HCWs themselves, their patients and the hospital community. Despite the introduction of mandatory vaccination, policy-makers should set up tailored strategies of clear communication to reduce reluctancy to vaccination among HCWs.

Background With COVID-19 disrupting school life, there is a need to examine whether COVID-related changes in our schools may be creating or exacerbating inequalities among students. The aim of this poster is to examine potential differences associated to socioeconomic status (SES) both in different facets of school stress, and in the overall impact of COVID and specific school COVID-related measures. Methods Sample consisted of 2,523 secondary school students (52.3% girls, M age = 13.78) from Spain who had participated in Project EASE from November 2020 to mid-January 2021, i.e. shortly after schools reopened for the new academic year. Using ANOVA and Chi-square analyses, differences associated to SES were examined in: (1) school stress, for which we used 3 subscales of the ASQ-S (school performance, future uncertainty, and school-leisure conflict), and (2) the perceived impact of COVID and specific school COVID-related measures (e.g. hygiene measures, social distancing, increased ICTs use) on stress levels. Results We found no significant differences associated to SES in stress of school performance or stress of school-leisure conflict, but low SES was associated with higher stress due to future uncertainty. Regardless of SES, the majority of students reported that their levels of school stress had increased due to COVID-19. As for specific measures, the percentage of students that reported an increase in their level of stress due to the more frequent use of ICTs was higher among low-SES students, who also reported lower levels of stress associated to reduced contact with classmates due to COVID. Conclusions Although most students reported an increase in school stress due to COVID-19, low-SES students experienced significantly higher stress due to future uncertainty. Potential differences in the role of specific school COVID-related measures would also deserve further examination. Key messages Low-SES students experienced higher levels of stress due to future uncertainty. The majority of students, regardless of SES, reported increases in their stress levels due to COVID-19.

Background The massive spread of the corona virus being relatively deadly, leads to psychological pressures dominated by an atmosphere of panic and worries mainly among Health Care workers (HCWs). Only few studies have evaluated this impact on HCWs mental health in Tunisia. Aim we aimed at determining the prevalence of corona virus fear and its associated factors among HCWs in the University Hospital Tahar Sfar Mahdia (Tunisia). Methods We conducted a cross sectional study among HCWs staff in the University Hospital Tahar Sfar Mahdia which is located in the Central-East part of Tunisia in December 2020. The fear of corona virus disease was assessed using the valid French version of the Fear of Covid-19 Scale (FCV-7). Results A total of 173 professionals were recruited with a mean age of 35.35 ± 9.31 years. Among them, 66% were women. One third of participants (33.3%) were medical professionals. Almost, 68% have experienced a high level of fear. Our survey showed a significantly higher level of fear among females 70.1% and elderly people 60.8%. It was positively associated (p < 0.05) with anxiety and depression, high risk perception and the responsibility degree of being a virus vector for their loved ones. Anxiety and depression disorders (standardized β = 3.118, CI = 0.545-5.832,p=0.018), high risk perception (β = 3.321,CI = 0.097-6.545, p = 0.044), knowledge about Covid-19 transmission (β = 2.586, CI = 0.439-4.734, p = 0.019), degree of responsibility (β = 3.130, CI = 0.373-5.887, p = 0.026), being a doctor (β = -6.475, CI = -8.785- -4.165, p = 0.001) and Perceived Vulnerability to Disease (β = 0.26,CI = 0.157-0.363, p < 001) were found to be predictive factors of corona virus fear in the linear regression model (Adjusted R2 = 0.374). Conclusions Authorities should introduce a preventive strategy based on psychological intervention for HCWs to overcome their fear and worries. Key messages The high prevalence of the fear of Covid-19 among health care workers is alarming. Its impact on mental health cannot be ignored. The health authorities worldwide should not have as objective only the reduction of the transmission, but also the work on individual fears to ensure a society totally free of covid-19.

Background On March 2020, COVID-19 was declared a global pandemic. It was perceived as an elderly issue in face of the high morbidity and mortality rates among people over 60 years old. Instructions regarding protective and preventative conduct were issued by the Israeli ministry of health, with emphasis concerning the elderly population. This study aimed at examining the adherence for future Covid-19 vaccine and its predicting factors among the elderly population in Israel. Methods A cross-sectional online survey was conducted in April 2020 among 1,797 Israeli respondents, aged 60 and above, via social media. The questionnaire assessed intentions to being vaccinated against the COVID-19 virus, attitudes and subjective norms regarding the disease and instructions issued by the ministry of health, adhering to these instructions, perception of threat, trust in the healthcare system, negative emotions and social support. Results Levels of willingness to future vaccination were extremely high (92%). Multiple logistic regression analysis found gender, level of religiosity, socio-economic status, perception of threat, social support, trust in the healthcare system, negative emotions and subjective norms regarding social distancing, as predictors of probability for future adherence to the vaccine. Conclusions The study findings point to future intention, in a time when an atmosphere of uncertainty regarding COVID-19 and its consequences is prevalent around the world. The adherence predictors are in concurrence with elements of the Health Belief Model and the Theory of Reasoned Action. Identifying the factors that predict future willingness to be vaccinated, may assist in developing ways to promote vaccination adherence against COVID-19, as well as against other illnesses. Key messages The results emphasize the importance of creating a supportive environment and shaping health-promoting attitudes among the elderly, as well as balanced and reliable threat communication of epidemics. Actual vaccination would depend on factors such as the pandemic severity at that time.

Background Croatian blood collection system is based on voluntary donation, according to the recommendations of the World Health Organisation and the Council of Europe. The ongoing COVID-19 pandemic has influenced all the dimensions of human lives and the functional pattern of the health care systems in the whole world. The aim of this study was to investigate the influence of ongoing COVID-19 pandemic on Croatian blood collection system and to evaluate the main factors that influence voluntary blood donation practice in blood donors (BDs). Methods This cross-sectional questionnaire study was conducted in convenient sample of voluntary BDs from Split-Dalmatia County during the May 2020 to December 2020. Results The study sample consisted of 479 regular BDs, 88.5% males and 11.5% females, mean age 39.8±10.8 years. Majority of them had high school education and living with the partner (67.4% and 74.5%, respectively). During COVID-19 pandemic 71.0% of them continued with regular donations while 29% of them postponed their donation. According to the BDs knowledge regarding COVID-19 infection there were 88.9% of those with unsatisfactory and only 11.1% of those with satisfactory knowledge regarding this infection. The study revealed that females, BDs living alone and younger BDs (aged 18 to 43 years) had more frequently postponed blood donation during COVID-19 pandemic (P < 0.0001, P = 0.004 and P = 0.017, respectively). The study further showed that there was no correlation between BDs knowledge about COVID-19 infection and their blood donation practice during ongoing pandemic. Conclusions The study revealed that ongoing COVID-19 pandemic impacted the Croatian blood collection system via reduction in the practice of voluntary blood donations. Sociodemographic characteristics of BDs were the main factors that influence Croatian BDs voluntary blood donation practice during pandemic while their knowledge about COVID-19 infection was not correlated with their behaviour. Key messages The sustainability of the health care system during a pandemic depends significantly on the blood supply, which is why it is necessary to ensure that blood collection system is continually maintained. The knowledge of blood donors about COVID-19 infection needs to be improved in order to prevent spreading of the infection generally and especially within this highly important population subgroup.

During the first wave of COVID-19 pandemic, the most affected area in Italy was the southeast part of the Lombardy region. The University of Brescia is one of the largest in Northern Italy. The aim of this study is to investigate the psychological and somatic symptoms driven by lifestyle changes due to the lockdown among the students of the University of Brescia.15261 University students were enrolled through institutional email;14302 were Master's and Bachelor's Degreestudents,724 were Residents and 235 doctorates.3553 students (23.28% of total),aged on average 22 years, completed the survey. Physical health, dietary and sleep habits, physical activities, economic and social issues were investigated through an anonymous, online ad hoc form, available until July 2020 and approved by the local Ethic Committee. Five psychosomatic outcomes were assessed: digestive disorders, headache, panic-anxiety crises, depression-sadness, fear od COVID-19.Factor analysis was applied to reduce the number of variables while logistic and ordinal logistic regression models were used to test the association between the latent variables and each outcome. Female gender, medium-intensive use of telephone, worsening of sleep quality, mnemonic difficulties and performance reduction were associated with all the outcomes. Low physical activity, increased time spent watching television and the worsening of dietary habits represented a significant risk factor for at least three of the outcomes. Despite the relatively low compliance, the survey clearly identified few priorities of intervention to prevent psychological and somatic effects of pandemic in the next future: circadian rhythm, nutritional habits, physical activity, use of media, gender issues. The results of this study show the psychosomatic effects of social isolation and the pandemic on a population at risk of young adults and can promote interventions to minimize the occurrence of psychosomatic consequences on young adults. Key messages Analysis of the main risk and protection factors in a population of young adults in the development of psycho-physical symptoms during the period of isolation due to the covid-19 pandemic. Support the need to implement public health services also to reduce health costs with possible methods of intervention, in harmony with the findings.

Background The SARS-CoV-2 outbreak in 2020 caused a highly transmissible disease with a significant impact on the elderly. Understanding viral clearance duration of COVID-19 is important to tailor prevention strategies to this vulnerable category. We aimed to investigate the SARS-CoV-2 infection duration and associated factors to prolonged viral clearance among elderly people comparatively to young people. Methods We conducted a cohort study of asymptomatic and mild forms of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia. Patients included in the study were divided into two cohorts: (elderly group: ≥ 60 years old) and (young group: < 60 years old) and were followed up to their RNA viral conversion. Stratified cox regression was performed to determine associated factors with prolonged viral SARS-CoV-2 RNA clearance in elderly subgroups. Results The study included a total of 289 patients with asymptomatic and mild forms of COVID-19. The median term of viral shedding was 20 days (IQR; 16 - 32 days) for the young group, and 21 days (IQR; 17 - 33 days) for the elderly group. The stratified cox regression showed that Age ≥ 60 was an associated factor to prolonged viral shedding in male sex (HR (Hazard Ratio): 1.91; 95% CI: 1.19 - 3.07) and patients with comorbidities (HR:1.68; 95% CI: 1.02 - 2.75) especially diabetics (HR: 2.06; 95% CI: 1.01 - 4.21). Conclusions This study, focused on the factors associated with a prolonged duration of viral RNA clearance in elderly with COVID-19. These Potential factors will help planners to chalk out effective strategies among this vulnerable category. Key messages Old age is associated with a prolonged duration of viral RNA clearance in specific subgroups. Identifying these subgroups is important to know how prioritize preventive strategies in elderly.

Background Frontline medical staff, combating the Covid-19 pandemic are forced to make clinical and behavioral decisions daily. Their decision-making process and the factors associated with it, are of utmost importance in preserving and supporting their own health and their patient's health. Aims Tto explore the factors associated with physicians' decision-making during the first wave of the COVID-19 pandemic in Israel Methods Cross- sectional data were collected among 200 physicians at the Israeli health care system between March and May 2020 via an online questionnaire. A multiple hierarchical regression was calculated to assess the contribution of the study variables to the physicians' decision making. Results Most physicians reported that they complied with hygiene guidelines at work, issued by the Israeli ministry of health (MOH), fully (42%) or very often (31%), and with the MOH COVID-19 behavior guidelines fully (27%), very often (34%), or in general (23%). According to the study Results trust, positive emotions, perception of COVID-19 threat, and risk perceptions were found significant and positive. In other words, higher trust, more positive emotions, and perceptions of greater threat and risk, were associated with higher compliance with the MOH guidelines and more cautious decision making. Conclusions While threat and risk perceptions may be inevitable during the pandemic, trust and positive emotions may act as protective factors, encouraging cautious decision making among physicians. Key messages Physicians' decision making is a complex process affected by their perceptions, emotions, and trust levels. High levels of trust and positive emotions may facilitate carful decision making.

Introduction The lives and relationships of many have been influenced by changes imposed by Covid-19, especially the strict lockdown which was imposed during the first months of the pandemic. The aim of the current study was to document how the pandemic affects family relations. Methods Participants from 46 countries were asked to complete an online survey including the Penn State Worry Questionnaire (PSWQ) and the newly devised Athens family cohesion scale (AFCS), comparing the periods before and during the pandemic. Results Two-thirds of the participants (N = 481) were women; mean age 36.7 ±14.6 years old. Mean score of the PSWQ was 50.6 ±13.1. Worsening of family cohesion was reported by 22% of the participants, while 40.7% reported a better family cohesion after the pandemic started. Total score of AFCS was correlated negatively with PSWQ by linear regression analysis of AFCS on sex, age and PSWQ (beta= -0.058 ±0.023, p = 0.012), showing that family cohesion was better the lower the worry. Change of family cohesion was not found to be correlated to PSWQ nor to total score of AFCS. Conclusions Family cohesion during the pandemic seems to be related to the level of worry of the reporting individual; in the majority of cases family cohesion did not change (neither improved nor deteriorated) during the lockdown. Key messages Family cohesion generally is unchanged under strict situations such as the lockdown. Family cohesion is related to the levels of worry as reflected in the Penn State Worry Questionnaire.

Issue The COVID-19 pandemic declared by WHO on 11 March 2020 brought not only a big threat to the global population but also a huge number of technical, policy and strategic documents with a very varied level of quality and accessibility. It has been a great challenge for frontline public health workers to surf the information wave, in order to effectively apply it in the context of crisis management. Description COVID-19 related policy, strategic and operational documents analysed and implemented by our team -at a public health centre at health department level, in the Valencian Region (Spain)- during the pandemic were reviewed. Key elements considered were: length, quality of structure and content, validity period, as well as dissemination channel. Results From February 2020 to date, the European Centre for Disease Prevention and Control (ECDC) alone has published 90 guidance and technical reports, representing 1,503 pages (mean length 16,7 pages, SD 14,0, range 3-92). As regards the Spain national COVID-19 strategy, i.e., a total of 26 versions have been issued so far, between 24 January 2020 and 26 February 2021. Mean length was 19,8 pages (SD 6,8, range 8-31) and average validity period of versions was 15,7 days (SD 16,4, range 1-70). They did not include a summary of recent changes. They were made publicly available through the official Ministry of Health website. As for regional-level documents, 5,3% (21) did not have a date, and their main channel of dissemination was via email. Lessons We strongly recommend that policy and strategic documents at all levels comply with a minimum set of quality standards -including essential elements such as organization, title, publication date, page numbers, table of contents, key messages, and summary of changes in comparison with previous versions- and are disseminated through internet or intranet knowledge management systems. This would efficiently save a large number of hours and headaches to frontline professionals. Key messages In the context of public health crisis management, timely and appropriate access of frontline public health professionals to updated and concise information is crucial. COVID19 policy and strategic documents at all levels were reviewed. They should comply with a minimum set of quality standards, including a summary of recent changes, and be adequately disseminated.

Background As a consequence of the Covid-19 outbreak, Italy has adopted unprecedented preventive measures such as large-scale application of social isolation and hospital rearrangements. These measures have led to difficulty in managing diseases and hospitalizations, particularly acute and severe conditions such as neurological morbidities. The aim of the present analysis is to investigate the change in hospital admissions for neurological diseases over the first nine months of 2020 in Abruzzo region. Methods Data were obtained from the Hospital Discharge Records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 1 (neurological diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage. Results A huge reduction in MCD 1 series hospitalizations was observed in each subgroup. Specifically, ordinary regimen had a peak of -47,3% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of more than 90% in April both in public and private hospitals. The largest reduction occurred in private hospitals, both in ordinary (-75% in April) and DH admissions (-93,8% in March). Conclusions Despite the severity of the diseases included in MDC 1 (i.e. ischemic stroke, intracranial hemorrhage), a significant decline was detected in hospital admissions in Abruzzo. Subsequently, a high number of subjects might have not received the necessary health assistance leading to an increase in mortality and morbidity for these severe pathologies. Additionally, patients might have avoided seeking hospital care in response to the fear of contagion triggered either by media or as a result of the stay-at-home government recommendations. Key messages An alarming reduction in all types of hospitalizations for neurological diseases occurred over the first months of pandemic in Abruzzo. Greater management efforts are needed to reduce the morbidity and mortality rates associated with the reduced hospital admissions during the pandemic.

Background Given the COVID-19 pandemic, Tunisian authorities have imposed quarantine in dedicated centers mainly for travelers coming from countries with highest coronavirus infection rates. Such restrictive measures may have a detrimental impact on people's mental health and can thus affect sleep. We aimed in this study to assess the impact of mandatory institutional quarantine on sleep quality in Tunisia and to determine factors associated with clinical insomnia. Methods Data were collected through a cross sectional study conducted from April to November 2020 among individuals who were in quarantine for 14 days including at least a week in a Tunisian quarantine center. Sleep quality was assessed using the Insomnia Severity Index. Factors associated with clinical insomnia were assessed using bivariate and multivariate analysis. Results In the present study, 506 participants were included with a mean age of 37.6±13.6 years. Majority (66.4%) were men. Nearly one fifth (19.2%) of surveyed individuals had symptoms of clinical insomnia. In multivariate analysis, we found that being a woman, spending longer time on covid-19 news per day, having experienced stigma during the quarantine period, financial difficulties due to the coronavirus pandemic and dissatisfaction by the accommodation conditions of the quarantine facility were independently associated with clinical insomnia. Conclusions Nearly one fifth of participants had clinical insomnia during the quarantine period. Providing a good sleep environment, educating sleep healthy behavior and giving adequate psychological support to quarantined individuals in quarantine centers is necessary. Key messages Among surveyed participants, 19.2% had symptoms of clinical insomnia. Providing a good sleep environment in quarantine centers and providing mental health support to quarantined individuals is essential.

Background Admission to the Intensive Care Unit (ICU) is one of the most used indicators to estimate the magnitude of the current COVID-19 pandemic. This study was performed to assess the relationship between demographic, lifestyles and comorbidity factors on the severity of patients with SARS-CoV2 infection. Methods An observational study including data from the regional surveillance dataset on acute respiratory infections from September 2020 to February 2021 in one large tertiary hospital in Murcia, Spain. Demographic, clinical and lifestyle factors were collected. A descriptive analysis was carried out using SPSS. Chi-square tests were performed to assess the relationship between comorbidities and lifestyle factors. Binary logistic regression was calculated to estimate the probability of being admitted to ICU. Analysis were adjusted by sex, age, and lifestyle factors. Results Overall, 906 patients with COVID-19 were identified. The mean age was 64.3 years (SD = 16.5 years), and 523 of the patients were male (57.7%). A total of 104 (11.5%) patients required admission to ICU and 142 (15.7%) died during the hospitalisation process. The average length of stay at the hospital was 8 days (SD = 6). Acute renal failure (OR = 7.7; 95% CI: 1.7-33.0), being a smoker (OR = 7.02; 95% CI: 2.7-19, 0) and suffering from obesity (OR = 3.5; 95% CI: 1.2-10.3) were the main risk factors associated with admission to ICU. Conclusions Acute renal failure, obesity, and smoking were strongly associated with both severity and admission to intensive care among patients with COVID-19 infection. More research needs to be done to assess the role of these underlying factors in the severity of COVID-19 infections. Key messages The design of predictive models for ICU admission during the COVID-19 pandemic should be promoted. Features associated to vulnerability in COVID-19 patients must be identified.

Background Effective and rapid immunologic response to vaccines is a crucial strategy for the control SARS-CoV-2 pandemic. Here, we present the results of an ongoing longitudinal observational study conducted among the healthcare workers (HCWs) of the Pineta Grande Hospital (Castel Volturno, Italy), who were administered the two-dose prime-boost mRNA vaccine BNT162b2. Methods Volunteer HCWs underwent either (i) six RT-PCR assay for qualitative detection of SARS-CoV-2 nucleic acid in nasopharyngeal/oropharyngeal swabs; (ii) or six quantitative serology testing for the research of virus-specific immunoglobulins (Ig) through chemiluminescent immunoassay with a reactivity cut-off of an Index of ≥ 1.0. The first tests were taken before the administration of the vaccine and then according to a predefined timeline. An active surveillance follow-up of SARS-CoV-2 infections was set amongst the vaccinees after the end of the study. Results Overall, among the 435 HCWs who accepted to participated in the study, 9.3% reported a previous laboratory-confirmed infection with SARS-CoV-2, though all subjects tested negative at the time of first vaccine dose. In the swab cohort, seven subjects tested positive in the first 15 days after the first vaccine dose and one about a week from the second dose. At 45- and 60-day follow-ups all vaccinees tested negative, but two positive tests were registered at the third month. In the second cohort, two weeks after the first vaccine dose anti-SARS-CoV-2 antibodies exceeded the reactivity cut-off in 82.5% the participants. At one-month follow-up, almost all (98.4%) the vaccinees had reached the maximum Index value of 10. No statistically significant associations were found between antibody response and HCWs' characteristics. Conclusions Our results showed that surveillance is a critical component of providing safe healthcare during COVID-19 pandemic, also after extended vaccination campaigns, thus enhancing the protection of patients and HCWs. Key messages All healthcare facilities should implement continuous post-vaccination surveillance programs in order to ensure patients and healthcare workers safety, and limit in-hospital transmission of SARS-CoV-2. Longer field follow-ups are indispensable to investigate immunogenicity trends and effectiveness of COVID-19 vaccines over time, and to consider booster doses, especially in high-risk population.

Background The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Scientific evidence showed that community mask wearing is an effective nonpharmacologic intervention to reduce the spread of this infection. However, few data are available about the effect of face masking on the duration of the disease. We aimed to study the association between recovery time among a Tunisian cohort of COVID-19 confirmed patients and mask wearing. Methods A prospective cohort study was conducted from March to July 2020 including patients with COVID-19 admitted to the Tunisian national containment center. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the association between recovery time and face masks use. Results Among the 264 patients included, the median duration of viral clearance was 20 days (interquartile range (IQR 17-32days)). The median time to RNA viral conversion was 18 days (IQR 16-21 days) when using masks versus 23 days (IQR17-36 days) without wearing masks. Face masks use was significantly associated with an accelerated RNA clearance of SARS-CoV-2 (HR 2.006, 95% CI 1.247-3.228) (p = 0.004). Conclusions With the emergence of new variants, it is important to adopt widespread mask wearing to avoid SARS-CoV-2 infection and accelerate RNA negative conversion, until effective levels of vaccination are achieved nationally. Key messages Face masking was associated with accelerated RNA clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Promoting community mask wearing during COVID-19 pandemic is crucial.

Background After the coronavirus disease 2019 (COVID-19) became a pandemic, the World Health Organization declared it to be a public health emergency. The population aged >of 18 years in Bingol province is 72766 and constitutes 25.8% of the entire population. This study aimed to examine the epidemiological characteristics of < 18-year-old patients with COVID-19 in Bingol Province. Methods In this study 1431 people aged Results The median age of the study patients was 14 (0-17) years. Of the patients, 99.8% did not have any comorbidity and 96% presented with a good clinical condition. Of the patients, 91.1% were home-isolated and 6.9% developed pneumonia. Pneumonia developed at significantly higher rate in the age groups of 0-4 and 5-9 years compared with other age groups (p = 0.004). There was no significant difference in the development of pneumonia according to gender and comorbidity (p > 0.05). Conclusions The rate of pneumonia development was low in the study group. The clinical condition of most of the patients was good, and they isolated at home. Pneumonia developed at a higher rate in younger patients. Key messages COVID-19 has a milder prognosis in patients aged

Background Although, there is a rapidly accumulating body of studies on the various aspects of COVID-19, little interest was given to develop valid specific scales measuring COVID-19-related stigma. The current study aims to testvalidity and reliability ofa modified version of the 12-item HIV Stigma Scale, adapted for adults with COVID-19 infection living in the region of Sousse (Tunisia). Methods A cross sectional study was conducted among patients with COVID-19 infection between November and December 2020. The 12-item HIV stigma scale was translated in Arabic and then adapted to the Tunisian context. A preliminary version with twenty items covering the four dimensions of COVID-19 stigma was tested (Personalised stigma, disclosure concerns, concerns with public attitudes and negative self-image). The psychometric evaluation included internal consistency as well as principal component analysis (PCA). Results Responses of 346 COVID-19 patients were obtained.Among participants, 60.4% were women with a median age of 40 years (interquartile range, 30 to 54.5 years). Evidence for internal validity was supported by a PCA, suggesting a three factor solution with fourteen items. The 14-item scale demonstrated good internal consistency. The global Cronbach'sα was 0.91, with values of 0.94, 0.93 and 0.98 for social stigma, negative self-image and disclosure concerns respectively. Conclusions The results suggest construct validity and reliability of the 14-item stigma scale measuring three aspects related to COVID-19 infection in Tunisia. Key messages The 14-item stigma scale is a good psychometric tool to be used in assessing COVID-19 related stigma in Tunisia. Monitoring COVID-19 stigma with a valid and reliable would guide its prevention actions.

Background The SARS-CoV-2-pandemic poses major demands for long-term care, which might have impacted the intention to quit the profession among managers of long-term care facilities. Methods We used cross-sectional data of an online survey of German long-term care managers from outpatient and inpatient nursing and palliative care facilities surveyed in April 2020 (survey cycle one; n = 532) and between December 2020 and January 2021 (survey cycle two; n = 301). Results Results from the multivariate logistic regression analysis, including all variables simultaneously, showed that the pandemic-specific demands [OR = 1.034; CI = 1.011-2.057] and the general demands [OR = 1.023; CI = 1.001-1.045] were significantly associated with the intention to quit the profession. This association was significantly stronger for general demands in survey cycle two compared with survey cycle one. The results highlight the pandemic's immediate impact on long-term care. The interaction term between survey cycle and demands indicated that the association between general demands and the intention to quit the profession significantly rose between survey cycle one and two [OR = 1.036; CI = 1.000-1.072], whereas the association between pandemic specific demands and intention to quit the profession did not significantly vary by survey cycle [OR = 0.975; CI = 0.940-1.012]. Conclusions In view of the increasing number of people in need of care and the already existing scarcity of specialized nursing staff, the results highlight the need for initiatives to ensure the provision of long-term care, also and especially in such times of crisis. Key messages The intention to quit the profession among German managers of long-term care facilities has significantly increased during the SARS-CoV-2-pandemic. During the SARS-CoV-2-pandemic the perceived general demands as well as those directly related to the pandemic have increased significantly.

Objective Experience report by professionals from Basic Health Care Centers working with homeless people during COVID-19 pandemic. Methods Descriptive and reflexive study by professionals and Nursing professors and academics. Results and discussion Professionals experience challenges when facing the pandemic considering the life conditions and misinformation of homeless people about COVID-19.Brazil's Unified Public Health System needs to take some measures to promote social distancing, access to toilets, mask and food distribution. Meetings with health teams and clinic on the street teams were held to organize care according to local reality, infrastructure, and users' flow. In a similar vein, intra and intersectoral articulations for joint actions on the street were articulated to provide access to health care and social assistance, and to accommodate and care for those presenting respiratory symptoms till improvement of the condition. Reorganizing actions is a dynamic process because each epidemiological stage demands new strategies as the pandemic advances or recedes. Attendance at Basic Health Care Centers was defined as priority:suspected COVID-19 cases and people with mental suffering or chronic disease.These people were identified to have face-to-face consultations or teleconsultations. In this sense, therapeutic interruption and worsening of conditions were avoided. Some management challenges are listed:information dynamics, the need to publicize, to qualify professionals and to articulate the network;care with the health team, keep away professionals from the group of risk and COVID-19 confirmed cases;training demands, input assurance, and agendas;electronic means to share information and to keep collegiate management. Conclusions To face COVID-19 and to work with homeless people it becomes fundamental to share challenges and caring strategies to minimize impacts.Health professionals perform to sensitize users according to their life experiences and singularities. Key messages The caring process is built through dialog and reflection. It is of utmost importance to make the population aware of the COVID-19 prevention.

Background The COVID-19 global pandemic triggered massive policy responses worldwide. Measures taken during the pandemic differed across countries and time. Governance systems may influence the capacity of countries to respond promptly and mobilize the necessary resources in time. Identifying measures and when they appeared are critical questions to assess emergency response strategies. The objective of this study was to analyze the policy response to slow down the infection rate of COVID-19 cases in Portugal and Spain according to timing (related to death rates) and stringency. Methods A descriptive comparative study of non-pharmaceutical interventions was conducted through a content analysis of policies and records review of official government sources. Portugal and Spain were selected considering the similarities between national health systems, but different government organization and epidemic impact. The Autonomous Community of Madrid was also included as example of subnational systems. Death rates were retrieved from daily statistics of open secondary sources. Results Results show that countries responded with a complex mix of measures across policy sectors, following dynamic patterns established by the epidemic evolution and governance systems. Policies aimed to reduce the spread of the virus, enable individuals and businesses to comply with restrictions, and reinforce National Health System's capacity. The declaration of state of emergency was a critical tool to organize actions under clear leadership, especially in devolved contexts. Conclusions Our findings suggest that, in early epidemic phases, a centralized command can be more effective at timely enacting nationwide stringent measures. Evidence from this study contributes to the argument that a fast, robust, and early response might have been more effective at containing spread at the initial stages of the pandemic. Key messages The policy response included measured to reduce spread of infection, enhance adherence and strengthen health systems capacity to deal with the pandemic. The declaration of state of emergency was essential to ensure an organized, coherent, timely, and robust response, especially in devolved contexts.

Background The supply of COVID-19 vaccine was limited when introduced. We aimed to inform decision makers at an early stage about targeted COVID vaccination strategies, accounting for limited capacities and adherence to support vaccination prioritization in Austria. Methods We applied a dynamic agent-based population model to compare different vaccination prioritization strategies targeting the elderly (65 ≥ years), middle aged (45-64 years), younger (15-44 years), vulnerable (risk of severe disease due to comorbidities), and healthcare workers (HCW), to minimize COVID-19-related hospitalizations and deaths. First, outcomes were optimized for an initially available vaccine batch for 200,000 individuals. Second, stepwise optimization was performed, deriving a prioritization sequence for 2.5 million people. We considered sterilizing and non-sterilizing immunity, with different assumptions of effectiveness, over a 6-month period. The project team was advised by a Standing Policy and Expert Panel, consisting of Austrian decision makers, clinical and ethical experts as well as international modeling specialists. Results Maximum reduction of hospitalizations and deaths was achieved by starting vaccinations with the elderly and vulnerable, followed by middle-aged, HCW, and younger individuals. Optimizations for vaccinating 2.5 million individuals yielded the same prioritization and avoided about one third of deaths and hospitalizations. Starting vaccination with HCWs leads to slightly smaller reductions. The negative effects of COVID-19-related HCW absenteeism were not yet considered in our model. Conclusions Our decision-analytic study shows that the elderly and vulnerable should be prioritized for vaccination until further vaccines are available to minimize COVID-19-related hospitalizations and deaths. An important ethical aspect complementing our modeling results is the protection of HCW, maximizing their occupational safety and ensuring risk-compensatory justice. Key messages To minimize COVID-19-related hospitalizations and death the elderly and vulnerable should be prioritized for vaccination until further vaccines are available. Prioritizing health care workers for COVID-19 vaccination is slightly less effective in the simulation but they may be considered for occupational safety and to ensure risk-compensatory justice.

Background The COVID-19 pandemic continues to spread throughout the world causing serious morbidity and mortality. healthcare professionals (HCP) are on the front line in the face of this pandemic and are identified as priorities for COVID-19 vaccination. The aim of this study was to evaluate the acceptability rate of the COVID-19 vaccination among HCP and to identify their predisposing factors. Methods This was a cross-sectional study using an anonymous self-administered questionnaire including a randomized sample of (HCP) at the university hospitals of Southern Tunisia on April 2021. Results Overall, 223 cases were females (74.4%). The average age was 29.5 years ±8.26. In total, 178 HCP were doctors (59.3%), 147 HCP (49%) were working in medical services and 58 HCP (19.3%) were in intensive care units. The vaccination acceptance rate was 65.3% (196), while 73 cases (24.3%) were reluctant. Factors statistically associated with vaccine acceptability were female gender (Odds ratio (OR)=2.9;p=0.001), advanced age (30.23±8.27 vs 28.09±8.12;p=0.034), urbanity of residence (OR = 4.5;p Conclusions This original study revealed a relatively reasonable acceptance rate for vaccination against covid-19. Socio-demographic, cultural and professional factors predisposing to the willingness to be vaccinated were highlighted. Thus, planning vaccination campaigns to raise awareness of the efficacy and the safety of vaccine is strongly recommended to promote vaccination in the general population. Key messages This original study revealed a relatively reasonable acceptance rate for vaccination against covid-19. Socio-demographic, cultural and professional factors predisposing to the willingness to be vaccinated were highlighted.

Introduction The COVID-19 pandemic is causing considerable lifestyle changes through barriers measures, lockdown and social distancing. These changes include: Preoccupation with Covid-19 pandemic news, sleep disturbances and eating habits changes. Aim To assess the lifestyle changes after exposure to a risk of coronavirus contamination. Methods We conducted a cross sectional study during November and December 2020 among adults tested for COVID-19 in Mahdia (Tunisia).To assess the life habits changes (sleep, physical exercises and diet), the compliance with barrier measures and preoccupation with COVID-19 pandemic news, a reliable tool was developed and pretested by experts at the department of Preventive and Community Medicine Results A total of 277 participants were enrolled, the average age was 34.32 years ± 13.7. Among them 60.8% were women (sex-ratio = 0.51).Almost two thirds 62.2% were tested positive for Covid-19. Doctors presented 29.2% of the respondents. Among the study sample, 38.6% lived with elderly people. Approximately three quarters 77.8% reported an improvement in compliance with barrier measures. The majority 92.1% respected more the social distancing. As for hand washing and for mask wearing, 87.7% said to wash their hands more, and 95.3% were more concerned about wearing masks. A life habits change was observed among 16.7% of the respondents. Almost half of the participants 45.5% increased their physical activity, while 76.2% tried to get a healthy diet. Sleep disorders were registered among 48.7% of respondents. Preoccupation with the COVID news was observed in approximately half of the participants (57.8%). Conclusions The COVID19 pandemic affected different aspects of our lives. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science. Key messages A life habits change was observed among 16.7% of the respondent, sleep disorder were registered among 48.7%, and 77.8% reported and improvement in applying barrier measures. Research related to lifestyle, social and behavioral studies are as important as those related to medical and biological science.

Background Emergency department (ED) crowding is a burden on public health, so understanding the characteristics of frequent ED users is a key concern of the healthcare system and policy makers. This study aims to examine the characteristics and healthcare-seeking behaviors in frequent ED users before and during the COVID-19 pandemic. Methods A retrospective observational study was conducted on ED users aged 18 years and over admitted to Taipei City Hospital in February 2019-January2020 (before pandemic) and February 2020-January2021 (during pandemic) (N = 120,011). Frequent and ED users were defined as patients with four or more ED visits in a year. Multivariate logistic regression was used to identify the predictors of frequent ED use before and during the COVID-19 pandemic. Results Monthly emergency department visits were significantly lower during the pandemic (by 10.1-26.8%). Frequent ED patients had shorter lengths of stay in the ED during the pandemic (212.5 vs.233.9 minutes; P < 0.0001). The proportion of ED patients receiving chest CT examination during the pandemic has increased by 0.5-0.6%. After adjusting for sociodemographic factors, triage status, mode of arrival, and copayment exemption, patients with a triage status of level 4-5 (AOR=1.60, 95% CI: 1.13-2.28), diagnosis of pneumonia (AOR=1.85, 95% CI: 1.07-3.17), giddiness (AOR=2.85, 95% CI: 1.82-4.45), dyspnea (AOR=1.85, 95% CI: 1.00-3.39), or chronic kidney disease (AOR=5.05, 95% CI: 2.66-9.59) were more likely to be frequent ED visitors during the pandemic. Conclusions Since SAR-CoV-2 is highly contagious, it is imperative to educate non-emergent patients to utilize outpatient medical services rather than emergency medical services to reduce the risk of COVID-19 outbreaks at the ED. Key messages This study found that the utilization of emergent medical services during the COVID-19 pandemic significantly decreased by 10.1%–26.8% compared to before the COVID-19 pandemic. The lengths of stay in frequent ED users during the COVID-19 pandemic were significantly shorter than that in frequent ED users before the COVID-19 pandemic.

Background The COVID-19 disease has a spectrum ranging from asymptomatic infection to multi-organ dysfunction. Most patients with mild symptoms are isolated at home until recovery. However, compliance with home-quarantine and recovery are not warranted especially in developed countries where health capacity is poor. The purpose of the current study is to evaluate compliance with home-quarantine and the prognosis of COVID-19 among a cohort of patients isolated at home in the Governorate of Sousse, Tunisia. Methods Prospective longitudinal study of three months was led among a cohort of 375 patients with COVID-19 isolated at home. Participants were randomly selected from the new declared cases in the governorate of Sousse. Data were collected using a pre-established and pre-tested questionnaire administered during phone calls interviews with trained medical doctors. Results The median age of participants was 40.0 (IQR: 29.75-54.25) years. Females represented 60% of them. The average duration between close contact with symptomatic person and onset of symptoms was 4.01(±1.9) days. The most commonly reported symptoms were asthenia (51.7%), smell disturbance (50.4%), myalgia (41.9%) and ageusia (40.8%). Thirty two (8.5%) participants required hospitalization and 4 (1.0%) were transferred to intensive care units.The median delay for recovery was 18 days (IQR 17.1-18.9). Otherwise, 95 (25.4%) declared not respecting the quarantine and 111 (29.6%) of participants transmitted the infection to their family members. Conclusions Complications and intra-family transmission are frequent among COVID-19 patients isolated at home in Sousse. Accelerating the implementation of the Tunisian telemedicine law would provide a cost-effective solution for this problem. Key messages Isolation at home of COVID-19 patients should be associated with close monitoring by health professionals.Individual prevention measures should be reinforced among patients isolated at home to limit intra-family spread of COVID-19.

Background Biocontainment systems in healthcare settings are intended to ensure isolation of contagious or potentially contagious patients so as to protect healthcare providers and control infection spread. The need for safe and effective biocontainment systems has emerged during the COVID-19 outbreak. In particular, transport of potentially contagious patients poses technical, logistical and medical challenges that are to be addressed to protect population health and enable safe healthcare services delivery. Methods As novel biocontainment systems become available it is important to assess their operational effectiveness and safety and to define their organizational impact. We applied the Health Technology Assessment (HTA) framework to evaluate a novel rigid bio-containment system (Billy-Cab) integrated with the stretcher support, for ambulance transport of contagious patients. Results We applied the EUnetHTA core model to conduct an HTA report of Billy-Cab. A multi-disciplinary working group was established. We assessed available biocontainment under the nine dimensions of the EUnetHTA core model. We derived and pooled: 1) original data derived from clinical practice, 2) secondary data derived from systematic reviews of the literature, conducted according to the PRISMA guidelines, 3) original data derived from validated questionnaires, 4) economic original data. Conclusions Preliminary data allow to conclude selected biocontainment systems are effective in ensuring infection control during ambulance transport, with manageable organizational impact. In addition, the use biocontainment systems positively influence healthcare professionals' attitudes and performances. The HTA methodology offers substantial support to evaluate the introduction of innovative technologies during health emergencies and beyond. Key messages Selected biocontainment systems are effective in ensuring infection control during ambulance transport. HTA is to be applied to evaluate the introduction of innovative technologies during health emergencies and beyond.

Background Healthcare decision-makers need comprehensive evidence to mitigate surges in the demand for human resources for health (HRH) during infectious disease outbreaks, in terms of both short- and longer-term impacts. This study aimed to assess the state of the evidence to address HRH surge capacity during COVID-19 and other outbreaks of global significance in the 21st century. Methods We systematically searched eight bibliographic databases to extract primary research articles published between 01/2000-06/2020, capturing temporal changes in HRH requirements and responses surrounding viral respiratory infection pandemics. A systems approach was used, considering providers in hospitals, out-of-hospital systems, emergency medical services, and public health. We narratively synthesized the evidence following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) standard. Results Of the 1,155 retrieved records, 16 studies met our inclusion criteria; of these, 5 focused on COVID-19, 3 on H1N1, and 8 on a hypothetical pandemic. Different training, mobilization, and redeployment options to address pandemic-time health system capacity were assessed. Few governance scenarios drew on observational HRH data allowing for comparability across contexts. Notable evidence gaps included occupational and psychosocial factors affecting healthcare workers' absenteeism and risk of burnout, gendered considerations of HRH capacity, evaluations in low- and lower-middle income countries, and policy-actionable assessments to inform post-pandemic recovery and sustainability of services for noncommunicable disease management. Conclusions This research emphasized the critical need for timely, internationally comparable, and equity-informative HRH data and research to enhance preparedness, response, and recovery policies for this and future pandemics. Full paper is available at: https://doi.org/10.1002/hpm.3137 Key messages The COVID-19 pandemic has highlighted the critical need for enhanced health workforce data and research, including better tracking of demographics, exposures, infections and deaths of health workers. Although women comprise 70% of the health workforce in many countries, gender-blindness persists in the global literature on health workforce research and governance in public health emergencies./bodyt

Background The global pandemic of COVID-19 has caused radical changes in the structure of people's daily routines in most of the countries around the world and have had a big impact on physical activity (PA) and daily movement. Previous studies reported the increase of sedentary behaviours during movement restrictions. This study investigates the impact of the first Italian lockdown measures (9 march - 3 may 2020) on PA habits and factors potentially associated with starting or ceasing PA practice during home confinement. Methods A web-based cross-sectional survey was carried out using an online 40-item questionnaire spread in May 2020 in Italy. Multivariable regressions were performed. Results A total of 1865 people were enrolled. During lockdown, PA was performed by 65.5% of the sample. Overall, the number of physically active people increased by 8%, compared to the pre-pandemic period level (56%). A change in PA habits occurred in 34.1% of the sample (37.9% of them stopped PA and 62.1% started it). Starting PA during lockdown was related to being on a diet, whereas living with children and having poor psychological well-being were inversely related with starting PA. Conversely, unhealthy factors like being overweight or obese, having poor mental well-being and the occurrence of emotional overeating were related to stopping PA during lockdown. Conclusions The first Covid-19 Italian lockdown had a significant impact on healthy habits of the population, leading to an increase of physically active individuals. Furthermore, a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic. Key messages Physical activity habits changed during lockdown due to Covid-19 pandemics and a relation between unhealthy lifestyle factors and stopping physical activity during lockdown was found. European governments should adopt health promotion strategies to avoid the increase of sedentary behaviours during and after the pandemic.

Issue/problem COVID-19 pandemic halted cruise operations globally. This project explored strategies and measures that could be adopted internationally for mitigating a disease outbreak on-board of a cruise ship by bringing evidence-based recommendations for an emergency response against current COVID-19 outbreak and future infectious threats. Description of the problem Research took place in October 2020-March 2021. Methods comprised of: a) consultation sessions with five international experts on public health, epidemiology, tourism and cruise management, b) both systematic and narrative literature reviews. Present guidance analysed why cruise ships promote an opportunistic environment for infectious outbreaks, along with a strategy for reducing the risks among passengers and crew. Results Results were organised under four main themes: a) advice on surface interactions and virus viability; b) prevention and control measures; c) suggestions on short and long term responses; d) advice on thermal and ventilation conditions and how they affect virus transmission. The guidance was very similar to other built environment contexts, ignoring the particularities of sociospatial interactions in cruise ships. Moreover, there was limited provision for the wellbeing and mental health during the outbreak. Lessons This project summarised recommendations for the preparedness of cruise ships during a pandemic from ports, off-board and on-board measures to repatriation. Demonstrated the importance of spatial characteristics in the preparedness of a ship. Pointed the effect pandemic can have upon crew and passengers. This needs to be taken into account when operations restart. Cruise experience would have to change due to covid-19, especially when social activity on board has to be restricted. The importance of future studies focusing on how this change will impact cruise industry arose, including crew hygiene, safety and supporting mental health during outbreaks. Key messages Multi-disciplinary approach on providing a set of recommendations for emergency response to infectious disease outbreak on cruise ships including environmental preparedness. Actions should include also the mental health of crew and passengers on copying with stress during infectious outbreaks.

Background COVID-19 pandemic effected preventive health services. The implementation of the breast cancer screening program (BSCP) in Croatia was paused for one and a half month in 2020. The aim of this research was to compare the results of BCSP rollout during and before pandemic. Methods Data of fourth, fifth and sixth BCSP round of women (about 700,000 women per round): invited in BCSP, responded to invitation and response rate were analysed. Results Of all women included in sixth round, 93.0% were invited (92.7% in fifth and 89.3% in fourth). Response rate (53.3%), including woman screened in BCSP and on the doctor's referral, was 5.7% lower compared to fifth and 5.4% lower compared to fourth round. Response rate on invitation letter was 44.9% in sixth, 42.3% in fifth and 40.1% in fourth round. There was 24,768 mammography check-ups in sixth, 41,040 in fifth and 80,846 in fourth round. There was 11.8% less mammography examinations in sixth round compared to fifth and 0.3% less compared to fourth round. Conclusions Lower response rate in the sixth BCSP invitation round was observed with similar invitation coverage. There was 11.8% less mammography examinations done in relation to the 5th and 0.3% less than in the 4th invitation round. Response rate to the invitation letter was higher in the sixth in relation to the previous rounds. Explanations for the observed differences could be lower number of mammography examinations done on the doctor's referral, less available terms in mammography units and consequently less second invitation letters sent because of the epidemiological measures. Intensive public health campaign and more mammography unit terms, including mobile mammography units, are needed in order to return the invitation and response rates to the pre-pandemic values. Key messages COVID-19 pandemic caused 5.7% lower response rate and 11.8% less mammography examinations in BCSP. In order to close the observed gap in the BCSP response rate, more mammography unit terms are needed to be available followed by the intensive public health campaign.

Background An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the association between a prolonged viral shedding in patients with COVID-19 and having symptoms. We aimed to study the association between the presence of symptoms and recovery time of COVID-19 confirmed patients. Methods We conducted a prospective cohort study of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia from March to July 2020. Kaplan-Meier survival curve and Cox proportional hazards regression models were used to assess viral shedding in asymptomatic versus symptomatic patients with COVID-19. Results Among the 264 patients included in the study, symptoms such as anosmia, dry cough, and fatigue were reported by 34.4% (n = 75) of cases. The median time to RNA viral conversion was 24 days (IQR 18-36 days) for symptomatic patients versus 20 days (IQR 16-30 days) for asymptomatic patients. Having symptoms was significantly associated with a prolonged viral shedding (HR 0.600, 95% CI 0.401-0.897) (p = 0.013). Conclusions Our findings revealed that having symptoms delayed viral clearance among COVID-19 patients. Therefore, symptomatology should be taken into consideration in isolation strategy for infected patients. Key messages Having symptoms was associated with a delay in SARS-CoV-2 RNA clearance. The presence of symptoms should be taken into consideration for patient’s isolation strategy.

Introduction The Russian Federation reported one of the largest number of COVID-19 infections. Major restrictions (social distancing, travel bans, event cancellation, changes to work practices) were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Purpose is to estimate the impact of COVID-19 on sleep among adults in Russia. Methods The NMRC TPM conducted a national online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Data were collected during the period of tightest restriction through the country between 26 April 2020 and 6 June 2020. A link on the online survey was distributed through the regional center of public health. Sleep quality was assessed by comparing the period before the COVID-19 and the last 7 days. Results In spring 2020, 2432 completed questionnaires from 62 regions of Russia were received. There was a predominance of female respondents (86.6%), the average age was 33.6±14.9 years and 38.2±13.1 years for men and women, respectively. The majority of completed questionnaires were received from the Republic of Tatarstan (n = 804), Irkutsk (n = 474), Sakhalin (n = 225) and Tver regions (n = 152). Compare pre-COVID to during COVID there was a significant decline in the number of days per week participants reported not getting enough sleep (3.21±2.44 to 2.86±2.57; p < 0.001) and participants also reported an increase in the number of days per week they had trouble falling asleep (1.70±2.24 to 2.13±2.48; P < 0.001). The number of days participants waking up earlier than wanted before and during the pandemic has not changed (2,6 Đ, 2,59 (p < 0,5)). Conclusions Effective health promotion strategies directed at adopting or maintain positive health related behaviors such as targeted social media messaging and balanced media reporting, should be used to maintain healthy sleep during these unprecedented times. Key messages Changes in sleep quality during COVID-19 identified as a result of the online-survey ‘Study of the impact of restrictions on physical activity of the population in self-isolation due to COVID-19'. Effective health promotion strategies directed at adopting or maintain positive health related behaviors should be used to maintain healthy sleep during COVID-19 pandemic.

The emergence of the COVID-19 virus highlighted the importance of public trust in official directives during a pandemic. As part of the measures taken to reduce the spread of the coronavirus, people were asked to maintain physical distancing. Compliance with physical distancing influenced by trust levels which are generally lower in minority groups. The current study aimed to explore the trust level and compliance with the physical distancing relationship among Arab minority and Jewish populations during three lockdowns during the COVID -19 outbreak in Israel. Three cross-sectional online surveys were conducted among a convenience sample of Jews and Arabs adults (≥18 years old) citizens of Israel following the first (April to June 2020), second (October to November 2020), and third lockdown (January to February 2021). The surveys collected demographic data, compliance with physical distancing, and trust level in official sources. In total, 613 (N = 281 Arab, N = 281 Jewish) participants completed the first online survey, 542 (N = 223 Arab, N = 319 Jewish) completed the second survey, and 98 (N = 38 Arab, N = 60 Jewish) completed the third survey. In the three surveys, both populations, Arabs and Jews, reported higher levels of trust in health professionals than in politicians. The level of trust and keeping physical distancing during the three lockdowns were significantly lower among Arab compared to the Jewish participants. However, the association between trust and social distancing was significant only in the first lockdown (OR = 2.02, 95% CI 1.37-2.97) but not in the second and third lockdowns. Trust in official directives is an important determinant of citizens' compliance with physical distancing guidelines during a pandemic. Minority groups have lower trust levels and face more challenges for keeping physical distancing. This should be brought to the policymakers' attention to increase trust and physical distancing among them. Key messages Understanding the relationship between trust and compliance and its potential consequences during a pandemic warrant particular attention in the present context of a global pandemic. It is of utmost importance to identify the unique characteristics of sub-populations and minority populations in which there may be additional factors affecting compliance.

Background Lockdown measures implementation (LMI) to prevent COVID19 disease diffusion was associated to increased depression and anxiety cases. The main aim was to evaluate whether LMI affected prevalence and incidence of antidepressants (ADs) use, and ADs treatment interruption (TI) in the general population. Methods Adults (≥18 years) with at least 1 dispensing of ADs between 01/01/2019-26/09/2020 were selected from a regional Italian healthcare administrative database. Patients presenting an AD dispensing in the year preceding the first observation were considered as prevalent otherwise as incident users. We divided the studied period into 3 parts: pre-lockdown (01/01/2019-08/03/2020), lockdown (09/03/2020-14/06/2020) and post-lockdown (15/06/2020-27/09/2020). The weekly prevalence (WP) and incidence (WI) per 10,000 inhabitants were compared among periods. Incidence of TI (no dispensing refill within 30 days of the end of its validity) was computed among prevalent AD users. Results The WP (mean of 552.3 per 10,000 pre-lockdown vs 505.5 lockdown phase; relative change: -9%) and WI (5.2 vs 3.7; -29%) of ADs use decreased after LMI. During the post-lockdown phase WP (505.5 vs 495.9; -2%) decreased whereas the WI (3.7 vs 4.3; 16%) slightly increased in relation to the lockdown period, although differences were not statistically significant. Conversely, the incidence of TI increased during lockdown (344.7 vs 384.3; 12%) and post-lockdown (384.3 vs 394.2; 3%) periods, even not always statistically significant. Conclusions Our analysis showed a reduction of ADs use during the early phase of lockdown. Several factors might have impacted on the observed phenomenon (i.e, patient reluctance to start new AD treatment). Considering the mutation of the virus and the potential waves that might occur in the next months, a continuous monitoring of the impact of COVID19 on mental diseases onset and treatment adherence are suggested. Key messages In Italy, the implementation of lockdown measures was followed by a reduction in antidepressants use, even though evidences are that diagnoses of psychiatric disorders increased. Future studies should monitor if these phenomena led to an increase in adverse events potentially correlated with inappropriate treatment of depression.

Issue The COVID-19 pandemic poses a challenge for prison settings, given their population vulnerability and the complexity of their internal functioning. We summarize the actions and outcomes concerning outbreak prevention and control in the Antoni Asunción Hernández (AAH) Prison (Valencian Region, Spain), one of the largest in Europe. Description An intersectoral commission was established in March 2020 at the Valencia General Hosp Health Dept to coordinate the COVID-19 response in penitentiary centres. A contingency plan was developed, with successive contention layers: general measures, restriction of interaction with the community (including suspension of visits), 14 days quarantine on admission and return, reduction of activities, modular confinement, voluntary confinement in cells, occupational risks prevention, vaccination, epi surveillance, outbreak management (incl sectorisation), isolation of cases (PCR at discharge), contact tracing and 14d quarantine (PCR at 0,7&14d), expanded testing and healthcare services. Results On 8 Jan 2021, with a regional 14d cum incidence of 394/100,000 pop, an outbreak was declared. The index case initiated symptoms the 14th day after return from leave, after quarantine discharge. In 57 days 281 confirmed cases were diagnosed: 274 inmates (out of 1,823) and 7 workers (of 890). Mean age 40,7 years (SD 12,0), 9 cases + 65 year-olds, 99,3% men. 7 out of 32 modules and the nursing unit were affected, with an overall attack rate of 38,5% (range 6,1-77,4%). 5 inmates were hospitalised, of which 2 in ICU. All patients had an uneventful recovery. Case fatality rate 0. No new variant was detected. Lessons Intersectoral coordination mechanisms, involving prison officials, public health authorities and healthcare services, are crucial to unfold an appropriate COVID-19 response. Tailored, rigorous, dynamic and proportionate measures are essential to reduce COVID-19 impact on the health and well-being of prisons' population and their communities. Key messages Prisons are at risk of large COVID-19 outbreaks, with potentially severe consequences, given their population vulnerability and organisational complexity. We recommend a 14d quarantine duration. Intersectoral coordination mechanisms are crucial to unfold an appropriate COVID-19 response, wich should include tailored, rigorous, dynamic and proportionate prevention and control measures.

Background During the SARS-COV 2 pandemic, Mexico has dealt with different manifestations unrelated to the information that is disseminated in different media based on scientific evidence, which has generated anti-vaccine expressions based on information of dubious scientific quality. Objective To determine the association between the use of information from social networks and the acceptance of the vaccine for SARS-COV2. A comparative, observational, cross-sectional and prospective study was carried out in Veracruz, Mexico, between January and April 2021, including residents of this city over 18 years of age through a non-probability sampling through virtual surveys conducted in Google forms. Results 704 subjects were included in the study, of which 426 (60.6%) were women. 93.9% of the participants stated that they would agree to be vaccinated when appropriate. The source of information most used by those who accept the vaccination were social networks (43%), and of these, Facebook is the one they use the most (42.7%) and where they find more information about COVID (52.0%), without However, the social network in which they most frequently take your information into account is tweeter (29.4%). The OR for not accepting to be vaccinated was 0.2 (95% CI 0.08-0.6) for those who use information mainly from tweeters, as well as for those whose neighbors are their main source of information OR 17.6 (95% CI 5.4-57.4), both with value of p < 0.05. Having as the main source of information other social networks, television, radio, medical or newspaper personnel, resulted in p values> 0.05 for not accepting the vaccine. Key messages Informal information decreases the likelihood of accepting the sarscov2 vaccine. Tweeter is a source of information that favors vaccination.

Background In response to the COVID-19 pandemic, the Irish health system redeployed public sector staff to contact tracing and recruited dedicated contact tracing staff. While contact tracers are provided with rapid intensive training they work in a dynamic setting, and may experience difficulties in managing the public's distress. Real-time data is essential to inform strategy, and respond to needs. This study aimed to understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods A mixed methods design was used to collect data over three time points during 2021 using an online survey and semi-structured interviews. Measures included the Oldenburg Burnout Scale, the Perceived Stress Scale-14, the General Health Questionnaire 12, and the Impact of Events Scale-6. Survey data was analysed with ANOVAs and multiple regressions. Contact tracing systems issues, and concerns among the public were identified. Interviews, analysed using thematic analysis, provided an in-depth understanding of contact tracers' experiences. At time point 1, 139 contact tracers completed the survey, and 22 were interviewed. Results Burnout related exhaustion was experienced by 57% of contact tracers, 52% experienced mental distress, and 26% reported symptoms of post-traumatic stress disorder (PTSD). Professional background was associated with PTSD [F = 6.43, p=.013], and perceived stress scores [F = 5.23, p=.024]. Age was associated with perceived stress [F = 7.38, p =

Background The COVID-19 pandemic was characterized by difficult communication challenges due also to scientific uncertainty regarding the nature and management of the new coronavirus. The aim of the study was to assess the impact of media information on the population's COVID-19-related knowledge, behavior and emotional state. Methods In a cross-sectional study, data from July to September 2020 was collected via survey posted on social media (SM). It included also an analysis of participants' e-health literacy (e-HEALS), and depression, anxiety, and stress symptoms using DASS-21 tool. Results Of the 2,140 subjects, as a main source of information, 69% indicated institutional websites and 26% SM. Fifty-four percent believed expert information to be crucial in changing their behavior. However 30% of health professionals (HP) and 37% of non-HP found expert (scientists) communication hard to understand. Despite high education level (44.3% graduates), 19% denied knowing of the virus origin. Others believed the human manipulation theory (33% of the total and 29% of HP). The e-HEALS score in these subjects was lower than those reporting the natural origin of virus (28.4 ± 6.2 vs 30.5 ± 6.1, p Conclusions Although the sample was overall well informed and followed preventive measures, institutional communication was found to be confusing especially by experts. The findings highlighted the strong psychological impact on the community, young people especially. Key messages The study confirms the importance of putting effort on population health literacy and more effective institutional communication strategies. Proactive and timely psychological interventions should be provided to address the mental health needs of the population resulting from the pandemic.

Background The Mediterranean Diet (MD) is one of the healthy eating plans recommended to promote health and prevent chronic diseases. During the COVID-19 pandemic, many countries adopted restrictive measures to mitigate infection spread, which might have influenced people's lifestyle and dietary habits. We conducted a systematic review to evaluate the impact of stay-at home orders' implementation on adherence to MD. Methods Studies were identified searching Medline, Embase, and Web Of Science, the search strategy was developed using a combination of free text and mesh terms referring to COVID-19 pandemic, lockdown, and MD. Studies published until March 31st, 2021 were included. We only considered studies reporting original data from quantitative analysis and assessing modifications of adherence to the MD through validated dietary scores or any change in consumption of food categories that are typically ascribed to the MD. Data extraction, pooling and quality appraisal of the included studies, were conducted applying PRISMA guidelines. Results 42 studies were retrieved. After duplicates removal, and in-blind two-step screening, 10 studies met our a priori defined inclusion criteria and were included in the review. 71.4% of the studies reporting a rate of change in adherence, measured through validated questionnaire both before and during lockdown, reported an increase, while 28.6% reported no significative changes. All included studies reporting the percentage of participants having a high adherence to the MD, based on their results on MEDAS questionnaire, before and during the lockdown, found an increase in this percentage. Conclusions Adherence to the MD could have raised in people undergoing lockdowns due to COVID-19. Key messages The impact of restrictive measures on determinants of health must be monitored. Despite the literature suggests adherence to MD has declined in the last years, this trend may have reversed or, at least, slowed during the initial phases of the current pandemic.

Background COVID-19 has posed a public health problem leading to considerably higher healthcare costs in the U.S. population. Additionally, social connectedness has been demonstrated to be directly correlated with improved disease management and outcome of treatment. The purpose of the current study was to explore 10-year mortality outcomes of loneliness. Methods We assessed data from the 1999-2008 National Health and Nutrition Examination Survey, with mortality data obtained through 2015. All individuals from this nationally representative study were 20 years and older. Hazard ratios with 95% confidence intervals (CIs) for all-cause and cardiovascular disease (CVD) mortality were estimated using Cox Regression models. Results Out of 994 participants (54% females vs. 46% males) with loneliness, 324 deaths were reported (including 71 CVD deaths) during an average of 10-year follow-up. The hazard ratio for mortality among those experiencing social isolation was 1.28 (95% CI = 1.17-1.39). The adjusted HR for all-cause mortality [1.24 (CI 1.12-1.38, p < 0.05)] and CVD mortality [1.31 (CI 1.09-2.56, p < 0.05)] were significant, after additional adjustment for demographic and health risk factors. There was also an increase in COVID-19 related loneliness search behavior. Conclusions Individuals who experience loneliness have a significantly higher likelihood of overall and CVD-mortality than those who are socially connected. Consequently, addressing loneliness in the face of social distancing and isolation may contribute to lower premature death risk and improve CVD-mortality in this vulnerable population. Key messages Loneliness may longitudinally lead to increased mortality from cardiovascular disease. Future public health interventions should incorporate active efforts to address loneliness.

Background Testing is a crucial tool in the pandemic response to identify and confirm COVID-19 in those who are symptomatic. The aim of the present study was to assess the negative predictive value (NPV) of COVID-19 Rapid Antigen Testing (RAT) according to the symptoms, test timing in relation to symptom onset and characteristics of the person. Methods We performed a prospective cohort study of patients attended the COVID-19 testing center at the university hospital of Monastir, between 23 November 2020 and 19 April 2021. In the first time we performed the COVID19 RAT. In the second time, if this result was negative we performed the reverse transcription polymerase chain reaction (rRT-PCR). The NPV was conducted with SPSS software, version 21.0. A logistic binary regression was performed to determine factors affected the NPV of COVID-19 RAT. A p value of < 0.05 was considered statistically significant. Results A total of 855 tests were performed, of which 807 were RAT and 467 rRT-PCR. Positive RAT test was found in 336 cases (39%). False negative RAT was noted in 87 cases (10.2%). The NPV of RAT was 83.6%. The NPV ranged between 80% and 88% for the following symptoms: fever, cough, myalgia, dyspnea, dizziness, asthenia, headache, myalgia, odynophagia, flu_rhume. It varied from 64.2 to 77.8 for Ageusia, Anosmia, Arthralgia, chest pain, thrill, digestive signs. The NPV was equivalent according to age and gender. The NPV varied from 80 to 100% if the test was applied between the first and the 5th day for the onset of symptoms. Beyond this duration, it decreased to 50%. A long period of symptom onset (>5 days) increased significantly the risk of false negative RAT (OR = 2.57 IC95%: [1.38-4.82], p = 0.003). Conclusions Many factors may affect the performance of COVID-19 Rapid Antigen Testing (RAT). In fact, negative RAT should be completed by a rRT-PCR according to the the type of symptoms and the time from illness onset. Key messages False negative RAT rate was high. Many factors must be taken into account in interpreting the RAT, in particular the type of symptoms and the time from illness onset.

Background Vaccines constitute a successful and cost-effective public health tool. Whereas, skepticism regarding their safety and efficacy remains prevalent. We aimed in this study to assess attitudes and beliefs regarding current vaccines among cancer patients in a national Tunisian center for cancer care. Methods A cross sectional study was conducted, during the month of February 2021, among hospitalized patients in the oncology unit of the Salah Azaiez Institute of cancer. We included patients who were aged 18 years and over and who were able to respond to the questionnaire. A standardized questionnaire was administered to patients to assess their attitudes and beliefs regarding current vaccines. Chi square test was used for comparing percentages and a p value Results A total of 200 patients were included with a mean age of 54.4±12.7 years. The willingness to receive influenza and COVID-19 vaccine were respectively of 39.0% and 35.0%. A higher proportion of 69.0% was observed for the willingness to receive vaccines against other infectious diseases. Among surveyed patients, the high majority (81.0%) agreed with the fact that there is no need to be vaccinated because native immunity exits and or because vaccines are unsafe. This belief was significantly associated to patients' unacceptance of COVID-19 (91.3% vs 63.8%, p < 0.001), influenza (86.8% vs 72.7%, p = 0.013) and other infectious diseases vaccines (93.5% vs 75.9%, p = 0.003). Conclusions This study reported low acceptance proportions of influenza and COVID-19 vaccines and that false beliefs constitute a threat to vaccine acceptance. Healthcare professionals should educate and encourage cancer patients to be vaccinated, especially against COVID-19, influenza and pneumococcal infections. Key messages Low acceptance proportions of influenza and COVID-19 vaccines, were found in this study. Improving communication strategies in order to redress false beliefs and increase vaccine acceptance is recommended.

Background To counter the spread of COVID-19 and avoid overwhelmed health-care systems and numerous deaths, strict lockdown measures were adopted by many countries, causing an unprecedented disruption of daily life. Our objective was to explore the changes in dietary intakes, physical activity, body weight, and food supply occurring during the first lockdown in France (March-May 2020), in light of individual characteristics. Methods 37,252 adults from the French web-based NutriNet-Santé cohort completed lockdown-specific questionnaires. Nutrition-related changes and their sociodemographic and lifestyle correlates were investigated using multi-adjusted logistic regressions. Clusters of participants were defined combining multiple correspondence analyses and an ascending hierarchical classification. Results During the lockdown, trends of unfavorable changes were observed: decreased physical activity (53% of the participants), increased sedentary time (63%), increased snacking, decreased consumption of fresh food (especially fruit and fish), and increased consumption of sweets, cookies, and cakes. Yet, the opposite trends were also observed: increased home cooking (40%) and increased physical activity (19%). Additionally, 35% of the participants gained weight (mean weight gain in these individuals:1.8kg (SD:1.3) and 23% lost weight (2kg (SD:1.4)). All of these trends displayed associations with sociodemographic and lifestyle characteristics. Conclusions These results suggest that nutrition-related changes occurred during the lockdown in both unfavorable and favorable directions, and differed according to individual characteristics. Key messages COVID-19-related lockdown in France led to nutritional changes in both unfavorable and favorable directions, linked to sociodemographic and lifestyle inequalities. Unfavorable changes should be considered to inform future lockdown decisions and monitored to prevent a future increase in the nutrition-related burden of disease.

Background The COVID-19 pandemic has had effects on populations worldwide. The social determinants of health affect an individual's capacity to cope during a crisis which could potentially impact on their wellbeing. The aim of this study was to examine the relationship between wellbeing and the social determinants of health among Australian adults during the COVID-19 pandemic. Methods A cross-sectional study of adults residing in Australia was conducted using SurveyMonkey (an online survey) between August - October 2020. Participants were recruited via social media. Wellbeing was measured using the 10-item Multicultural Quality of Life Index and social determinants of health were measured using validated tools and investigator developed questions. Data were analysed using SPSS version 25. Inferential statistics, including independent t-test and one-way ANOVA were undertaken. Multiple regression analysis was used to investigate the predictors of wellbeing. Results In total, 1211 responses were received. Females accounted for 80.7% of the responses, men 16.7% and transgender/non-binary 2.6%. The mean age of the respondents was 43 years (SD 14.5). The mean score for total wellbeing was 62.58 (SD 21.22). Housing insecurity (p = 0.000), food insecurity (p = 0.000, social support (p = 0.000) and access to health care (p = 0.000) were all predictors of poor total wellbeing. Being a male (p = .0380) was the only predictor of higher wellbeing. Conclusions This study demonstrates that adults in Australia who had poor social support, had difficultly accessing health care, had insecure housing and food insecurity had significantly poorer wellbeing during the COVID-19 pandemic. This study exposes the social determinants of health that are responsible for health and social inequalities. It shows that the COVID-19 pandemic has exacerbated the social vulnerabilities and highlights the need take action on the social determinants of health and inequalities. Key messages The COVID-19 pandemic has further exposed the longstanding health and social inequalities that exist in Australia. Action on social determinants of health is required in a post COVID-19 world to rebuild social protection and safeguard populations from any future public health emergencies.

Background CKD 5 is a life threatening condition irrespective of cause. Most patients reach RRT. Predominant therapy is HD. Pandemic preparedness is an important pro-active public health function. Objectives 1) to describe the incidence of COVID19 and IFR among CKD HD patients; 2) to evaluate the vaccination coverage among HD patients (Jan-Mar 2021); 3) to update a spreadsheet CKD5 HD 12-scenario treatment model by considering two new scenarios based on IFR: before and after vaccination. Methods First two objectives use secondary data: JHSU and ECDC (secondary sources of COVID19 data) for Apr 2020-Mar 2021. The 3 NPM periods are: Apr-May 2020 (state of emergency), Jun-Dec 2020 (state of alert; vaccination -), Jan-Mar 2021 (state of alert; vaccination +). Data are taken from the Romanian Renal Registry and population data from Eurostat (available July 2021). IFR was estimated with a modified Kaplan-Meier method (Ghani,2005). A calibrated and validated CKD5 treatment model has previously been defined (10.1093/eurpub/cku161.026). Scenarios are re-run with one parameter adjusted by IFR levels. Analyses used Excel, SPSS. Results n = 14300 adult HD patients in March 2020; highest incidence (risk) was recorded in Apr-May 2020: 4.5% (CI95% from 4.1 to 4.8) and 2.5% (CI95% from 2.2 to 2.7). Cumulative incidence was 6.9% vs 18.5 pmp in the general population (period 1). In the general pop COVID19 incidence was highest at 443 pmp in Nov 2020 (period 2). The IFR requires full data validation; CFR was 7.7% (CI95% from 5.97 to 9.46; period 1). It is estimated that by Mar 2021 the IFR has decreased by 50%. Vaccination coverage in HD patients reached 94% (Apr 2021). Preliminary results from the updated model are presented. The model upholds its validity as the IFR allows for a better fine tuning of one parameter (mortality). Conclusions treatment need and inequality in service provision can be addressed with a spreadsheet model by including pandemic preparedness measures. Key messages Haemodialysis patients had a very high COVID-19 incidence and CFR during the first two months of the COVID-19 pandemic when compared with the incidence in the general population. Pandemic preparedness must include protection measures for patients with chronic diseases. Renal patients are particularly vulnerable given their co-morbidity.

Background Since the outbreak of COVID-19 has raged, large-scale measures for prevent disease transmission have been implemented worldwide. If effectively implemented, these measures may have led to a reduction of the spread of other respiratory infectious diseases at community level. The aim of the present study was to evaluate the indirect impact of COVID-19 large-scale containment measures on the incidence of community-acquired pneumonia (CAP) in the elderly during the first epidemic wave of COVID-19 in Tuscany, Italy. Methods A population based study was carried out on data from the Tuscany healthcare system. Hospitalization rate for CAP, severity of CAP hospitalizations, and outpatient consumptions of antibacterials for CAP in people aged 65 years and older were considered as outcome measures. Percentage changes in the outcome measures were calculated considering corresponding periods of the 2020 and 2017-19. 95% confidence intervals and the statistical significance of the percentage changes were calculated using the Poisson model. Results A total of 3,346 new CAP hospitalizations occurred in people aged 65 years and older in the whole study time-frame. Significant reductions in the weekly hospitalization rates for CAP were observed starting from the week in which the national containment measures were imposed, this negative deviation continued even after the lift of the national lock-down until the end of the first wave of COVID-19 in July (maximum weekly decrease of 46%). All the antibacterial classes for CAP showed a significant decrease in their outpatient consumptions during the COVID-19 epidemic period. Conclusions The implementation of large-scale COVID-19 containment measures likely reduced the incidence of CAP in the elderly during the first wave of COVID-19 pandemic. Furthermore, findings suggests that individual prevention measures that remained mandatory after the lift of the national lock-down also had a relevant role in the reducing CAP incidence. Key messages The potential benefits of pandemic containment measures can extend beyond the prevention of COVID-19 to include the reduction of the burden of respiratory infectious diseases Taking into account the indirect impact of pandemic containment measures on respiratory tract infections may improve the planning of health services during a pandemic.