Special Issue "A Public Health View on COVID-19: Epidemiology, Implications and Responses"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Public Health Statistics and Risk Assessment".

Deadline for manuscript submissions: 30 November 2021.

Special Issue Editors

Prof. Dr. Riccardo Polosa
E-Mail Website
Guest Editor
Department of Internal Medicine, University of Catania, 95124 Catania, Italy
Interests: internal medicine; COVID-19; smoking cessation; tobacco harm reduction; immunotherapy
Dr. Pietro Ferrara
E-Mail Website
Guest Editor
Center for Public Health Research, University of Milan-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
Interests: epidemiology; public health; population-based healthcare; health policy; preventive medicine
Special Issues and Collections in MDPI journals
Dr. Luciana Albano
E-Mail Website
Guest Editor
Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 5, Via Luciano Armanni, 80138 Naples, Italy
Interests: public health; epidemiology; health systems; health policy; preventive medicine
Special Issues and Collections in MDPI journals
Prof. Dr. Venera Tomaselli
E-Mail Website
Guest Editor
Department of Political and Social Sciences, University of Catania, 95124 Catania, Italy
Interests: medical statistics; biostatistics; data analysis; big data; demography

Special Issue Information

Dear Colleagues,

We are editing the Special Issue “A Public Health View on COVID-19: Epidemiology, Implications, and Responses” of the International Journal of Environmental Research and Public Health (IF 2.849).

The novel coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to the society and the health sector all over the globe. As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread internationally, public health concerns have been raising.

As known, public health moves from the knowledge about diseases to the identification of the most appropriate actions to contain them. The first important efforts include all the initiatives tending to reveal the true disease burden, also through active surveillance and population-based seroprevalence surveys. The implementation of public health measures and policies depends on the real extent of COVID-19—also in terms of asymptomatic patients, immune people, and individuals who remain susceptible to the virus. Nowadays, the road to COVID-19 control is still long. With this Special Issue, we want to identify and collect important but still poorly known pieces of the research on SARS-CoV-2 and COVID-19, spanning from epidemiology to public health implications and responses. Possible themes are: advances on the geospatial distribution of the disease; the impact of COVID-19 measured by mortality, morbidity, cost, and other valuable indicators; possible control measures of the disease; the evaluation of national, regional, and local responses to the COVID-19 outbreak; all other public health actions to minimize the impact of COVID-19.

We look forward to receiving your contributions, both qualitative and quantitative, on COVID-19 research.

Prof. Dr. Riccardo Polosa
Dr. Pietro Ferrara
Dr. Luciana Albano
Prof. Dr. Venera Tomaselli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Coronavirus
  • COVID-19
  • Disease burden
  • Disease control
  • Disease impact
  • Epidemiology
  • Health response
  • Preparedness
  • SARS-CoV-2
  • Surveillance system

Published Papers (26 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review, Other

Article
Reopening International Borders without Quarantine: Contact Tracing Integrated Policy against COVID-19
Int. J. Environ. Res. Public Health 2021, 18(14), 7494; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18147494 - 14 Jul 2021
Viewed by 514
Abstract
With the COVID-19 vaccination widely implemented in most countries, propelled by the need to revive the tourism economy, there is a growing prospect for relieving the social distancing regulation and reopening borders in tourism-oriented countries and regions. This need incentivizes stakeholders to develop [...] Read more.
With the COVID-19 vaccination widely implemented in most countries, propelled by the need to revive the tourism economy, there is a growing prospect for relieving the social distancing regulation and reopening borders in tourism-oriented countries and regions. This need incentivizes stakeholders to develop border control strategies that fully evaluate health risks if mandatory quarantines are lifted. In this study, we have employed a computational approach to investigate the contact tracing integrated policy in different border-reopening scenarios in Hong Kong, China. Explicitly, by reconstructing the COVID-19 transmission from historical data, specific scenarios with joint effects of digital contact tracing and other concurrent measures (i.e., controlling arrival population and community nonpharmacological interventions) are applied to forecast the future development of the pandemic. Built on a modified SEIR epidemic model with a 30% vaccination coverage, the results suggest that scenarios with digital contact tracing and quick isolation intervention can reduce the infectious population by 92.11% compared to those without contact tracing. By further restricting the inbound population with a 10,000 daily quota and applying moderate-to-strong community nonpharmacological interventions (NPIs), the average daily confirmed cases in the forecast period of 60 days can be well controlled at around 9 per day (95% CI: 7–12). Two main policy recommendations are drawn from the study. First, digital contact tracing would be an effective countermeasure for reducing local virus spread, especially when it is applied along with a moderate level of vaccination coverage. Second, implementing a daily quota on inbound travelers and restrictive community NPIs would further keep the local infection under control. This study offers scientific evidence and prospective guidance for developing and instituting plans to lift mandatory border control policies in preparing for the global economic recovery. Full article
Show Figures

Figure 1

Article
COVID-19 Scientific Facts vs. Conspiracy Theories: Is Science Failing to Pass Its Message?
Int. J. Environ. Res. Public Health 2021, 18(12), 6343; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18126343 - 11 Jun 2021
Viewed by 3187
Abstract
Science may be failing to convince a significant number of people about COVID-19 scientific facts and needed public health measures. Individual and social factors are behind believing conspiracy theories. Adults (N = 1001) were asked to rate their beliefs in various conspiracy theories [...] Read more.
Science may be failing to convince a significant number of people about COVID-19 scientific facts and needed public health measures. Individual and social factors are behind believing conspiracy theories. Adults (N = 1001) were asked to rate their beliefs in various conspiracy theories circulating in social media, rate their psychological distress relating to COVID-19, rate their trust in science to solve COVID-19 problems, and rate their willingness to adhere to measures regarding social distancing and quarantine. The findings showed conspiracy theories are widely believed and related to lower age, lower education, living in less densely populated areas, and lower income. Stronger conspiracy theory beliefs predicted science mistrust and unwillingness to adhere to public health measures. Psychological state was a strong predictor of conspiracy beliefs. Recommendations, stemming from the findings, for reducing such beliefs and better serving public health are discussed. Full article
Article
Associations of Sociodemographic Factors and Health Behaviors with the Emotional Well-Being of Adolescents during the COVID-19 Pandemic in Brazil
Int. J. Environ. Res. Public Health 2021, 18(11), 6160; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18116160 - 07 Jun 2021
Cited by 2 | Viewed by 800
Abstract
This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. [...] Read more.
This cross-sectional study utilizes data from a nationwide web-based survey aimed to identify the factors affecting the emotional well-being of Brazilian adolescents aged 12–17 during the period of school closures and confinement. Data collection took place from 27 June to 17 September 2020. We used the “virtual snowball” sampling method, and students from private and public schools were included. A total of 9470 adolescents were analyzed. A hierarchical logistic regression model was used to find the factors associated with reporting at least two of three self-reported problems—sadness, irritability, and sleep problems. The main proximal factor was loneliness (AdjOR = 8.12 p < 0.001). Problems related to school closures also played an important role. Regular intake of fruits and vegetables, as well as physical activity, demonstrated a positive influence on emotional well-being, while excessive screen time (AdjOR = 2.05, p < 0.001) and alcohol consumption negatively affected outcomes (AdjOR = 1.73, p < 0.001). As for distal variables, less affluent adolescents were the most affected, and males reported fewer emotional problems than females. Uncertainty regarding the disease in a context of socioeconomic vulnerability, together with rises in unhealthy behaviors and isolation from their immediate social circles, have negatively affected adolescents’ emotional status throughout the COVID-19 pandemic. Full article
Article
Incidence of Reported Flu-Like Syndrome Cases in Brazilian Health Care Workers in 2020 (March to June)
Int. J. Environ. Res. Public Health 2021, 18(11), 5952; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18115952 - 01 Jun 2021
Viewed by 760
Abstract
Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, [...] Read more.
Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, FS corresponds to a suspected case of COVID-19. The manuscript analyzed cases of FS in five Brazilian states, estimating the incidence rates of cases of FS and clinical and epidemiological characteristics. Registered cases (March to June 2020) totaled about 1,100,000 cases of FS. HCWs represented 17% of the registers, whose incidence was 20.41/100 vs. 2.15/100 in the GC. FS cases in HCWs concentrated the highest percentages in the age group of 30 to 49 years (65.15%) and among the nursing staff (46.86%). This study was the first interstate evaluation in Brazil to estimate suspected cases of FS by COVID-19 in HCWs. In order to control the spread of viral respiratory infections in HCWs, including COVID-19, it is necessary to review the management of health information to identify who they are, how many they are, and to what situations these workers are most frequently exposed, as well as in what professions they have. This information can guide specific, practical, and far-reaching actions. Full article
Show Figures

Figure 1

Article
Exploring the Impact of COVID-19 Response on Population Health in Saudi Arabia: Results from the “Sharik” Health Indicators Surveillance System during 2020
Int. J. Environ. Res. Public Health 2021, 18(10), 5291; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105291 - 16 May 2021
Viewed by 163709
Abstract
Background: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. Objective: To explore the prevalence of some behavioral health risk [...] Read more.
Background: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. Objective: To explore the prevalence of some behavioral health risk factors, intermediate risk factors, and chronic diseases at different timepoints during 2020 using the data available from a currently used surveillance system in Saudi Arabia. Methods: This study undertook a secondary analysis of data from the Sharik Health Indicators Surveillance System (SHISS). The SHISS employs short cross-sectional phone interviews, conducted in all 13 administrative regions of Saudi Arabia on a quarterly basis. Each interview lasts approximately 4 min and is conducted by a trained data collector. The SHISS collects demographic data, as well as data on the major behavioral and intermediate chronic disease risk factors and the major chronic diseases, including diabetes, heart disease, stroke, cancer, and chronic respiratory diseases. Results: Of the 44,782 potential participants contacted in 2020, 30,134 completed the interview, with a response rate of 67.29%. Out of the total participants, 51.2% were female. The mean age was 36.5. The behavioral risk factors in this period exhibited significant changes compared to those in the first quarter (Q1) of 2020, when there were no significant restrictions on daily activities. These significant changes are related to reductions in fruit and vegetable intake (adjusted odds ratio (AOR), 0.23) and physical activity (AOR, 0.483), and a significant increase in e-cigarette use (AOR 1.531). In terms of the intermediate risk factors observed in the SHISS, significant increases in hypercholesterolemia (AOR, 1.225) and hypertension (AOR, 1.190) were observed. Finally, heart disease (AOR, 1.279) and diabetes (AOR, 1.138) displayed significant increases compared to Q1. Conclusions: This study shows some evidence of the impact of responses to COVID-19 on the health of the population in Saudi Arabia. Significant reductions in fruit and vegetable intake and physical activity, and significant increases in e-cigarette use, hypertension, and hypercholesterolemia may increase the burden of chronic diseases in Saudi Arabia in the near future. Thus, continuous monitoring of the health risk factors within the population, and early interventions, are recommended to prevent future increases in chronic diseases. Full article
Show Figures

Figure 1

Article
A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients
Int. J. Environ. Res. Public Health 2021, 18(10), 5144; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105144 - 12 May 2021
Cited by 1 | Viewed by 650
Abstract
Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference [...] Read more.
Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital. Full article
Show Figures

Figure 1

Communication
COVID-19 Severity and Neonatal BCG Vaccination among Young Population in Taiwan
Int. J. Environ. Res. Public Health 2021, 18(8), 4303; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084303 - 18 Apr 2021
Viewed by 852
Abstract
Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established [...] Read more.
Background: Data have not been reported to explore the relation between COVID-19 severity and BCG vaccination status at the individual patient level. Methods: Taiwan has a nationwide neonatal BCG vaccination program that was launched in 1965. The Taiwan Centers for Disease Control established a web-based National Immunization Information System (NISS) in 2003 and included all citizens’ BCG vaccination records in NISS for those born after 1985. We identified COVID-19 Taiwanese patients born after 1985 between 21 January and 19 March 2021. Study participants were further classified into ages 4–24 years (birth year 1996–2016) and 25–33 years (birth year 1986–1995). We described their clinical syndrome defined by the World Health Organization and examined the relation between the COVID-19 severity and BCG vaccination status. Results: In the 4–24 age group, among 138 BCG vaccinated individuals, 80.4% were asymptomatic or had mild disease, while 17.4% had moderate disease, 1.5% had severe disease, and 0.7% had acute respiratory distress syndrome but none of them died. In contrast, all 6 BCG unvaccinated individuals in this age group experienced mild illness. In the 25–33 age group, moderate disease occurred in 14.2% and severe disease occurred in 0.9% of the 106 patients without neonatal BCG vaccination records, as compared to 19.2% had moderate disease and none had severe or critical disease of the 78 patients with neonatal BCG vaccination records. Conclusions: Our finding indicated that BCG immunization might not relate to COVID-19 severity in the young population. Full article
Article
Fine-Scale Space-Time Cluster Detection of COVID-19 in Mainland China Using Retrospective Analysis
Int. J. Environ. Res. Public Health 2021, 18(7), 3583; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073583 - 30 Mar 2021
Viewed by 685
Abstract
Exploring spatio-temporal patterns of disease incidence can help to identify areas of significantly elevated or decreased risk, providing potential etiologic clues. The study uses the retrospective analysis of space-time scan statistic to detect the clusters of COVID-19 in mainland China with a different [...] Read more.
Exploring spatio-temporal patterns of disease incidence can help to identify areas of significantly elevated or decreased risk, providing potential etiologic clues. The study uses the retrospective analysis of space-time scan statistic to detect the clusters of COVID-19 in mainland China with a different maximum clustering radius at the family-level based on case dates of onset. The results show that the detected clusters vary with the clustering radius. Forty-three space-time clusters were detected with a maximum clustering radius of 100 km and 88 clusters with a maximum clustering radius of 10 km from 2 December 2019 to 20 June 2020. Using a smaller clustering radius may identify finer clusters. Hubei has the most clusters regardless of scale. In addition, most of the clusters were generated in February. That indicates China’s COVID-19 epidemic prevention and control strategy is effective, and they have successfully prevented the virus from spreading from Hubei to other provinces over time. Well-developed provinces or cities, which have larger populations and developed transportation networks, are more likely to generate space-time clusters. The analysis based on the data of cases from onset may detect the start times of clusters seven days earlier than similar research based on diagnosis dates. Our analysis of space-time clustering based on the data of cases on the family-level can be reproduced in other countries that are still seriously affected by the epidemic such as the USA, India, and Brazil, thus providing them with more precise signals of clustering. Full article
Show Figures

Figure 1

Article
Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients
Int. J. Environ. Res. Public Health 2021, 18(7), 3491; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18073491 - 27 Mar 2021
Cited by 5 | Viewed by 1048
Abstract
The coronavirus disease 2019 (COVID-19) pandemic poses a worldwide healthcare challenge that needs an efficient response. Unfortunately, to date there is no highly effective treatment, so a deep understanding of COVID-19 risk factors could be an important step in treating the disease. Vitamin [...] Read more.
The coronavirus disease 2019 (COVID-19) pandemic poses a worldwide healthcare challenge that needs an efficient response. Unfortunately, to date there is no highly effective treatment, so a deep understanding of COVID-19 risk factors could be an important step in treating the disease. Vitamin D affects the immune system in many different ways, and other authors already found that COVID-19 patients have low levels of vitamin D. In our retrospective study, we evaluated the vitamin D status at the time of hospital admission in 50 COVID-19 patients in Sicily, which is the southernmost region of Italy, and compared them with 100 control subjects matched for age and sex. Our data showed markedly low levels of vitamin D in patients with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but no association was found with inflammation markers or clinical severity. Vitamin D levels were reduced at the time of hospital admission in Sicilian SARS-CoV-2-positive patients, but it is not clear whether this condition has an impact on the clinical course of COVID-19. Full article
Show Figures

Figure 1

Article
Investigating the Self-Reported Health Status of Domestic and Overseas Chinese Populations during the COVID-19 Pandemic
Int. J. Environ. Res. Public Health 2021, 18(6), 3043; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18063043 - 16 Mar 2021
Viewed by 623
Abstract
To control the spread of COVID-19, governments in different countries and regions implemented various types of lockdown and outdoor restrictions. The research aimed to describe and compare the health status of Chinese people both domestically and abroad in this global health crisis. An [...] Read more.
To control the spread of COVID-19, governments in different countries and regions implemented various types of lockdown and outdoor restrictions. The research aimed to describe and compare the health status of Chinese people both domestically and abroad in this global health crisis. An online questionnaire survey was distributed to Chinese mainland citizens living in Hubei (the lockdown province), outside Hubei, and those living abroad in 2020. A total of 1000 respondents were recruited and reported worse health status compared with Chinese population norms. People living in Hubei reported worse health status than those living outside Hubei but revealed better health status than overseas respondents. It was clear that the pandemic as well as strict lockdown and outdoor restriction policies affected Chinese people’s health. It is important for the Chinese government to be aware of the negative impact of such strict policies and to take measures to reduce the panic of society when implementing similar policies in the future. It also implies that governments in other countries should promote social support for those who live far from home and actively call for support for non-discriminatory attitudes toward ethnic minorities. Full article
Article
Ocular Involvement of SARS-CoV-2 in a Polish Cohort of COVID-19-Positive Patients
Int. J. Environ. Res. Public Health 2021, 18(6), 2916; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062916 - 12 Mar 2021
Cited by 2 | Viewed by 826
Abstract
The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by [...] Read more.
The coronavirus SARS-CoV-2 responsible for the current human COVID-19 pandemic has shown tropism toward different organs with variable efficiency, eyes included. The purpose of this study has been to investigate the presence of detectable SARS-CoV-2 infection in ocular swabs in patients affected by COVID-19. A consecutive series of 74 COVID-19-positive patients (age 21–89) were enrolled at two Polish COVID-19 hospitals for 4 months and were characterized by PCR for the presence of the SARS-CoV-2 genetic material in nasopharyngeal (NP) and ocular swabs, while their respiratory and ocular symptoms were noted. Almost 50% of them presented with severe/critical respiratory involvement, and some degree of eye disease. No tight correlation was observed between the presence of ocular and respiratory symptoms. Three male patients presenting with severe/critical lung disease tested positive in ocular swab, however with mild/moderate ocular symptoms. In conclusion, our study lends further support to the view that overt ocular infection by the SARS-CoV-2 virus is not such a frequent occurrence. Full article
Show Figures

Figure 1

Article
Intolerance of COVID-19-Related Uncertainty and Negative Emotions among Chinese Adolescents: A Moderated Mediation Model of Risk Perception, Social Exclusion and Perceived Efficacy
Int. J. Environ. Res. Public Health 2021, 18(6), 2864; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18062864 - 11 Mar 2021
Cited by 2 | Viewed by 988
Abstract
The uncertainty caused by the COVID-19 pandemic has exacerbated negative emotions, especially among adolescents, who feel unable to tolerate the uncertainty of the epidemic. However, the mechanism by which the intolerance of COVID-19-related uncertainty (COVID-19 IU) affects negative emotions in adolescents remains unclear. [...] Read more.
The uncertainty caused by the COVID-19 pandemic has exacerbated negative emotions, especially among adolescents, who feel unable to tolerate the uncertainty of the epidemic. However, the mechanism by which the intolerance of COVID-19-related uncertainty (COVID-19 IU) affects negative emotions in adolescents remains unclear. This study explored the underlying mechanism from COVID-19 IU to negative emotions using a moderated mediation model in adolescents. In total, 3037 teenagers completed a cross-sectional survey including measures of COVID-19 IU, risk perception, social exclusion, perceived efficacy, and negative emotions. The results showed that COVID-19 IU positively predicted negative emotions and that risk perception and social exclusion mediated this relationship. In addition, both the direct effect of COVID-19 IU on negative emotions and the mediating effect of risk perception on this relationship were moderated by perceived efficacy; in particular, COVID-19 IU had a greater impact on negative emotions among adolescents with lower levels of perceived efficacy. These findings suggest that COVID-19 IU is closely associated with negative emotions among adolescents and that effective measures should be taken to enable adolescents to improve their perceived efficacy and develop a reasonable perception of risk, help them eliminate the stigma of the disease, and strengthen their connections with society. Full article
Show Figures

Figure 1

Article
Occupational Exposure in the Lombardy Region (Italy) to SARS-CoV-2 Infection: Results from the MUSTANG–OCCUPATION–COVID-19 Study
Int. J. Environ. Res. Public Health 2021, 18(5), 2567; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052567 - 04 Mar 2021
Viewed by 1052
Abstract
Sero-epidemiological surveys are valuable attempts to estimate the circulation of SARS-CoV-2 in general or selected populations. Within this context, a prospective observational study was conducted to estimate the prevalence and persistence of SARS-CoV-2 antibodies in different categories of workers and factors associated with [...] Read more.
Sero-epidemiological surveys are valuable attempts to estimate the circulation of SARS-CoV-2 in general or selected populations. Within this context, a prospective observational study was conducted to estimate the prevalence and persistence of SARS-CoV-2 antibodies in different categories of workers and factors associated with positivity, through the detection of virus-specific immunoglobulin G and M (IgG/IgM) in serum samples. Enrollees were divided in low exposure and medium-high groups on the basis of their work activity. Antibody responders were re-contacted after 3 months for the follow-up. Of 2255 sampled workers, 4.8% tested positive for SARS-CoV-2 IgG/IgM antibodies, with 81.7% to IgG only. Workers who continued to go to their place of work, were healthcare workers, or experienced at least one COVID-19-related symptom were more likely to test positive for SARS-CoV-2 antibodies. SARS-CoV-2 antibodies prevalence was significantly higher in the medium-high risk vs. low-risk group (7.2% vs. 3.0%, p < 0.0001). At 3-month follow-up, 81.3% of subjects still had antibody response. This study provided important information of SARS-CoV-2 infection prevalence among workers in northern Italy, where the impact of COVID-19 was particularly intense. The presented surveillance data give a contribution to refine current estimates of the disease burden expected from the SARS-CoV-2. Full article
Show Figures

Figure 1

Article
Relations between Air Quality and Covid-19 Lockdown Measures in Valencia, Spain
Int. J. Environ. Res. Public Health 2021, 18(5), 2296; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052296 - 26 Feb 2021
Cited by 7 | Viewed by 1088
Abstract
The set of measures to contain the diffusion of COVID-19 instituted by the European governments gave an unparalleled opportunity to improve our understanding of the transport and industrial sectors’ contribution to urban air pollution. The purpose of this study was to assess the [...] Read more.
The set of measures to contain the diffusion of COVID-19 instituted by the European governments gave an unparalleled opportunity to improve our understanding of the transport and industrial sectors’ contribution to urban air pollution. The purpose of this study was to assess the impacts of the lockdown measures on air quality and pollutant emissions in Valencia, Spain. For this reason, we determined if there was a significant difference in the concentration levels of different particulate matter (PM) sizes, PM10, PM2.5, and NOx, NO2, NO, and O3, between the period of restrictions in 2020 and the same period in 2019. Our findings indicated that PM pollutant levels during the lockdown period were significantly different from the same period of the previous year, even if there is variability in the different local areas. The highest variations reduction in the PM10 and PM2.5 levels were observed for the València Centre, València Avd Francia, and València Pista de Silla (all of the urban traffic type) in which there was a reduction of 58%–42%, 56%–53%, and 60%–41% respectively. Moreover, consistent with recent studies, we observed a significant reduction in nitric oxide levels in all the air monitoring stations. In all seven monitoring stations, it was observed, in 2020, NOx, NO2, and NO concentrations decreased by 48.5%–49.8%–46.2%, 62.1%–67.4%–45.7%, 37.4%–35.7%–35.3%, 60.7%–67.7%–47.1%, 65.5%–65.8%–63.5%, 60.0%–64.5%–41.3%, and 60.4%–61.6%–52.5%, respectively. Lastly, overall O3 levels decreased during the lockdown period, although this phenomenon was more closely related to weather conditions. Overall, no significant differences were observed between the meteorological conditions in 2019 and 2020. Our findings suggest that further studies on the effect of human activities on air quality are needed and encourage the adoption of a holistic approach to improve urban air quality. Full article
Show Figures

Figure 1

Article
Different Responses to Stress, Health Practices, and Self-Care during COVID-19 Lockdown: A Stratified Analysis
Int. J. Environ. Res. Public Health 2021, 18(5), 2253; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052253 - 25 Feb 2021
Cited by 4 | Viewed by 1496
Abstract
The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from [...] Read more.
The aim of the present cross-sectional study was to analyze the differential impact of the first COVID-19 lockdown (3 April 2020) on stress, health practices, and self-care activities across different Hispanic countries, age range, and gender groups. One thousand and eighty-two participants from Spain, Chile, Colombia, and Ecuador took part in this study. Irrespective of the country, and controlling for income level, young people, especially females, suffered a greater level of stress, perceived the situation as more severe, showed less adherence to health guidelines, and reported lower levels of health consciousness, in comparison to their male peers and older groups. However, in the case of self-care, it seems that older and female groups are generally more involved in self-care activities and adopt more healthy daily routines. These results are mostly similar between Colombia, Ecuador, and Spain. However, Chile showed some different tendencies, as males reported higher levels of healthy daily routines and better adherence to health guidelines compared to females and people over the age of 60. Differences between countries, genders, and age ranges should be considered in order to improve health recommendations and adherence to guidelines. Moreover, developing community action and intersectoral strategies with a gender-based approach could help to reduce health inequalities and increase the success of people’s adherence to health guidelines and self-care-promoting interventions. Future studies should be addressed to explore the possible causations of such differences in more cultural-distant samples and at later stages of the current outbreak. Full article
Show Figures

Figure 1

Article
Socioeconomic Inequalities in COVID-19 in a European Urban Area: Two Waves, Two Patterns
Int. J. Environ. Res. Public Health 2021, 18(3), 1256; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031256 - 30 Jan 2021
Cited by 6 | Viewed by 3791
Abstract
Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by [...] Read more.
Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41–1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44–1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe. Full article
Show Figures

Figure 1

Article
Estimating Unreported COVID-19 Cases with a Time-Varying SIR Regression Model
Int. J. Environ. Res. Public Health 2021, 18(3), 1090; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031090 - 26 Jan 2021
Cited by 1 | Viewed by 960
Abstract
Background: Potential unreported infection might impair and mislead policymaking for COVID-19, and the contemporary spread of COVID-19 varies in different counties of the United States. It is necessary to estimate the cases that might be underestimated based on county-level data, to take better [...] Read more.
Background: Potential unreported infection might impair and mislead policymaking for COVID-19, and the contemporary spread of COVID-19 varies in different counties of the United States. It is necessary to estimate the cases that might be underestimated based on county-level data, to take better countermeasures against COVID-19. We suggested taking time-varying Susceptible-Infected-Recovered (SIR) models with unreported infection rates (UIR) to estimate factual COVID-19 cases in the United States. Methods: Both the SIR model integrated with unreported infection rates (SIRu) of fixed-time effect and SIRu with time-varying parameters (tvSIRu) were applied to estimate and compare the values of transmission rate (TR), UIR, and infection fatality rate (IFR) based on US county-level COVID-19 data. Results: Based on the US county-level COVID-19 data from 22 January (T1) to 20 August (T212) in 2020, SIRu was first tested and verified by Ordinary Least Squares (OLS) regression. Further regression of SIRu at the county-level showed that the average values of TR, UIR, and IFR were 0.034%, 19.5%, and 0.51% respectively. The ranges of TR, UIR, and IFR for all states ranged from 0.007–0.157 (mean = 0.048), 7.31–185.6 (mean = 38.89), and 0.04–2.22% (mean = 0.22%). Among the time-varying TR equations, the power function showed better fitness, which indicated a decline in TR decreasing from 227.58 (T1) to 0.022 (T212). The general equation of tvSIRu showed that both the UIR and IFR were gradually increasing, wherein, the estimated value of UIR was 9.1 (95%CI 5.7–14.0) and IFR was 0.70% (95%CI 0.52–0.95%) at T212. Interpretation: Despite the declining trend in TR and IFR, the UIR of COVID-19 in the United States is still on the rise, which, it was assumed would decrease with sufficient tests or improved countersues. The US medical system might be largely affected by severe cases amidst a rapid spread of COVID-19. Full article
Show Figures

Figure 1

Article
Reduction of Multidrug-Resistant (MDR) Bacterial Infections during the COVID-19 Pandemic: A Retrospective Study
Int. J. Environ. Res. Public Health 2021, 18(3), 1003; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18031003 - 23 Jan 2021
Cited by 4 | Viewed by 1383
Abstract
Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case–control study to identify if the incidence of [...] Read more.
Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case–control study to identify if the incidence of MDR bacterial infections while using pandemic-related preventive measures is lower than in previous years. From 2017 to 2020, we monitored hospital discharges over a four-month period (P #) (1 March to 30 June) in St. Andrea Hospital, Rome. In total, we reported 1617 discharges. Pearson’s chi-squared test was used to identify significant differences. A value of p ≤ 0.05 was considered statistically significant. A significant reduction in the incidence of total MDR bacterial infections was observed during the pandemic compared to in prepandemic years (p < 0.05). We also found a significantly higher incidence of MDR bacterial infections in COVID-19 departments compared with other medical departments (29% and 19%, respectively), with extended-spectrum β-lactamase Klebsiella pneumoniae as the pathogens presenting the highest increase. This study demonstrates that maintaining a high level of preventive measures could help tackle an important health problem such as that of the spread of MDR bacteria. Full article
Show Figures

Figure 1

Article
Keeping Low Reproductive Number Despite the Rebound Population Mobility in Korea, a Country Never under Lockdown during the COVID-19 Pandemic
Int. J. Environ. Res. Public Health 2020, 17(24), 9551; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249551 - 20 Dec 2020
Cited by 2 | Viewed by 896
Abstract
Nonpharmaceutical intervention has been one of the most important strategies to prevent the spread of the SARS-CoV-2 in the communities during the COVID-19 pandemic. Korea has a unique experience that we had the first large outbreak during the early pandemic and could flatten [...] Read more.
Nonpharmaceutical intervention has been one of the most important strategies to prevent the spread of the SARS-CoV-2 in the communities during the COVID-19 pandemic. Korea has a unique experience that we had the first large outbreak during the early pandemic and could flatten the epidemic curve without lockdown. In this study, the effective reproductive numbers were calculated for the entire nation and Seoul (the capital city) Metropolitan Area from February 16–15 July, where 60% of the population reside. We compared the changes in population mobility data and reproductive number trends according to the changes in the government’s nonpharmaceutical intervention strategy. The total daily mobility decreased when Korea had the first wave of a large outbreak in February–March 2020, which was mainly caused by the decrease of daily noncommuting mobility. However, daily commuting mobility from 16 February to 30 June 2020 was maintained at a similar level since there was no national lockdown for workers who commute between home and work. During the first half-year of 2020, Korea could control the outbreak to a manageable level without a significant decrease in daily public mobility. However, it may be only possible when the public follows personal hygiene principles and social distancing without crisis fatigue or reduced compliance. Full article
Show Figures

Figure 1

Article
Analysis of COVID-19 Prevention and Control Effects Based on the SEITRD Dynamic Model and Wuhan Epidemic Statistics
Int. J. Environ. Res. Public Health 2020, 17(24), 9309; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249309 - 12 Dec 2020
Viewed by 707
Abstract
Since December 2019, millions of people worldwide have been diagnosed with COVID-19, which has caused enormous losses. Given that there are currently no effective treatment or prevention drugs, most countries and regions mainly rely on quarantine and travel restrictions to prevent the spread [...] Read more.
Since December 2019, millions of people worldwide have been diagnosed with COVID-19, which has caused enormous losses. Given that there are currently no effective treatment or prevention drugs, most countries and regions mainly rely on quarantine and travel restrictions to prevent the spread of the epidemic. How to find proper prevention and treatment methods has been a hot topic of discussion. The key to the problem is to understand when these intervention measures are the best strategies for disease control and how they might affect disease dynamics. In this paper, we build a transmission dynamic model in combination with the transmission characteristics of COVID-19. We thoroughly study the dynamical behavior of the model and analyze how to determine the relevant parameters, and how the parameters influence the transmission process. Furthermore, we subsequently compare the impact of different control strategies on the epidemic, the variables include intervention time, control duration, control intensity, and other model parameters. Finally, we can find a better control method by comparing the results under different schemes and choose the proper preventive control strategy according to the actual epidemic stage and control objectives. Full article
Show Figures

Figure 1

Review

Jump to: Research, Other

Review
Air Pollution and COVID-19: A Possible Dangerous Synergy for Male Fertility
Int. J. Environ. Res. Public Health 2021, 18(13), 6846; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136846 - 25 Jun 2021
Viewed by 689
Abstract
Several studies indicate that semen quality has strongly declined in the last decades worldwide. Air pollution represents a significant co-factor with the COVID-19 impact and has negative effects on the male reproductive system, through pro-oxidant, inflammatory and immune-dysregulating mechanisms. It has recently been [...] Read more.
Several studies indicate that semen quality has strongly declined in the last decades worldwide. Air pollution represents a significant co-factor with the COVID-19 impact and has negative effects on the male reproductive system, through pro-oxidant, inflammatory and immune-dysregulating mechanisms. It has recently been reported that chronic exposure to PM2.5 causes overexpression of the alveolar ACE2 receptor, the entry route of SARS-CoV-2 into the organism shared by the lungs and testis where expression is highest in the body. In the testis, the ACE2/Ang-(1–7)/MasR pathway plays an important role in the regulation of spermatogenesis and an indirect mechanism of testicular damage could be due to the blockade of the ACE2 receptor by SARS-CoV-2. This prevents the conversion of specific angiotensins, and their excess causes inflammation with the overproduction of cytokines. PM2.5-induced overexpression of the alveolar ACE2 receptor, in turn, could increase local viral load in patients exposed to pollutants, producing ACE2 receptor depletion and compromising host defenses. By presenting an overall view of epidemiological data and molecular mechanisms, this manuscript aims to interpret the possible synergistic effects of both air pollution and COVID-19 on male reproductive function, warning that the spread of SARS-CoV-2 in the fertile years may represent a significant threat to global reproductive health. All of this should be of great concern, especially for men of the age of maximum reproductive capacity, and an important topic of debate for policy makers. Altered environmental conditions, together with the direct and indirect short- and long-term effects of viral infection could cause a worsening of semen quality with important consequences for male fertility, especially in those areas with higher environmental impact. Full article
Show Figures

Figure 1

Review
COVID-19 and Recreational Skiing: Results of a Rapid Systematic Review and Possible Preventive Measures
Int. J. Environ. Res. Public Health 2021, 18(8), 4349; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18084349 - 20 Apr 2021
Cited by 1 | Viewed by 773
Abstract
COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. [...] Read more.
COVID-19 is a novel infectious disease which has rapidly spread around the globe, disrupting several aspects of public life over the past year. After numerous infection clusters emerged among travelers hosted in ski resorts in early 2020, several European countries closed ski areas. These measures were mostly upheld throughout the 2020 and 2021 winter season, generating significant economic loss for mountain communities. The aim of this rapid systematic review was to explore the association between recreational skiing and the spread of COVID-19. This review was conducted according to the WHO practical guidelines on rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, MedRxiv and Promed-mail were screened to identify relevant scientific and grey literature published since the emergence of COVID-19. Among the 11 articles included, seven focused on cases recorded during the first epidemic wave, when COVID-19 containment measures were not yet mandatory. Most infection clusters could be directly linked to public gatherings which took place without the enforcement of restrictions. There is currently no evidence to suggest an association between COVID-19 spread and recreational skiing. It may be reasonable to consider the reopening of ski areas in compliance with strict rules and preventive measures. Full article
Show Figures

Figure 1

Review
Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19)
Int. J. Environ. Res. Public Health 2021, 18(5), 2772; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18052772 - 09 Mar 2021
Cited by 8 | Viewed by 1507
Abstract
Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is [...] Read more.
Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients—MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19. Full article
Show Figures

Figure 1

Other

Jump to: Research, Review

Reply
Reply to Ialongo et al. Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on “Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491”
Int. J. Environ. Res. Public Health 2021, 18(13), 7036; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18137036 - 01 Jul 2021
Viewed by 567
Abstract
We read the comment by Ialongo et al. [...] Full article
Comment
Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491
Int. J. Environ. Res. Public Health 2021, 18(13), 6793; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18136793 - 24 Jun 2021
Cited by 1 | Viewed by 495
Abstract
We read with great interest the paper by Gaudio and colleagues on vitamin D and on the state of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of admission [...] Full article
Show Figures

Figure 1

Commentary
Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies
Int. J. Environ. Res. Public Health 2021, 18(4), 1437; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18041437 - 03 Feb 2021
Cited by 2 | Viewed by 2680
Abstract
We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces [...] Read more.
We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces with non-users. The fact that the respiratory flow associated with vaping is visible (as opposed to other respiratory activities) clearly delineates a safety distance of 1–2 m along the exhaled jet to prevent direct exposure. Vaping is a relatively infrequent and intermittent respiratory activity for which we infer a mean emission rate of 79.82 droplets per puff (6–200, standard deviation 74.66) comparable to mouth breathing, it adds into shared indoor spaces (home and restaurant scenarios) a 1% extra risk of indirect COVID-19 contagion with respect to a “control case” of existing unavoidable risk from continuous breathing. As a comparative reference, this added relative risk increases to 44–176% for speaking 6–24 min per hour and 260% for coughing every 2 min. Mechanical ventilation decreases absolute emission levels but keeps the same relative risks. As long as direct exposure to the visible exhaled jet is avoided, wearing of face masks effectively protects bystanders and keeps risk estimates very low. As a consequence, protection from possible COVID-19 contagion through vaping emissions does not require extra interventions besides the standard recommendations to the general population: keeping a social separation distance of 2 m and wearing of face masks. Full article
Show Figures

Figure 1

Back to TopTop