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AbstractBackgroundCoronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, has led to significant global mortality and morbidity. Until now, no treatment has proven to be effective in COVID-19. To explore whether the use of remdesivir, initially an experimental broad-spectrum antiviral, is effective in the treatment of hospitalized patients with COVID-19, we conducted a systematic review and meta-analysis of randomized, placebo-controlled trials investigating its use.MethodsA rapid search of the MEDLINE and EMBASE medical databases was conducted for randomized controlled trials. A systematic approach was used to screen, abstract, and critically appraise the studies. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was applied to rate the certainty and quality of the evidence reported per study.ResultsTwo RCTs studies were identified (n=1,299). A fixed-effects meta-analysis revealed reductions in mortality (RR=0.69, 0.49 to 0.99), time to clinical improvement (3.95 less days, from 3.86 days less to 4.05 less days), serious adverse events (RR=0.77, 0.63 to 0.94) and all adverse events (RR=0.87, 0.79 to 0.96).ConclusionIn this rapid systematic review, we present pooled evidence from the 2 included RCT studies that reveal that remdesivir has a modest yet significant reduction in mortality and significantly improves the time to recovery, as well as significantly reduced risk in adverse events and serious adverse events. It is more than likely that as an antiviral, remdesivir is not sufficient on its own and may be suitable in combination with other antivirals or treatments such as convalescent plasma. Research is ongoing to clarify and contextual these promising findings.

Background: This is the first phylodynamic study attempted on SARS-CoV-2 genomes from India to infer the current state of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) evolution using phylogenetic network and growth trends. Materials & Methods: Out of 286 retrieved whole genomes from India, 138 haplotypes were used to build a phylogenetic network. The birth–death serial model (BDSIR) package of BEAST2 was used to calculate the reproduction number of SARS-CoV-2. Population dynamics were investigated using the stamp date method as implemented in BEAST2 and BEAST 1.10.4. Results: A median-joining network revealed two ancestral clusters. A high basic reproduction number of SARS-CoV-2 was found. An exponential rise in the effective population size of Indian isolates was detected. Conclusion: The phylogenetic network reveals dual ancestry and possibility of community transmission of SARS-CoV-2 in India.

Extant theory suggests that crises such as the COVID-19 pandemic may change people's trust in others. A crisis-to-solidarity model suggests that people become more trusting, while a crisis-to-negative experience theory suggests that people lose trust, and a stability perspective predicts that social trust will largely remain unchanged. We argue that, when a crisis occurs, trust is likely to fall into distinct trajectories of change that will conform to these different perspectives, and placement into contrasting trajectories of change will be predicated on socioeconomic position. To test our argument, we use data from multiple waves of Canadian national surveys conducted from September 2019 to February 2021 and examine how two major forms of social trust-generalized trust and neighborhood trust-changed during the COVID-19 pandemic. A longitudinal latent class analysis (LLCA) shows increasing, decreasing, and stable trajectories of trust, which conform to each of the proposed patterns. We further show that individuals' baseline socioeconomic position is a strong indicator of the placement in these trajectories. Both forms of trust increased among individuals with higher socioeconomic positions while decreased among individuals with lower socioeconomic positions. This research contributes to the literature on the social context of trust by reconciling contrasting views of the consequences of crises for trust, and also in showing that the segmentation of changes in trust are proscribed by structures of social stratification.

Abstract Recent decades have witnessed a steady increase in efforts from a range of actors to facilitate and support meaningful and effective engagement with coastal communities and stakeholders. Indeed, this move towards improved participatory approaches are increasingly framed as being integral to successful and sustainable management of coastal resources and spaces, including in the context of climate adaptation The effectiveness of the processes, structures and frameworks underpinning coastal community engagement has always been subject to external and internal drivers; however, the global threat posed by COVID-19 presented, and continues to present, an unexpected shift in approach, and the need for rapid adaptation by those of us working within these spheres. Using the Coastal Communities Adapting Together (CCAT) project as a case study, we explore how engagement with coastal communities and stakeholders in the project areas of Fingal, Ireland, and Pembrokeshire, Wales, has been impacted and forced to adapt as a result of COVID-19. Through a qualitative data collection process, we explore how project teams across different scales have rapidly adapted their models of community and stakeholder engagement, identify successes and failures, and explore challenges that have been faced. Finally, we consider if the legacy of COVID-19 has provided an opportunity for coastal community engagement approaches being used across the globe to become more diverse, adapting to new technologies and increasing accessibility and effectiveness. Insights identified as fundamental to successful adaptation and enhancing resilience include: a rapid response to change, adoption of a diversity of techniques, broadened participation and supported social learning and knowledge exchange.

The COVID-19 pandemic escalated in almost all parts of the world over a very short period of time. The speed of the spread was determined by the degree of mobility of the population, while the risk of severe illness or death depended on the population?s demographic characteristics, population health status, and the capacity of the health system to treat patients. This paper aims to assess spatio-temporal patterns of patients with COVID-19 in Serbia at the early stage and whether these patterns are linked to valid public health measures that were enforced during this period. The study adopted the local Moran?s index to identify the spatial grouping of the number of infected at a municipality level and joinpoint regression analysis to identify whether and when statistically significant changes occurred to the number of infected by gender and age groups, and to the number of deaths in the entire population. The results show the polarisation of the spatial grouping of the number of infected. Considering the change in the trend in the number of infected between genders, no significant difference was noticeable. When the age-gender categories of infected were examined, the differences became more significant. In addition, changes in the trend were associated with the tightening or loosening of public health measures.

In a prospective study, we sought to determine acceptability of linkage of administrative and clinical trial data among Canadian patients and Research Ethics Boards (REBs). The goal is to develop a more harmonized approach to data, with potential to improve clinical trial conduct through enhanced data quality collected at reduced cost and inconvenience for patients. On completion of the original LY.12 randomized clinical trial in lymphoma (NCT00078949), participants were invited to enrol in the Long-term Innovative Follow-up Extension (LIFE) component. Those consenting to do so provided comprehensive identifying information to facilitate linkage with their administrative data. We prospectively designed a global assessment of this innovative approach to clinical trial follow-up including rates of REB approval and patient consent. The pre-specified benchmark for patient acceptability was 80%. Of 16 REBs who reviewed the research protocol, 14 (89%) provided approval; two in Quebec declined due to small patient numbers. Of 140 patients invited to participate, 115 (82%, 95% CI 76 to 88%) from across 9 Canadian provinces provided consent and their full name, date of birth, health insurance number and postal code to facilitate linkage with their administrative data for long-term follow-up. Linkage of clinical trial and administrative data is feasible and acceptable. Further collaborative work including many stakeholders is required to develop an optimized secure approach to research. A more coordinated national approach to health data could facilitate more rapid testing and identification of new effective treatments across multiple jurisdictions and diseases from diabetes to COVID-19.

Abstract Background The COVID-19 pandemic and pandemic response created novel challenges for abortion services. Canada was uniquely positioned to transition to telemedicine because internationally common restrictions on abortion medication were removed before the pandemic. Objective We sought to characterize the experiences of abortion health care professionals in Canada during the COVID-19 pandemic and the impact of the pandemic response on abortion services. Methods We conducted a sequential mixed methods study between July 2020 and January 2021. We invited physicians, nurse practitioners and administrators to participate in a cross-sectional survey containing an open-ended question about the impact of the pandemic response on abortion care. We employed an inductive codebook thematic analysis, which informed the development of a second, primarily quantitative survey. Results Our initial survey had 307 respondents and our second had 78. Fifty-three percent were family physicians. Our first survey found respondents considered abortion access essential. We identified three key topicss: access to abortion care was often maintained despite pandemic-related challenges (e.g. difficulty obtaining tests, additional costs); change of practice to low-touch medication abortion care and provider perceptions of patient experience, including shifting demand, telemedicine acceptability and increased rural access. The second survey indicated uptake of telemedicine medication abortion among 89% of participants except in Quebec, where regulations meant procedures were nearly exclusively surgical. Restrictions did not delay care according to 76% of participants. Conclusions Canadian health care professionals report their facilities deemed abortion an essential service. Provinces and territories, except Quebec, described a robust pandemic transition to telemedicine to ensure access to services. Podcast An accompanying podcast is available in the Supplementary Data, in which the authors Dr Madeleine Ennis and Kate Wahl discuss their research on how family planning care and access to abortion services have changed during the COVID-19 pandemic. Lay Summary Access to abortion care was challenged by the response to COVID-19. Canada had fewer restrictions on medical abortion than many other countries when the pandemic began. The goal of this study was to describe the experiences of health care practitioners providing abortion in Canada and the impact of the pandemic and the pandemic response measures on abortion services. We conducted two surveys of physicians, nurse practitioners and administrators between July 2020 and January 2021. Most of the health care practitioners who participated reported that medical and surgical abortion care were essential and that, except in the province of Quebec, there was a rapid transition to virtual telemedicine care for first trimester abortions. Several practitioners said that virtual care made abortion more accessible. Other practitioners reported that it was challenging to order certain tests, access operating room facilities or make referrals for late second trimester cases. Practitioners felt that patients had strong fears about COVID-19 exposure and reported that limited contraception access was increasingly a reason for seeking abortion care. The results of the study suggested that abortion was considered essential and that the pandemic instigated a transition to virtual care in all provinces and territories except Quebec.

Background Health campaign interventions, particularly those tailored to the target audience’s needs and preferences, can cost-effectively change people’s attitudes and behaviors towards better health decision-making. However, there is limited research on how to best tailor seasonal influenza vaccination campaigns for young adults. Vaccination is vital in protecting young adults and their social circles (vulnerable populations like older adults) from the influenza virus and critical in shaping these emerging adults’ vaccination habits in the long run. However, amid the prevalence of easily-accessible, attention-grabbing, and often malicious false and misinformation (e.g., COVID-19 vaccine conspiracy theories), it may be more challenging to develop vaccination messages that resonate with young adults well enough to attract their attention. Therefore, to bridge the research gap, this study examines young adults’ preferences for seasonal influenza vaccination campaigns to inform effective intervention design and development. Methods Qualitative survey questions were developed to gauge young adults’ preferences for seasonal influenza vaccination campaigns. A total of 545 young adults (73.9% female, Mage ​= ​19.89, SD ​= ​1.44) from a large University offered complete answers to a cross-sectional online survey. Braun and Clarke’s thematic analysis procedures were adopted to guide the data analysis process. Results Thematic analysis revealed that young adults prefer seasonal influenza vaccination campaigns that rely on (1) quality and balanced information from (2) credible information sources, positioned in the (3) relevant health contexts, (4) emphasize actionable messages, and incorporate (5) persuasive campaign design. Interestingly, while many participants underscored the importance of fear-appeal messages in persuading them to take health actions, some young adults also suggested avoiding fear campaigns due to discomfort. Conclusions Insights of the study can inform seasonal influenza vaccination design and development, and have the potential to shed light on vaccination messaging in other vaccine contexts, such as COVID-19 vaccines. Results also underscore the need for health experts and government officials to adopt a more nuanced approach when selecting persuasive campaign appeals. While some young adults may resonate well with fear appeals, others may not. Future research could examine the underlying mechanisms that drive young adults’ preference for vaccination campaign intervention to enrich the literature further. Highlights • Vaccination is vital in protecting young adults and their social circles from the influenza virus and shaping their vaccination habits in the long run. However, vaccination rates in young adults are suboptimal. • This study aims to investigate young adults’ preferences for seasonal influenza vaccination campaigns to inform effective intervention design and development (e.g., COVID-19 vaccination). • Thematic analysis revealed that young adults prefer vaccination campaigns that rely on 1) quality and balanced information from 2) credible information sources, positioned in the 3) relevant health contexts, 4) emphasize actionable messages, and incorporate 5) persuasive campaign design. • Interestingly, while many young adults underscored the importance of fear-appeal messages in persuading them to take health actions, some young adults also suggested avoiding fear campaigns due to discomfort.

Background: The COVID-19 pandemic is having considerable impacts on population-level mental health, with research illustrating an increased prevalence in suicidal thoughts due to pandemic stressors. While the drivers of suicidal thoughts amid the pandemic are poorly understood, qualitative research holds great potential for expanding upon projections from pre-pandemic work and nuancing emerging epidemiological data. Despite calls for qualitative inquiry, there is a paucity of qualitative research examining experiences of suicidality related to COVID-19. The use of publicly available data from social media offers timely and pertinent information into ongoing pandemic-related mental health, including individual experiences of suicidal thoughts.Objective: To examine how Reddit users within the r/COVID19_support community describe their experiences of suicidal thoughts amid the COVID-19 pandemic.Methods: This study draws on online posts from within r/COVID19_support that describe users' suicidal thoughts during and related to the COVID-19 pandemic. Data were collected from creation of this subreddit on February 12, 2020 until December 31, 2020. A qualitative thematic analysis was conducted to generate themes reflecting users' experiences of suicidal thoughts.Results: A total of 83 posts from 57 users were included in the analysis. Posts described a range of users' lived and living experiences of suicidal thoughts related to the pandemic, including deterioration in mental health and complex emotions associated with suicidal thinking. Reddit users situated their experiences of suicidal thoughts within various pandemic stressors: social isolation, employment and finances, virus exposure and COVID-19 illness, uncertain timeline of the pandemic, news and social media, pre-existing mental health conditions, and lack of access to mental health resources. Some users described individual coping strategies and supports used in attempt to manage suicidal thoughts, however these were recognized as insufficient for addressing the multilevel stressors of the pandemic.Conclusions: Multiple and intersecting stressors have contributed to individuals' experiences of suicidal thoughts amid the COVID-19 pandemic, requiring thoughtful and complex public health responses. While ongoing challenges exist with self-disclosure of mental health challenges on social media, Reddit and other online platforms may offer a space for users to share suicidal thoughts and discuss potential coping strategies.