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      Russo-Ukrainian war amid the COVID-19 pandemic: Global impact and containment strategy

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          Abstract

          Dear Editor, Coronavirus disease 2019 (COVID-19) pandemic caused severe damage to humankind not only by affecting the healthcare systems of many countries but all the socio-economic structures of the entire globe. As of May 4, 2022, 512 million cases of COVID-19 have been reported with a mortality of 6.23 million people (World Health Organization, https://covid19.who.int/). The epidemiology of COVID-19 in Russia, Ukraine, and refugees-hosting countries during the Russo-Ukraine war has been delineated in Table 1 . The COVID-19 pandemic has no definitive treatment other than supportive care, though a vaccine course has been developed but remains elusive. Amid the scarcity of reliable and standard therapeutic regimens, prevention approaches such as social isolation, face mask use, and aggressive hygiene are effective ways to contain the causative agent of COVID-19, i.e., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1,2]. While many countries’ serious efforts are underway to contain the COVID-19 pandemic, the Russo-Ukraine conflict has emerged as a severe threat that can change the trajectory of the pandemic. Hence, the aim of this correspondence article is to highlight the global effects of the Russo-Ukraine war during the ongoing COVID-19 pandemic. Table 1 Epidemiology of COVID-19 in Russia, Ukraine, and refugees-hosting countries. Table 1 Feb 24, 2022 March 24, 2022 Persons fully vaccinated per 100 population Vaccinated % March 28, 2022 Cases Deaths Cases Deaths Russia 132998 762 25387 418 49.603 79,914,874 (54.77%) Ukraine 25789 276 3855 55 34.65 15,729,617 (36.19%) Poland 18282 341 8988 146 58.85 22,582,308 (59.75%) Romania 11477 119 4521 40 41.88 8,162,071 (42.67%) Hungary 5512 102 2651 35 62.72 6,401,980 (66.45%) Belarus 6230 15 1647 10 58.9 5,801,653 (61.44%) Slovakia 15183 24 9649 24 50.69 2,819,636 (51.74%) Moldova 1069 14 431 7 25.98 1,081,073 (26.87%) Ritchie, Hannah; Mathieu, Edouard; Rodés-Guirao, Lucas; Appel, Cameron; Giattino, Charlie; Ortiz-Ospina, Esteban; Hasell, Joe; Macdonald, Bobbie; Beltekian, Diana; Dattani, Saloni; Roser, Max (2020–2021). Coronavirus Pandemic 2019 (COVID-19). Our World in Data. Retrieved March 28, 2022 (World Health Organization, https://covid19.who.int/). Several geopolitical, economic, infrastructural, and health consequences have been associated with the Russo-Ukraine war. Furthermore, the implications of this war, notably in terms of healthcare services both within and beyond Ukraine, will last long even after the physical battle has ended [3,4]. It is essential to notice that the Ukrainian healthcare system is already under extreme strain as a result of the rising number of casualties and negative repercussions on the socio-economic system. Furthermore, the scarcity of water resources and sanitation infrastructure, low vaccine coverage, overcrowding, and lack of access to primary medical treatment are all expected to exacerbate these issues. It is important to remember that all these issues are most likely to increase the other infectious diseases such as measles, typhoid, malaria, polio, tuberculosis (TB), human immunodeficiency virus (HIV), and also gastrointestinal disorders of parasitic origin. The rapid spread of these diseases has been associated with overcrowding in refugee containment camps. Furthermore, the interruption in the immunization programs in war regions can play an essential role in the spread of other infectious diseases [4]. Additionally, a considerable increase in non-communicable diseases, notably cardiovascular disease, diabetes, and cancer mortality will occur from further disruption of medical supply chains and health services. The absence of access to obstetric care will also raise maternal and newborn morbidity and mortality [5]. Till now, more than six million Ukrainian individuals escape from the fires of the war in their country, which constitutes the fastest-growing refugee crisis in Europe since World War Two. Undoubtedly, the health care and well-being of the Ukrainian people are now at severe risk. UNICEF, the UN children’s agency, believes hundreds of thousands of Ukrainian refugees were youngsters. A vital question has been raised in our mind, and it needs an urgent answer; How do the hosted countries enable them to keep their health, social and emotional stability? Community organizations, such as civil society organizations, could develop programs to help them with their economic, social, educational, and health requirements, based on family and individual needs (Bergman et al. 2017 [6]). Schoolwork and college are among the concerns in their mind, and consequently, teachers in schools and physicians in clinics should adopt education of these war crisis-undergoing children resilience-building strategies (Bergman et al. 2017 [6]). Given the ongoing war in Ukraine and enormous economic penalties faced by Russia, the world economy, which has already been damaged by the COVID-19 pandemic, has been adversely affected. Nations throughout the world are experiencing significant interruptions in the supply of energy and raw materials as well as soaring costs for commodities, oil, and food, as well as one of the greatest interruptions to wheat availability in history. As Ukraine and Russia combined account for a third of worldwide wheat and barley exports and more than seventy percent of sunflower oil exports, the war might have a catastrophic effect on starvation throughout the globe. Large proportions of agricultural imports from Russia and Ukraine are consumed by conflict-affected nations and areas, such as Lebanon, the Democratic Republic of the Congo, Syria, Iraq, Afghanistan, North Africa, and West Africa. Such an invasion, according to the International Monetary Fund, could throw the world's food supply into destruction owing to increase food prices and Ukraine's failure to plant crops, such as wheat, because 70% of the country's land is devoted entirely to agriculture-the so-called breadbasket of Europe-is unable to plant crops, which include wheat [5]. In addition to food and water deprivation, there are several environmental challenges that should be considered seriously. Some of these concerns include chemical wastes, heavy metals, and radioactive materials infiltrating into natural water sources from destroyed industrial sites, water dam damage, gasoline and hydrocarbon leakage from conflict regions, weapons combustion, and leakage in underground coal mines. Ukraine, wherein Russia has been at war with the country since 2014, is facing a unique double hazard: a catastrophic reaction to conflict and a fatal contagious illness. Increased North Atlantic Treaty Alliance (NATO) integration across Ukraine's disaster response structures within the Ministries of Health, Defense, and Interior, must be augmented and increased to effectively serve biosurveillance, aid in pandemic disaster response, and bolster health security in Europe, across the NATO and Black Sea regions, to mitigate the COVID-19 global crisis [7]. Furthermore, there are critical short- and long-term deleterious repercussions on mental and physical health due to mass migrations. Depression, social withdrawal, and anxiety are just a few of the long-term psychological and physical health repercussions that will afflict subsequent civilizations [[4], [5], [7]]. To cope with the deleterious consequences of war, mental health and psychosocial services are critically needed. Additionally, Funding and research focused on populations affected by the ongoing Russia-Ukraine conflict is desperately needed for those who have fled and for those who remain to fight. Besides providing the social and educational sides, the need to vaccinate Ukraine children against COVID-19, particularly since Ukraine had had high vaccine hesitancy before the Russian invasion (Zaprutko et al. 2022 [8]). Ultimately, vaccination is still critical, and it is essential to vaccinate the maximum number of people, especially the vulnerable groups, as just a third of adult Ukrainians are completely immunized. To augment the resiliency of the Ukrainian population and to contain the associated negative repercussions of the war, worldwide interventions and public health support are required right away. Provenance and peer review Not commissioned, internally peer-reviewed. Ethical approval This article does not require any human/animal subjects to acquire such approval. Sources of funding This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author contributions Manish Dhawan: Conceptualization, Data Curation, Writing - Original Draft, Writing - review & editing. Om Prakash Choudhary: Conceptualization, Data Curation, Supervision, Writing - Original Draft, Writing - review & editing. Priyanka: Writing - Original Draft, Writing - review & editing. AbdulRahman A. Saied: Writing - Original Draft, Writing - review & editing. All authors critically reviewed and approved the final version of the manuscript. Trial registry number 1. Name of the registry: Not applicable. 2. Unique Identifying number or registration ID: Not applicable. 3. Hyperlink to your specific registration (must be publicly accessible and will be checked): Not applicable. Guarantor Om Prakash Choudhary, Assistant Professor (Senior Scale), Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl-796015, Mizoram, India. Tel: +91–9928099090; Email: dr.om.choudhary@gmail.com. Data statement The data in this correspondence article is not sensitive in nature and is accessible in the public domain. The data is therefore available and not of a confidential nature. Declaration of competing interest All authors report no conflicts of interest relevant to this article.

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          Aerosol transmission of SARS-CoV-2: The unresolved paradox

          Dear Editor The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aetiological agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic defying the geographical borders and putting the lives of billions at risk. The commonly evident symptoms include fever, altered sense of smell and/or taste, cough, sputum expectoration, sore throat, dyspnoea, fatigue and myalgia; whereas the uncommon symptoms include confusion, dizziness, headache, conjunctivitis, rhinorrhoea, nasal congestion, hemoptysis, chest pain, bronchial breath sounds, tachypnoea, crackles/rales on auscultation, cutaneous manifestations, cyanosis, and gastrointestinal symptoms. Throughout the world, mitigation strategies have lingered on the adoption of social distancing, face masks, hand hygiene and environmental disinfection. However, these precautionary measures are still not completely reliable until the modes of transmission of the SARS-CoV-2 remain unraveled. The transmission of respiratory pathogens have been associated with three primary modes known as “contact,” “droplet,” and “airborne” transmission. These modes are also being speculated in the context of SARS-CoV-2, but the existing research-based literature and the consequent guidance from the leading public health agencies are still paradoxical. The contact transmission can occur directly by physical touch or indirectly via fomites containing settled droplets. The droplet transmission involves large droplets more than 20 μm in diameter resulting from a violent expiratory event and deposited upon the conjunctiva or mucus membranes of a susceptible host directly [1] apart from being captured by inspiratory air flows and deposited along the respiratory tract. The airborne or aerosol transmission occurs via small respiratory droplets or droplet nuclei, less than 10 μm in diameter, which remains airborne for sufficient time to transmit the pathogen and may get deposited deep into the respiratory tract, including alveolar region [1]. For the distinction of the transmission modes, droplet sizes need to be carefully interpreted; however, the propositions on the size-related terms are also paradoxical. An example of dichotomy is the postulation from the World Health Organization that respiratory droplets are more than 5 to 10 μm in diameter, whereas droplet nuclei are less than 5 μm in diameter. However, it is also being speculated that the particles of various sizes but indistinct behavior are produced in continuum during the respiratory activities of the infected person and particles as large as 50 μm can also remain airborne and travel the considerable distance as per the factors including force and volume of exhalation, airflow, temperature and humidity [2]. Although the contact and droplet routes are still being advocated as the main modes by leading public health agencies, including WHO, the airborne transmission had been recognized only for aerosol-generating procedures within the healthcare settings. But considering the emerging evidence of the presence of viable SARS-CoV-2 even in the absence of aerosol-generating procedures, the airborne transmission should also be recognized as an important mode of transmission of the SARS-CoV-2 [3]. Furthermore, it should not be neglected that the aerosols are generated even from activities such as exhalation, coughing, sneezing and talking by the infected individuals [2]. The indoor, as well as outdoor airborne transmission, have been elucidated by various empirical and laboratory studies conducted in countries including China, Italy, Singapore and USA [4]. The median estimates of the half-lives of the SARS-CoV-2 and SARS-CoV in aerosols are almost the same i.e. approximately 1.1–1.2 hours (3 hours viability), indicating that both viruses have similar stability characteristics for the plausible aerosol transmission and superspreading [5]. This time is enough for the exposure, inhalation and infection by the virus, which may occur near or far from the actual source, even beyond 1 to 2 m from an infected individual [6]. Recently, even the timeline of 16 hours has been reported for the virus to retain infectivity in laboratory-created aerosols [6]. Considering the airborne transmission, precautions such as hand washing and social distancing are appropriate but insufficient. As the viable SARS-CoV-2 has been isolated in air samples even 2 to 4.8 m away from the source, social distancing by currently recommended parameters of 6 feet would not be effective, especially in an indoor setting [3]. Additional mitigation measures should include the provision of effective ventilation, local exhausts, high-efficiency air filtration, germicidal ultraviolet light, avoidance of overcrowding in public places [6], toilet flushing with a closed lid, minimal use of central air conditioner, universal use of proper facial masks (N95 respirators or surgical or cloth masks as per the availability) fitting tightly to the face apart from proper personal protective equipment (PPE) including the N95 particle protective mask in the laboratory and healthcare settings [4] (Figure 1 ). From the scientific community throughout the globe, there is an urgent and critical requirement of the research to unravel the paradox of SARS-CoV-2 transmission and infectivity so that effective mitigation measures can be outlined. Whereas, the policymakers and leading public health agencies need to upgrade the precautionary approach to interrupt all the plausible modes of transmission until this uncertainty is deciphered. Figure 1 Primary control measures to mitigate the transmission of SARS-CoV-2 as per the consideration of aerosol transmission. Figure 1 CRediT authorship contribution statement Priyanka: Conceptualization, Writing - review & editing. Om Prakash Choudhary: Conceptualization, Writing - review & editing. Indraj Singh: Writing - review & editing. Gautam Patra: Writing - review & editing. Declaration of Competing Interest We declare that we have no competing interests.
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            Is Open Access

            When a parent dies – a systematic review of the effects of support programs for parentally bereaved children and their caregivers

            Background The death of a parent is a highly stressful life event for bereaved children. Several studies have shown an increased risk of mental ill-health and psychosocial problems among affected children. The aims of this study were to systematically review studies about effective support interventions for parentally bereaved children and to identify gaps in the research. Methods The review’s inclusion criteria were comparative studies with samples of parentally bereaved children. The focus of these studies were assessments of the effects on children of a bereavement support intervention. The intervention was directed towards children 0–18 years; but it could also target the children’s remaining parent/caregiver. The study included an outcome measure that dealt with effects of the intervention on children. The following electronic databases were searched up to and including November 2015: PubMed, PsycINFO, Cinahl, PILOTS, ProQuest Sociology (Sociological Abstracts and Social Services Abstracts). The included studies were analysed and summarized based on the following categories: type of intervention, reference and grade of evidence, study population, evaluation design, measure, outcome variable and findings as effect size within and between groups. Results One thousand, seven hundred and-six abstracts were examined. Following the selection process, 17 studies were included. The included studies consisted of 15 randomized controlled studies, while one study employed a quasi-experimental and one study a pre-post-test design. Thirteen studies provided strong evidence with regards to the quality of the studies due to the grade criteria; three studies provided fairly strong evidence and one study provided weaker evidence. The included studies were published between 1985 and 2015, with the majority published 2000 onwards. The studies were published within several disciplines such as psychology, social work, medicine and psychiatry, which illustrates that support for bereaved children is relevant for different professions. The interventions were based on various forms of support: group interventions for the children, family interventions, guidance for parents and camp activities for children. In fourteen studies, the interventions were directed at both children and their remaining parents. These studies revealed that when parents are supported, they can demonstrate an enhanced capacity to support their children. In three studies, the interventions were primarily directed at the bereaved children. The results showed positive between group effects both for children and caregivers in several areas, namely large effects for children’s traumatic grief and parent’s feelings of being supported; medium effects for parental warmth, positive parenting, parent’s mental health, grief discussions in the family, and children’s health. There were small effects on several outcomes, for example children’s post-traumatic stress disorder (PTSD) symptoms, anxiety, depression, self-esteem and behaviour problems. There were studies that did not show effects on some measures, namely depression, present grief, and for the subgroup boys on anxiety, depression, internalizing and externalizing. Conclusions The results indicate that relatively brief interventions can prevent children from developing more severe problems after the loss of a parent, such as traumatic grief and mental health problems. Studies have shown positive effects for both children’s and remaining caregiver’s health. Further research is required including how best to support younger bereaved children. There is also a need for more empirically rigorous effect studies in this area.
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              Health impacts of the Russian invasion in Ukraine: need for global health action

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                Author and article information

                Journal
                Int J Surg
                Int J Surg
                International Journal of Surgery (London, England)
                IJS Publishing Group Ltd. Published by Elsevier Ltd.
                1743-9191
                1743-9159
                13 May 2022
                June 2022
                13 May 2022
                : 102
                : 106675
                Affiliations
                [1]Department of Microbiology, Punjab Agricultural University, Ludhiana, 141004, India
                [2]Trafford College, Altrincham, Manchester, WA14 5PQ, UK
                [3]Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl, 796015, Mizoram, India
                [4]Independent Researcher, 07, Type IV Quarter, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl, 796015, Mizoram, India
                [5]National Food Safety Authority (NFSA), Aswan Branch, Aswan, 81511, Egypt
                [6]Ministry of Tourism and Antiquities, Aswan Office, Aswan, 81511, Egypt
                Author notes
                []Corresponding author. Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl-796015, Mizoram, India.
                Article
                S1743-9191(22)00452-6 106675
                10.1016/j.ijsu.2022.106675
                9098802
                35569761
                d1c43664-16e0-43d7-b95d-99b73bb492e1
                © 2022 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 5 May 2022
                : 10 May 2022
                Categories
                Correspondence

                Surgery
                sars-cov-2,covid-19,pandemic,russia,ukraine,war,global impact,containment strategy
                Surgery
                sars-cov-2, covid-19, pandemic, russia, ukraine, war, global impact, containment strategy

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