n = 999 .
Characteristic . | Overall n = 999 . | Placebo n = 495 . | Metformin n = 504 . |
---|---|---|---|
Age | 46 (38–55) | 45 (38–54) | 46 (38–55) |
Biologic sex, female | 56% (559) | 57% (282) | 55% (277) |
Race Native American | 2.2% (22) | 2.6% (13) | 1.8% (9) |
Asian | 3.6% (36) | 3.8% (19) | 3.4% (17) |
Hawaiian, Pacific Islander | 0.7% (7) | 0.4% (2) | 1.0% (5) |
Black or African American | 6.2% (62) | 6.1% (30) | 6.3% (32) |
White | 85% (849) | 85% (420) | 85% (429) |
Other, missing, declined | 5.0% (50) | 4.4% (22) | 5.6% (28) |
Ethnicity, Hispanic | 12% (118) | 13% (63) | 11% (55) |
Medical history | |||
BMI | 30.0 (27.1–34.3) | 30.0 (26.9–34.7) | 29.8 (27.2–34.0) |
BMI ≥30 kg/m | 50% (496) | 51% (250) | 49% (246) |
Cardiovascular disease | 28% (282) | 28% (140) | 28% (142) |
Diabetes | 2.0% (20) | 2.6% (13) | 1.4% (7) |
Vaccination status at baseline | |||
No vaccine | 46% (457) | 48% (240) | 43% (217) |
Primary series only | 50% (495) | 47% (232) | 52% (263) |
Monovalent booster | 4.7% (47) | 4.6% (23) | 4.8% (24) |
Days since last vaccine dose | 194 (132–240) | 195 (132–235) | 192 (132–245) |
Time from symptom onset to first dose | |||
Days, mean (± standard deviation) | 4.7 (±1.9) | 4.7 (±1.8) | 4.7 (±1.9) |
≤4 days | 46% (453) | 48% (230) | 45% (223) |
Severe acute respiratory syndrome coronavirus 2 variant period | |||
Alpha (before 19 June 2021) | 13% (132) | 13% (65) | 13% (67) |
Delta (2021 June 19 2021 to 2021 December 12) | 65% (645) | 65% (320) | 64% (325) |
Omicron (after 2021 December 12,) | 22% (222) | 22% (110) | 22% (112) |
Insurance status | |||
Private | 65% (652) | 65% (324) | 65% (328) |
Medicare | 7.5% (75) | 6.9% (34) | 8.1% (41) |
Medicaid | 14% (136) | 14% (69) | 13% (67) |
No insurance | 12% (123) | 12% (60) | 12% (63) |
Unknown | 1.3% (13) | 1.6% (8) | 1.0% (5) |
Values are percent (n) or median (interquartile range) unless specified. Cardiovascular disease defined as hypertension, hyperlipidemia, coronary artery disease, past myocardial infarction, congestive heart failure, pacemaker, arrhythmias, or pulmonary hypertension.
Abbreviation: BMI, body mass index.
a Unknown n = 22.
The overall mean SARS-CoV-2 viral load reduction with metformin was −0.56 log 10 copies/mL (95% CI, −1.05 to −0.06) greater than placebo across all follow-up ( P = .027). The antiviral effect of metformin compared with placebo was −0.47 log 10 copies/mL (95% CI, −0.93 to −0.014) on day 5 and −0.64 log 10 copies/mL (95% CI, −1.42 to 0.13) on day 10 ( Figure 1 ). Neither ivermectin nor fluvoxamine had virologic effect ( Figure 2 , Supplementary Figure 2 , Supplementary Tables 8–10 ).
Effect of metformin versus placebo on viral load over time, detectable viral load, and rebound viral load. A , Adjusted mean change in log10 copies per milliliter (viral load) from baseline (day 1) to day 5 and day 10 for metformin (lower line) and placebo (upper line). Mean change estimates are based on the adjusted, multiply imputed Tobit analysis (the primary analytic approach) that corresponds to the overall metformin analysis presented in Figure 2 . B , Adjusted percent of viral load samples that were detectable at day 1, day 5, and day 10. The percent viral load detected estimates were based on the adjusted, multiply imputed logistic generalized estimating equations (GEE) analysis corresponding to the overall metformin analysis depicted in Figure 3 . Odds ratios correspond to adjusted effects on the odds ratio scale. C , Bar chart depicting the percent of participants whose day 10 viral load was greater than the day 5 viral load and the odds ratio for having viral load rebound using the multiply imputed logistic GEE. Abbreviation: CI, confidence interval.
Overall results for metformin, ivermectin, and fluvoxamine on viral load; heterogeneity of treatment effect of metformin versus placebo. This is a forest plot that depicts the effect of active medication compared with control on log10 copies per milliliter (viral load), overall, and at day 5 and day 10. Viral Effect* denotes the adjusted mean change in viral load in log10 copies per milliliter with 95% confidence intervals for the adjusted mean change. Analyses were conducted using the primary analytic approach, a multiply imputed Tobit model. The vertical dashed line indicates the value for a null effect. The top 3 rows show ivermectin, the next 3 rows show fluvoxamine, and the following 3 rows show metformin. Below these, the effect of metformin compared with placebo is shown by a priori subgroups of baseline characteristics. Abbreviation: CI, confidence interval.
When the adjustment covariates were dropped one at a time—baseline viral load, vaccination status, time since last vaccination, other study medications within the factorial trial, and the laboratory processing the nasal swabs—in addition to dropping all adjustment covariates, the results were similar. The range in the estimated average effect was −0.51 log 10 copies/mL (95% CI, −1.04 to 0.01; P = .056) to −0.66 log 10 copies/mL (95% CI, −1.215 to −0.097; P = .021) with the latter arising from the unadjusted model ( Supplementary Table 9 ).
Those in the metformin group were less likely to have a detectable viral load than those in the placebo group (OR, 0.72; 95% CI, .55 to .94; Figure 1) . This effect was higher at day 10 (OR, 0.65; 95% CI, .43 to .98) when 1500 mg/d of metformin was being prescribed than at day 5 (OR, 0.79; 95% CI, .60 to 1.05) when 1000 mg/d was prescribed. Viral rebound was defined as having a higher viral load at day 10 than day 5. In the placebo group, 5.95% (22 of 370) of participants had viral rebound compared with 3.28% (12 of 366) in the metformin group (adjusted OR, .68; 95% CI, .36 to 1.29) for metformin compared with placebo ( Figure 1) .
Metformin's effect on continuous viral load and conversion to undetectable viral load was consistent across a priori identified subgroups of baseline characteristics ( Figures 2 and 3 ). Subgroups should be interpreted with caution because of low power, risk of making multiple comparisons without correction, and sparse data bias. One subgroup warrants additional detail for interpretation. The antiviral effect on geometric log 10 scale was greater among those with baseline viral loads <100 000 copies/mL (mean −1.17 log 10 copies/mL reduction) than among those with >100 000 copies/mL (mean −0.49 log 10 copies/mL reduction); although the reduction in absolute copies per milliliter would be greater among those with higher viral loads ( Figures 2 and 3 ). Mean, median viral load levels are presented in Supplementary Table 11 ; sensitivity analyses are presented in Supplementary Figures 5–7 and Supplementary Table 12 .
Overall results for metformin, ivermectin, and fluvoxamine on detectability of viral load; heterogeneity of treatment effect of metformin versus placebo. This is a forest plot that depicts the effect of active medication compared with control on the proportion of participants with a detectable viral load, overall and at days 5 and 10. Estimate* denotes the adjusted mean risk difference in the percent of samples with detected viral load with 95% confidence intervals for the adjusted risk difference. The vertical dashed line indicates the value for a null effect. The estimated risk differences are derived from the adjusted, multiply imputed logistic generalized estimating equations (GEE) analytic approach. The top 3 rows show ivermectin, the next 3 rows show fluvoxamine, and the following 3 rows show metformin. Below these, the effect of metformin compared with placebo is shown by a priori subgroups of baseline characteristics. Abbreviation: CI, confidence interval.
In the virologic end point of the COVID-OUT phase 3, randomized trial, metformin significantly reduced SARS-CoV-2 viral load over 10 days [ 1 ]. The mean reduction was −0.56 log 10 copies/mL greater than placebo. The antiviral response is consistent with the statistically significant and clinically relevant effects of metformin in preventing clinical outcomes: severe COVID-19 (emergency department visit, hospitalization, or death) through day 14, hospitalization or death by day 28, and the diagnosis of long COVID [ 1 , 12 ]. The magnitude of effect on clinical outcomes was larger when metformin was started earlier in the course of infection at <4 days from symptom onset, with metformin reducing the odds of severe COVID-19 by 55% (OR, 0.45; 95% CI, .22 to .93) and of long COVID by 65% (hazard ratio = 0.35; 95% CI, .15 to .95; Figure 4) . An improved effect size for clinical outcomes when therapies are started earlier in the course of infection is consistent with an antiviral action [ 14 ].
Overview of results from the COVID-OUT trial. This is a forest plot that combines the severe, acute coronavirus disease 2019 outcome as well as the long-term follow-up outcome from the COVID-OUT trial [ 1 , 12 ]. Two a priori subgroups from the COVID-OUT trial are also presented: pregnant individuals and those who started the study drug within 4 days of symptom onset, to match the primary analytic sample of other antivirals. Abbreviations: COVID-19, coronavirus disease 2019; ITT, intention to treat; mITT, modified intention to treat; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
The objective of the COVID-OUT trial was to determine whether metformin prevented severe COVID-19. Severe COVID-19 was defined with a binary, 4-part composite outcome (<94% SpO 2 on a home oximeter/emergency department visit/hospitalization/death) at a time when the implications of “silent hypoxia” were unknown and fears of overwhelmed emergency services caused concern that deaths would occur at home before patients reached the emergency department. As a scientific community, we now understand that 1 reading below 94% is not severe COVID-19. An accurate definition of severe COVID-19 (emergency department visit/hospitalization/death) was ascertained within the same data-generation process. In such situations, recommendations are sometimes made based on the totality of evidence from a single randomized trial [ 15–17 ].
The antiviral effect in this phase 3, randomized trial is also consistent with emerging data from other trials. In a phase 2, randomized trial with 20 participants, the metformin group had better clinical outcomes, achieved an undetectable viral load 2.3 days faster than placebo ( P = .03), and had a larger proportion of patients with an undetectable viral load at 3.3 days in the metformin group ( P = .04) [ 18 ]. A recent in vitro study showed that metformin decreased infectious SARS-CoV-2 titers and viral RNA in 2 cell lines, Caco2 and Calu3, at a clinically appropriate concentration [ 19 ].
Conversely, an abandoned randomized trial testing extended-release metformin 1500 mg/d without a dose titration did not report improved SARS-CoV-2 viral clearance at day 7 [ 20 ]. Several differences between the Together Trial and the COVID-OUT trial are important for understanding the data. First, the Together Trial allowed individuals already taking metformin to enroll and be randomized to placebo or more metformin [ 20 , 21 ]. To compare starting metformin versus placebo, the authors excluded those already taking metformin at baseline and reported that emergency department visit or hospitalization occurred in 9.2% (17 of 185) randomized to metformin compared with 14.8% (27 of 183) randomized to placebo (relative risk, 0.63; 95% confidence interval, .35 to 1.10, Probability of superiority = 0.949) [ 22 ]. Thus, the Together Trial results for starting metformin versus placebo are similar. Second, 1500 mg/day without escalating the dose over 6 days would cause side effects, especially if the study participant was already taking metformin [ 23 ]. Third, extended-release and immediate-release metformin have different pharmacokinetic properties. Immediate-release metformin has higher systemic exposure than extended-release metformin, which may improve antiviral actions, but this is not known [ 24 , 25 ]. Given the similar clinical outcomes between immediate and extended-release, a direct comparison of the 2 may be important for understanding pharmacokinetics against SARS-CoV-2.
In comparison with other SARS-CoV-2 antivirals, when considering all enrolled participants, at day 5, the antiviral effect over placebo was 0.47 log 10 copies/mL for metformin, 0.30 log 10 copies/mL for molnupiravir, and 0.80 log 10 copies/mL for nirmatrelvir/ritonavir [ 26 , 27 ]. At day 10, the viral load reduction over blinded placebo was 0.64 log 10 copies/mL for metformin, 0.35 log 10 copies/mL for nirmatrelvir, and 0.19 log 10 copies/mL for molnupiravir [ 26 , 27 ]. We note that the 3 trials enrolled different populations and at different times and locations during the pandemic. In the COVID-OUT metformin trial, half were vaccinated [ 1 , 12 ].
The magnitude of metformin's antiviral effect was larger at day 10 than at day 5 overall and across subgroups, which correlates with the dose titration from 1000 mg on days 2–5 to 1500 mg on days 6–14. The dose titration to 1500 mg over 6 days used in the COVID-OUT trial was faster than typical use. When used chronically, that is, for diabetes, prediabetes, or weight loss, metformin is slowly titrated to 2000 mg daily over 4–8 weeks. While metformin's effect on diabetes control is not consistently dose-dependent, metformin's gastrointestinal side effects are known to be dose-dependent [ 25 ]. Thus, despite what appears to be dose-dependent antiviral effects, a faster dose titration should likely only be considered in individuals with no gastrointestinal side effects from metformin.
When assessing for heterogeneity of effect, metformin was consistent across subgroups. Metformin's antiviral effect in vaccinated versus unvaccinated of −0.48 versus −0.86 log 10 copies/mL at day 10 mirrors nirmatrelvir, for which the effect in seropositive participants was smaller than in the overall trial population, −0.13 versus −0.35 log 10 copies/mL at day 10 [ 26 ]. Effective primed memory B- and T-cell anamnestic immunity prompting effective response by day 5 in vaccinated persons may account for this trend in both trials. Subgroups should be interpreted with caution because of low power and multiple comparisons [ 28 ].
Both nirmatrelvir and molnupiravir are pathogen-directed antiviral agents. Therapeutics may have an important role in targeting host factors rather than viral factors, as targeting the host may be less likely to induce drug-resistant viral variants through mutation–selection [ 11 , 29 ]. We did not study the mechanism for the antiviral activity or an antiinflammatory action in this trial. Previous work has shown that metformin's inhibition of mTOR complex 1 may depend on AMP-activated protein kinase (AMPK) at low doses but not high doses [ 5 ]. An AMPK-independent inhibition of mTOR may be more efficient. Additionally, metformin demonstrates a dose-dependent ability to inhibit interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha in the presence of lipopolysaccharide, inflammatory products that correlate with COVID-19 severity [ 30 , 31 ].
In addition to antiviral activity, metformin appears to have relevant antiinflammatory actions. In mice without diabetes, metformin inhibited mitochondrial ATP and DNA synthesis to evade NLRP3 inflammasome activation [ 32 ]. In macrophages of mice without diabetes infected with SARS-CoV-2, metformin inhibited inflammasome activation, IL-1 production, and IL-6 secretion and also increased the IL-10 antiinflammatory response to lipopolysaccharide, thereby attenuating lipopolysaccharide-induced lung injury [ 32 ]. In a recent assay of human lung epithelial cell lines, metformin inhibited the cleavage of caspase-1 by NSP6, inhibiting the maturation and release of IL-1, a key factor that mediates inflammatory responses [ 7 ]. The idea of pleiotropic effects is being embraced in novel therapeutics being developed for both antiviral and anti-inflammatory actions [ 33 ].
Strengths of our study include the large sample size and detailed participant information collected, including the exact time and date of specimen collection. One limitation was the sampling time frame of only day 1, day 5, and day 10 due to limited resources. By day 10 post-randomization, 77% of participants in the placebo group and 86% in the metformin group had an undetectable viral load. As viral load is lower in vaccinated persons [ 34 ], this degree of undetectable viral loads differs from findings from earlier clinical trials conducted in unvaccinated participants without known prior infection [ 26 , 27 ]. Sampling earlier and more frequently, that is, day 1, day 3, day 6, and day 9 in future trials, may better characterize differences in viral shedding earlier in the infection and over time, dependent on the duration of therapy and timing of enrollment.
Future work could assess whether synergy exists between metformin and direct SARS-CoV-2 antivirals, as previous work showed that metformin improved sustained virologic clearance of hepatitis C virus and improved outcomes in other respiratory infections [ 35–37 ]. The biophysical modeling that motivated this trial predicts additive/cooperative effects in combination with transcription inhibitors. Combination therapy might decrease selective pressure, and metformin has few medication interactions, so treatment with metformin could continue beyond 5 days while home medications are restarted. Additionally, continuing metformin could reduce symptom rebound, given its effects on T-cell immunity [ 38 , 39 ]. Further data are needed to understand whether decreased viral load and faster viral clearance decrease onward transmission of SARS-CoV-2.
Metformin is safe in children and pregnant individuals with and without preexisting diabetes [ 40–42 ]. Individuals with or without diabetes do not need to check blood sugar when taking metformin. Historical concerns about lactic acidosis were driven by other biguanides; metformin does not increase risk of lactic acidosis [ 43 ]. Metformin improves outcomes in patients with heart, liver, and kidney failure, as well as during hospitalizations and perioperatively [ 44–48 ].
In a large randomized, controlled trial conducted in nonhospitalized, standard-risk adults, metformin reduced the incidence of severe COVID-19 by day 14, of hospitalizations by day 28, and of long COVID diagnosis by day 300. In this virologic analysis, we found a corresponding significant reduction in viral load with metformin compared with placebo and a lower likelihood of viral load rebound. While 22% of participants in the trial were enrolled during the Omicron era, metformin has not been assessed in individuals with a history of prior infection and thus should be trialed in the current state of the pandemic. Metformin is currently being trialed in low-risk adults [ 49 ].
Supplementary materials are available at Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.
Disclaimer. The funders had no influence on the design or conduct of the trial and were not involved in data collection or analysis, writing of the manuscript, or decision to submit for publication. The authors assume responsibility for trial fidelity and the accuracy and completeness of the data and analyses.
Financial support . The fluvoxamine placebo tablets were donated by the Apotex Pharmacy. The ivermectin placebo and active tablets were donated by the Edenbridge Pharmacy. The trial was funded by the Parsemus Foundation, Rainwater Charitable Foundation, Fast Grants, and the UnitedHealth Group Foundation. C. T. B. was supported by grants (KL2TR002492 and UL1TR002494) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and by a grant (K23 DK124654) from the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH. J. B. B. was supported by a grant (UL1TR002489) from NCATS. J. M. N. was supported by a grant (K23HL133604) from the National Heart, Lung, and Blood Institute (NHLBI) of the NIH. D. J. O. was supported by the Institute for Engineering in Medicine, University of Minnesota Office of Academic and Clinical Affairs COVID-19 Rapid Response Grant, the Earl E. Bakken Professorship for Engineering in Medicine, and by grants (U54 CA210190 and P01 CA254849) from the National Cancer Institute of the NIH. D. M. L. receives funding from NIH RECOVER (OT2HL161847). L. K. S. was supported by NIH grants (18X107CF6 and 18X107CF5) through a contract with Leidos Biomedical and by grants from the HLBI of the NIH (T32HL129956) and the NIH (R01LM012982 and R21LM012744). M. A. P. receives grants from the Bill and Melinda Gates Foundation (INV-017069), Minnesota Partnership for Biotechnology and Medical Genomics (00086722) and NHLBI (OT2HL156812).
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You may wonder how coronavirus disease 2019 (COVID-19) could affect your risk of illness, birth plan or time bonding with your baby. You also might have questions about the safety of the COVID-19 vaccines. Here's what you need to know.
Pregnant people seem to catch the virus that causes COVID-19 at about the same rate as people who aren't pregnant. Also, pregnant people usually get better without needing care in the hospital. But pregnancy is a factor that raises the risk of severe COVID-19. That risk stays higher for at least a month after giving birth.
And the risk continues to go up if a pregnant person has other health issues linked to severe COVID-19. Examples of these health issues are obesity, diabetes, high blood pressure or lung disease.
Being very sick with COVID-19 means that a person's lungs don't work as well as they should. Severe or critical COVID-19 is treated in the hospital with oxygen and other medical help to treat damage throughout the body. Severe COVID-19 can lead to death.
Pregnant people with severe COVID-19 also may be more likely to develop other health problems as a result of COVID-19. They include heart damage, blood clots and kidney damage. Moderate to severe symptoms from COVID-19 have also been linked to higher rates of preterm birth, high blood pressure or preeclampsia.
These risks may shift as the virus that causes COVID-19 changes. Risks also may change as disease prevention and treatment evolve. But risks are lowered significantly when a pregnant person gets the COVID-19 vaccine.
The Centers for Disease Control and Prevention recommends getting a 2023-2024 COVID-19 vaccine if:
Staying up to date on your COVID-19 vaccine helps prevent severe COVID-19 illness. It also may help a newborn avoid getting COVID-19 if you are vaccinated during pregnancy.
People at higher risk of serious illness can talk to a healthcare professional about additional COVID-19 vaccines or other precautions. It also can help to ask about what to do if you get sick so you can quickly start treatment.
While you’re pregnant, it’s important for you and those in your household to:
Try to spread out in crowded public areas, especially in places with poor airflow. This is important if you have a higher risk of serious illness.
The CDC recommends that people wear a mask in indoor public spaces if you're in an area with a high number of people with COVID-19 in the hospital. They suggest wearing the most protective mask possible that you'll wear regularly, that fits well and is comfortable.
Unlike earlier in the pandemic, in-person prenatal visits typically are not disrupted by COVID-19.
If you test positive for COVID-19, your healthcare professional will want to discuss your options with you. That might mean a virtual or in-person appointment to figure out how to best keep track of your health. It may help to know that in most cases, the COVID-19 infection doesn't spread to the unborn baby.
If you test positive for COVID-19 and have symptoms, your healthcare team will monitor you closely. A healthcare professional may ask about your symptoms, review your other medical conditions and determine your risk of serious illness. You may be offered medicine to block the infection from getting worse. Treatment with these medicines may be a pill that you swallow, or a liquid given through a needle into a vein.
You also may be asked to use a device to monitor your oxygen level, called a pulse oximeter.
After the infection, your healthcare professional may plan on extra imaging tests to make sure the unborn baby is growing as expected.
If you test positive for COVID-19 close to when you give birth, you may not need to change your birth plan.
But it's also possible that your healthcare professional will suggest a change in timing or delivery options for your safety. People who also are managing high blood pressure linked to pregnancy or preeclampsia are more likely to be monitored in the hospital if they get COVID-19.
After the baby is born, research suggests it's safe for your baby to stay with you even if you have COVID-19. If you are too ill to care for your baby, your healthcare professional may suggest the baby stay in another hospital area.
To limit your baby's exposure to the virus, wear a well-fitting face mask and have clean hands when caring for your newborn. Stay a reasonable distance from your baby when not feeding, if possible.
If you have COVID-19 but feel well enough, there is no need to stop breastfeeding or stay separate from your baby. To avoid spreading the infection, wash your hands before breastfeeding. Also, wear a well-fitting face mask whenever you are in close contact with your baby.
If you're pumping breast milk, wash your hands before touching any pump or bottle parts and follow instructions for pump cleaning. If you need care in the hospital, you may be able to keep pumping.
Staying healthy can be a big concern for new parents. Worry about COVID-19 illness for yourself or your newborn may be an added burden. But it is typical for newborns to get their first illness during their first year of life. In fact, your baby may have mild illness regularly during this first year as the baby comes in contact with the world.
If you find that worry over COVID-19 or other illness is affecting your or your baby's health, talk to your healthcare professional.
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New research has found that patients who developed inflammation of the heart, or myocarditis, after receiving an mRNA vaccine for COVID-19 had fewer complications in the 18 months after hospitalization than those who developed it from contracting COVID-19 or some other cause.
The population study, conducted in France and published online Monday in JAMA , found that hospital readmission rates, diagnoses of other heart-related conditions, or instances of death were significantly lower in the group that received the vaccine.
The long-term effects of COVID-19 and COVID-19 vaccines are a concern for the U.S. military, which saw nearly 500,000 cases of the coronavirus in the first two years of the pandemic and required all members to get the vaccine .
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The study findings were the same regardless of age, according to the research, although the authors noted that post-vaccine myocarditis patients, who were mainly healthy young men, "may require medical management up to several months after hospital discharge."
"Although patients with myocarditis after COVID-19 mRNA vaccination appear to have a good prognosis near hospital discharge, their longer-term prognosis and management remain unknown," wrote the researchers, led by Laura Semenzato, a statistician with EPI-PHARE Scientific Interest Group.
The Defense Department vaccinated more than 2 million service members from December 2020, when the U.S. Food and Drug Administration issued an emergency use authorization for the Pfizer and Moderna COVID-19 vaccines, through December 2022, according to the Pentagon.
The vaccines used a novel mRNA technology to stimulate the body's immune response to the illness, using messenger RNA to instruct cells to make pieces of the virus' spike protein to trigger an immune response.
As early as February 2021, the U.S. military began seeing patients who developed myocarditis after receiving their COVID-19 vaccine series.
Military.com began tracking the cases shortly after a civilian member of the Pentagon press corps and a Military.com reporter who serves in the National Guard developed the condition, although the Pentagon did not confirm it had additional cases until April.
In a report to Congress last September on troop health following the Defense Department's COVID-19 vaccine mandate, which went into effect in August 2021, a Pentagon official said 25 service members developed myocarditis in early 2021 but did not give a total number of cases for the force over the years.
The report said the rate for service members developing myocarditis was 57 cases per 100,000 "person years," which measures the number of people across the observation time, versus 98 cases per 100,000 person years among those who contracted COVID-19 in 2021.
The Department of Veterans Affairs , which could be asked to provide disability compensation for veterans who have long-term health effects from COVID-19 contracted on active duty or from the vaccine, has 11 ongoing studies on long-term coronavirus.
"The VA research program remains tightly focused on understanding the long-term impacts
of COVID-19," wrote VA Under Secretary for Health Dr. Shereef Elnahal in an article in Federal Practitioner last November. "At the same time, the VA is committed to using lessons learned during the crisis in addressing high priorities in veterans' health care."
Dr. Harlan Krumholz, a cardiologist at Yale School of Medicine who was not involved in the French study, said the latest research provides reassurance to patients and doctors about the possible long-term effects on the heart and body of post-vaccine myocarditis.
But, he noted, while the study focuses on the outcomes at 18 months after hospitalization -- what Krumholz described as "meaningful follow-up," it does not provide insight into longer-term outcomes.
"In general, myocarditis at a young age can potentially lead to chronic heart issues like arrhythmias or heart failure in some patients, though many recover fully. Ongoing monitoring is important," Krumholz wrote in an email Tuesday to Military.com.
For the study, researchers examined 4,635 patients ages 12 to 49 who were hospitalized for myocarditis in France from Dec. 27, 2020, to June 30, 2022.
Of those, 12% developed post-vaccine myocarditis within seven days of getting the immunization while 6% developed post COVID-19 myocarditis and 82% had a conventional form of the condition.
While the number of patients who developed myocarditis after contracting the illness was smaller than the vaccine group, they were hospitalized and had rates of complications or death similar to those who developed regular myocarditis.
The study noted, however, that one patient with post-vaccine myocarditis required extensive medical interventions and died after leaving the hospital, with myocarditis likely the cause of death.
"While outcomes were generally favorable, some patients required ongoing medical management for several months after discharge. Also, 3% of those who had post-vaccine myocarditis were rehospitalized ... over the subsequent 18 months," noted Krumholz after reviewing the study.
Myocarditis can result from a viral infection or an overactive immune response to an illness. The reason why some people, especially young men, develop myocarditis after getting a COVID-19 mRNA vaccine is not well understood. Krumholz said it likely involves an "exaggerated immune response," occurring in roughly 1 to 10 of every 100,000 vaccinated individuals.
The JAMA study has its limitations, as researchers were able to look only at hospitalizations for myocarditis and not all potential cases during the time frame. They also did not include details on the severity of cases and based their research on medical diagnoses, relying on the accuracy of medical providers.
The researchers noted that the American Heart Association and the American College of Cardiology guidelines advise patients with myocarditis to refrain from competitive sports for 3 to 6 months and to have their health condition assessed prior to the resumption of sports.
They also said that, while several studies have reported "reassuring results" for the prognosis of post-vaccine myocarditis, patients with the low likelihood of poor outcomes, residual symptoms and cardiac abnormalities have been detected up to a year after illness.
The study, the researchers said, should be "taken into account for ongoing and future mRNA vaccine recommendations."
"Overall, this study provides important data on medium-term outcomes, but continued research on longer-term prognosis is still needed," Krumholz added.
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Maria gayatri.
1 Directorate for Development of Service Quality of Family Planning, National Population and Family Planning Board (BKKBN), Jakarta, Indonesia
2 Research Center for Population, National Research and Innovation Agency (BRIN), Jakarta, Indonesia
Background: COVID-19 has changed family life, including employment status, financial security, the mental health of individual family members, children's education, family well-being, and family resilience. The aim of this study is to analyze the previous studies in relation to family well-being during the COVID-19 pandemic. Methods: A literature review was conducted on PubMed, Medline, Web of Science, and Scopus for studies using a cross-sectional or quasi-experimental design published from their inception to October 15, 2020, using the keywords “COVID-19,” “pandemic,” “coronavirus,” “family,” “welfare,” “well-being,” and “resilience.” A manual search on Google Scholar was used to find relevant articles based on the eligibility criteria in this study. The presented conceptual framework is based on the family stress model to link the inherent pandemic hardships and the family well-being. Results: The results show that family income loss/economic difficulties, job loss, worsening mental health, and illness were reported in some families during the COVID-19 pandemic. Family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to curb the spread of coronavirus. During the pandemic, it is important to maintain family well-being by staying connected with communication, managing conflict, and making quality time within family. Conclusion: The government should take action to mitigate the social, economic, and health impacts of the pandemic on families, especially those who are vulnerable to losing household income. Promoting family resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.
Coronavirus disease 2019 (COVID-19) is a form of pneumonia caused by the severe acute respiratory coronavirus syndrome 2 (SARS-CoV-2) ( Lai et al., 2020 ). The appearance of COVID-19 becomes an outbreak in December 2019 in China. The coronavirus disease can be transmitted through the respiratory tract, digestive system, and also mucosal surface ( Ye et al., 2020 ). Fever, cough, shortness of breath, and diarrhea are the symptoms of COVID-19 infection at the onset. The pandemic of COVID-19 has brought many changes to all the communities, workers, and families to reduce the spread of the coronavirus and limit its impact on health, societal, and economic consequences. This pandemic had a powerful impact on family life. Mental resilience is required for coping strategies during the pandemic ( Barzilay et al., 2020 ).
COVID-19 has changed family life, including employment, financial instability, the mental health of family members, children's education, family well-being, and family resilience. People start to protect themselves from the spread of the coronavirus by physical and social distancing, sheltering-in-place, restricting travel, and implementing health protocols. Some public places are abrupt closures, such as schools, childcare centers, community programs, religious places, and workplaces. This change impacts social life, such as isolation, psychological distress, substantial economic distress, depression, and also domestic violence, including child abuse ( Campbell, 2020 ; Patrick et al., 2020 ). The Internet has become the most important thing to support all activities while staying at home and staying connected with others.
Families are forced to maintain a work–life balance in the same place with all family members during the pandemic ( Fisher et al., 2020 ). Parents are working from home while children are in school. Therefore, parents and children should share the space for their activities at home. On the one hand, parents should focus on their job to maintain their working target in order to avoid losing their job, heighten their financial concerns, sustain their food security, maintain healthy habits, and keep their family members safe from COVID-19. Balancing life during the pandemic is challenging ( Fisher et al., 2020 ). Fathers and mothers should work together not only on the paid job but also on domestic chores, childcare, and teaching their children.
The aim of this literature review is to identify the impact of the COVID-19 pandemic on family well-being based on the previously published articles.
The coronavirus pandemic has become a public health crisis or disaster that has had an impact on family well-being both directly and indirectly. An infectious disease outbreak has spread rapidly, severely disrupted the world, and resulted in morbidity and mortality. This pandemic produced not only a health crisis, but also a social crisis among the population ( Murthy, 2020 ).
The conceptual framework was adapted from McCubbin and Patterson's family stress model. Using McCubbin and Patterson's family stress model, stressful life events (external stressors) had an impact on family life. During the COVID-19 pandemic, there was a profound impact on Indonesian economic growth and labor market, indicating that more people were living in poverty ( Gandasari & Dwidienawati, 2020 ; Olivia et al., 2020 ; Suryahadi et al., 2020 ). Stress-frustration theory indicates that diminished economic resources in the family could add to stress, frustration, and conflict in interpersonal interactions, which might increase the risk of men committing violence against women ( Kaukinen, 2020 ). It means that unemployment and economic instability contributed to the family stress. Furthermore, the underlying pandemic difficulties posed a threat to Indonesian people's mental health ( Abdullah, 2020 ; Megatsari et al., 2020 ). A higher risk of stress could lead to domestic violence. Domestic violence was defined as a coping mechanism for stress induced by social-systemic variables, such as poverty, unemployment, homelessness, loneliness, and ecological characteristics ( Zhang, 2020 ). Individual stress and other factors (such as job loss, lower income, limited resources and support, and hazardous and harmful alcohol use) were associated with domestic violence during the COVID-19 pandemic ( Campbell, 2020 ). Indonesian children were also affected. A recent study found that the financial burden within the family constituted a risk to Indonesian child competency and adjustment ( Riany & Morawska, 2021 ). The well-being of children might be dependent on the well-being of their parents ( Dahl et al., 2014 ). As a result, the inherent pandemic hardships posed a risk to family well-being.
According to the family stress model, the family must engage in an active process to balance external stressors with personal and family resources and a positive outlook on COVID-19 in order to develop and sustain an adaptive coping strategy to face the inherent pandemic hardships and eventually reach a level of family well-being. Mental health and prevention from the risk of mental disorders were required by incorporating individuals, families, communities, and government during and after pandemic events, so that family well-being and resilience could be achieved and improved ( Murthy, 2020 ). Resilience was characterized as a process that encompassed not just successfully adapting and functioning after experiencing adversity or crisis, but also the possibility of personal and relationship transformation and positive growth as a result of adversity ( Walsh, 1996 ). There were three fundamental processes to becoming resilient: shared belief systems, organizational patterns, and communication processes within the family ( Walsh, 1996 ).
A literature review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( Moher et al., 2009 ). This study was conducted from the beginning of March 2020, when the first positive case occurred in Indonesia, to October 1, 2020.
In order to meet the research objective, the authors carried out the literature review by searching various databases. The present study uses an integrative review to summarize the existing evidence to obtain a comprehensive understanding of the impact of the COVID-19 pandemic on family welfare. PubMed, Medline, Web of Science, and Scopus are selected as the main sources of the article's database. A manual search on Google Scholar is also conducted to find relevant articles based on the study’s eligibility criteria. The following keywords are used to perform the search, such as “COVID-19,” “pandemic,” “coronavirus,” “family,” “welfare,” “resilience,” and “mental health.” A total of 67 articles with the matching keywords were primarily retrieved.
Studies were eligible for inclusion if the studies are cross-sectional, experimental designs, or cohort studies describing the impact of the pandemics on family well-being both physical and mental well-being. Studies had to be published from the inception of the pandemic to October 15, 2020, in a journal with impact factors, English-language studies, and related to the COVID-19 pandemic. However, some articles are excluded because they are duplicate articles or studies in non-English language. We also excluded opinions, letters to the editor, and systematic reviews or meta-analyses. Moreover, unpublished articles and reports are also excluded from this study. Finally, based on the inclusion and exclusion criteria, eight articles met the inclusion criteria, and the data were extracted for the next analysis.
Based on eight articles, the data were extracted to include some important information, such as (1) Country/Region, (2) The purpose of the study, (3) Methods of the study, (4) The respondents (sample size and sample characteristics), (5) the main result of the study. The data extraction is done using a form on Microsoft Excel. All articles in this study were evaluated using narrative synthesis and presented data in the table forms.
A total of eight articles were selected for this study, with various subjects consisting of children, adolescents, adults, and parents. The literature review in this study is based on previous studies in the United States, Canada, Brazil, the United Kingdom, Germany, Ireland, Israel, China, Taiwan, Japan, and Bangladesh. Common impacts are physiological stress, anxiety, depression, income loss, fear, economic hardship, food insecurity, and family violence. Higher resilience is associated with fewer COVID-19-related worries, lower anxiety, and lower depression. Greater parental control is associated with lower stress and a lower risk of child abuse. Positive children were infected by the household contact. The results of the review are shown in Table 1 .
Characteristics of the Studies.
Reference | Country | Purpose | Method | Respondents | Main result |
---|---|---|---|---|---|
) | The United States | To determine how the pandemic and mitigation efforts affected the physical and emotional well-being of parents and children in the United States through early June 2020 | Online research panel created by using probability-based address sampling of U.S. households. National survey of parents using the Ipsos Knowledge Panel. Households without Internet at the time of recruitment are provided with an Internet-enabled tablet | 1,011 parents with at least one child under the age of 18 years old in the household | 27% of parents reported worsening mental health themselves, and 14% reported worsening behavioral health of their children. The proportion of families with moderate or severe food insecurity increased. Employer-sponsored insurance coverage for children decreased, and parents reported a loss of regular childcare |
) | Bangladesh | To investigate the relationships between human COVID-19 stress with basic demographic, fear of infection, and insecurity-related variables, which can be helpful in facilitating mental health policies and strategies during the COVID-19 crisis period | Online-based survey | 340 Bangladeshi adult populations (65.9% male) | About 85.60% of the participants are in COVID-19-related stress, which results in sleep shortness, short temper, and chaos in family. Fear of COVID-19 infection (i.e., self and/or family member(s), and/or relatives), hampering scheduled study plans and future career, and financial difficulties are identified as the main causes of human stress Economic hardship and food shortages are linked together and cause stress for millions of people, while hamper of formal education and future plan create stress for job seekers |
) | Israel | To investigate the extent to which individual resilience, well-being, and demographic characteristics may predict two indicators of the coronavirus pandemic: distress symptoms and perceived danger | Online survey: an Internet panel company and an Internet survey through social media by using snowball sampling | 605 Jewish Israelis from the Internet survey company and 741 respondents from the Internet sample | Individual resilience and well-being were the strongest predictors of distress symptoms and a sense of danger |
) | The United States, Israel, and other countries (the United Kingdom, Canada, Brazil, Germany, Ireland, etc.) | To measure resilience using self-reported surveys and explore differences in COVID-19-related stress and resilience | Online survey on a crowdsourcing research website | 3,042 participants of healthcare providers and non-healthcare providers (engineering, computers, finance, research, legal, government, administration, student, teaching). | Respondents were more distressed about family members contracting COVID-19 and unknowingly infecting others than they were about contracting COVID-19 themselves Higher resilience scores were associated with fewer COVID-19-related worries. Increasing resilience score was associated with a reduced rate of anxiety and depression |
) | United States | To examine the impacts of the COVID-19 pandemic in relation to parental perceived stress and child abuse potential | Online survey via Qualtrics | 183 parents with a child under the age of 18 years old in the western United States | Greater COVID-19-related stressors and high anxiety and depressive symptoms are associated with higher parental perceived stress. Receipt of financial assistance and high anxiety and depressive symptoms are associated with higher child abuse potential. Conversely, greater parental support and perceived control during the pandemic are associated with lower perceived stress and child abuse potential. The results also indicate racial and ethnic differences in COVID-19-related stressors |
) | China | To analyze the different clinical characteristics between children and their families infected with severe acute respiratory syndrome coronavirus 2 | Retrospective review of the clinical, laboratory, and radiologic tests | 9 children and their 14 families | All the children were diagnosed with positive results after their family's onset, which indicated that they were infected by the household contact. A positive PCR among children may relate to mental health after discharge. The duration of positive PCR among children is longer compared with their adult families |
) | Taiwan | To explore family members’ concerns for their relatives during the lockdown period, assess their level of acceptance of the visiting restriction policy, and determine the associated factors | Telephone interviews of family members of residents in long-term care facilities comprising 186 beds | 156 family members | The most common concerns of the family members for their relatives were psychological stress (such as feelings of loneliness among residents), followed by nursing care, and daily activity. More than 80% of respondents accepted the visiting restriction policy, and a higher satisfaction rating was independently associated with acceptance of the visiting restriction policy |
) | Japan | To examine the relationship between the presence or absence of a COVID-19 patient in a close setting and psychological distress levels | Administrative survey using social networking service (SNS): chatbot on LINE | 16,402 people aged 15 years and older | In the groups under the age of 60 years old, respondents with COVID-19 patients in a close setting had higher psychological stress |
Coronavirus diseases put families in uncertain conditions without clarity on how long the pandemic situation will last. The pandemic has caused many challenges that impact on family unit and the functions of the family unit, including distraction in family relationships ( Luttik et al., 2020 ). These challenges will have an influence on family well-being in many aspects, such as loss of community, loss of income, resources, planned activities, and travel due to quarantine. The concern about nuclear family members increased because they did not want their family to become ill from the coronavirus. It is suggested to not visit the older members or those with serious illnesses who are more vulnerable to the virus.
Family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to curb the spread of coronavirus. Physical and social distancing are effective mitigations to reduce the spread of the coronavirus during the outbreak. However, distancing requires adaptation among family members to improve family well-being. Sheltering-in-place makes more frequent interactions among family members because they have limited opportunities to have a leisure time into the outside world. This condition, on the one hand, can create a quality time and intimate interactions among family members, but on the other hand, it may lead to long-standing high conflicts, occasionally domestic violence, and divorce ( Lebow, 2020b ). In this condition, a home can be described as a place of warmth, love, and safety or as a place of intimidation, abuse, and fear ( Hitchings & Maclean, 2020 ). Other studies found a positive outlook on the COVID-19 pandemic regarding the necessity of focusing on and enjoying family relationships, especially taking advantage of the pandemic's gift of extended time together ( Evans et al., 2020 ; Holmberg et al., 2021 ). This optimistic attitude could function as a shared belief system within the family, resulting in family resilience. Working life balance at home during the time of COVID-19 provides a new chance for internal conflicts, disagreements, and arguments in which parents try to play their multi-roles with all family members to mitigate some problems such as unemployment and financial instability ( Lebow, 2020b ). Family income loss/economic difficulties, job loss, experienced hardships during the pandemic, worsening mental and behavioral health, stress, high anxiety, distress about family contracting COVID-19, and illness are reported in some families during the COVID-19 pandemic.
Domestic violence related to mental and physical health may happen during the COVID-19 quarantine. Family members lived in complex situations during the pandemic, which increased the risk of overexposure by increasing the levels of stress, anxiety, and instability. The increase in domestic violence during the pandemic is reported in many countries, such as China, Brazil, the United States, and Italy, which may represent as “tip of the iceberg” since many victims do not have the freedom to report the abuse ( Campbell, 2020 ). Domestic violence is reported as physical harm, emotional harm, and abuse. Intimate partner violence is a common form of family violence during the COVID-19 pandemic ( Kaukinen, 2020 ; Zhang, 2020 ). There are three factors of family violence, such as the opportunities of family violence during lockdown and isolation at home, the economic crisis in the households, and insufficient social support for the victims of domestic violence ( Zhang, 2020 ). Individual resilience is a strong predictor of the willingness of people to cope with emergencies and challenges of different kinds, including the COVID-19 pandemic ( Kimhi et al., 2020 ). Individual resilience and well-being are significant factors influencing distress symptoms and a sense of danger ( Kimhi et al., 2020 ). Physical abuse, emotional abuse, and stalking are kinds of intimate partner violence that are experienced by some women during the COVID-19 quarantine ( Mazza et al., 2020 ).
Family violence is one of the causes of divorce. Family violence has become a serious social problem. During the pandemic in China, some couples decide to divorce due to family violence in their spousal relationship ( Zhang, 2020 ). Divorcing partners in the wake of COVID-19 have more complex issues because they should physically and emotionally separate in their households. It is suggested to involve family therapy so they can share their problems that arise readily to prevent anger, contempt, and other problematic conflicts ( Lebow, 2020b ). A good cooperation and communication among divorced parents may help children achieve their goals through this hard time. A recent study found that communication between two single parents discussing the impact of the COVID-19 epidemic on their family life could acquire something considerably more significant than just support and self-discovery ( Abdellatif & Gatto, 2020 ).
Financial distress, economic depression, unemployment, poverty, and added stressors such as the care and homeschooling of children, social distancing, and family isolation have increased the opportunities for family violence ( Kaukinen, 2020 ; Zhang, 2020 ). Family members with lower financial income, lower education status, and lower occupational status are more likely to experience family violence, including family conflicts, economic distress, high tension, lower mental well-being, and insufficient support during physical distancing or lockdown ( Zhang, 2020 ). Families have been dealing with threats from COVID-19 pandemics, both direct and indirect effects ( Lebow, 2020a ). The direct effects are the loss of family members, anxiety feelings related to family loss, increased unemployment, limited physical and social contact, family stress, conflict, and financial vulnerability. During the pandemic, families may have a virtual connection to maintain their communication. Therefore, geographic challenges are becoming less important due to virtual interconnection. Furthermore, a recent study found that virtual communication during the COVID-19 pandemic could improve family well-being and happiness ( Gong et al., 2021 ). At this time, digital technology, which needs digital literacy, becomes essential ( Hitchings & Maclean, 2020 ).
The coronavirus pandemic has increased the risk of mental health problems (such as mood disorders, fear, anxiety, depression, alcohol and smoking abuse) as well as physical health problems (such as sleep disturbance, gastrointestinal problems, poorer health condition) ( Mazza et al., 2020 ). The mental problems are caused by work stress, financial stress, and changes in the social life. The coronavirus pandemic has increased the risk of mental disorders (such as mood disorders, anger, anxiety, depression, alcohol and smoking abuse) as well as physical disorders (such as sleep disturbance, gastrointestinal problems, poorer health condition). Children’s health and well-being are also in danger during the pandemic, because most of the children may get the transmission of the virus from their adult family members who were previously infected ( Su et al., 2020 ). Therefore, individual resilience and well-being as a part of family resilience and well-being should be maintained to cope with the threat of the coronavirus pandemic.
Homeschooling during the pandemic makes parental responsibilities extended to include being teachers, coaches, trainers, and mentors for their children's school from home and other extracurricular activities ( Lebow, 2020b ). The condition of staying at home may increase parental stressors, particularly for working parents who are responsible for their multi-task dealing with other stressful conditions as paid workers and also doing domestic tasks. Moreover, violence may increase among children during homeschooling. During this time, parents and children are similarly living with stress, fear, and many challenges because they share their activities in the same place for uncertain time. Some factors influence the home learning as a distance learning, such as poverty, the educational levels of parents, mental health, the availability of gadget, and Internet access. During the pandemic, however, parental involvement in their children's activities provided an opportunity to develop and preserve family well-being ( Evans et al., 2020 ).
During the pandemic, it should be more widely focused on helping family members generate their individual space. A good and intensive family communication is needed to deal with the uncertainty of the COVID-19 pandemic. Some interventions are needed to improve maternal and child health and nutrition, such as strengthening the food supply chain, reducing food insecurity, building a net social security program, and a cash support program for the disadvantaged families during the COVID-19 pandemic. Based on the literature review, it is recommended to increase public awareness to staying connected and reporting if they find any family violence. Improving the readiness and knowledge of healthcare providers and counselors is needed to provide counseling services to help families who have physical and mental health problems. Fulfilling parents with updated information and guidance is important to deal with pandemic especially how to have working life balance and quality of life between working, guiding children in their homeschooling and other activities. Providing parenting resources during COVID-19 including conflict management is needed to have positive relationship and manage parenting stress. The government should take action to mitigate the social, economic, and health impacts of the pandemic on families, especially those who are vulnerable to losing household income. During the pandemic, it is important to maintain family well-being by staying connected with communication, managing conflict, and making quality time within family. Promoting family resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.
This study has some limitations. The limitation of this article is the possibility of omission of the potential article related to the family welfare during the COVID-19 pandemic. Moreover, the exclusion of unpublished articles will become another limitation. The findings of this literature review were mostly conducted in higher-income countries, which limits the generalization of the findings to low- and middle-income countries. The future research is required regarding family welfare as responses to women’s empowerment during the COVID-19 pandemic with homogenous family’s samples or with a large sample size with heterogeneity of welfare's status. The future research can be conducted by mixed methods between qualitative and quantitative methods.
COVID-19 outbreak around the world has become a public health concern. The coronavirus pandemic has had a substantial impact on the family's life. Physical and mental health problems, economic instability, and family violence are social issues during the pandemic that should be dealt with. The government should take action to mitigate the social, economic, and health impacts of the pandemic on families especially those who are vulnerable to losing household income. Promoting family welfare and resilience through shared beliefs and close relationships within families is needed during the COVID-19 pandemic.
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
ORCID iDs: Maria Gayatri https://orcid.org/0000-0002-2792-5586
Mardiana Dwi Puspitasari https://orcid.org/0000-0002-6827-3350
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Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form. To help students explain how the pandemic affected them, The Common App ...
How to Write About Coronavirus Using the Special COVID-19 (250-Word) Section on the Common App. Option 1: The Straightforward Way. Option 2: The Slightly More Creative Way. How to Write About Coronavirus Using the (650-Word) Additional Information Section.
100 Words Essay on Covid 19. COVID-19 or Corona Virus is a novel coronavirus that was first identified in 2019. It is similar to other coronaviruses, such as SARS-CoV and MERS-CoV, but it is more contagious and has caused more severe respiratory illness in people who have been infected. The novel coronavirus became a global pandemic in a very ...
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Horrific history. Looking back, the COVID-19 pandemic stands as arguably the most disruptive event of the 21st century, surpassing wars, the September 11, 2001, terrorist attacks, the effects of climate change, and the Great Recession. It has killed more than seven million people to date and reshaped the world economy, public health, education ...
Community disruptions such as COVID-19 and natural disasters can have deep and long-lasting impacts. If you need it, this space is yours to describe those impacts. Colleges care about the effects on your health and well-being, safety, family circumstances, future plans, and education, including access to reliable technology and quiet study spaces.
This essay examines key aspects of social relationships that were disrupted by the COVID-19 pandemic. It focuses explicitly on relational mechanisms of health and brings together theory and emerging evidence on the effects of the COVID-19 pandemic to make recommendations for future public health policy and recovery. We first provide an overview of the pandemic in the UK context, outlining the ...
experienced an average decrease of 11.5 hours of work per week and a 21% decrease in weekly earnings, arnings for 52% of the sample, which again re ects s. variation in the e ects of COVID-19 across students. In terms of labor market expectations, on average, students foresee a 13 percentage points decrease in.
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Writing About Coronavirus in Main and Supplemental Essays. Students can choose to write a full-length college essay on the coronavirus or summarize their experience in a shorter form. To help ...
Reading time: 3 min (864 words) The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty ...
1. Introduction. The newly identified infectious coronavirus (SARS-CoV-2) was discovered in Wuhan and has spread rapidly since December 2019 within China and to other countries around the globe (Zhou et al., 2020; Kabir et al., 2020).The source of SARS-CoV-2 is still unclear (Gorbalenya et al., 2020).Fig. 1 demonstrates the initial timeline of the development of SARS-CoV-2 (Yan et al., 2020).
1. Introduction. The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented changes in people's daily lives, with implications for mental health and well-being [1-4], both at the level of a given country's population, and when considering specific vulnerable groups [5-7].In order to mitigate the untoward impact of the pandemic (including lockdown) and support mental health ...
From lifestyle changes to better eating habits, people are using this time to get healthier in many areas. Since the pandemic started, nearly two-thirds of the survey's participants (62%) say ...
In conclusion, COVID-19 tested the patience and resilience of the mankind. This pandemic has taught people the importance of patience, effort and humbleness. Also Read: Essay on My Best Friend. Essay On COVID-19 in 300 Words. COVID-19, also known as the coronavirus, is a serious and contagious disease that has affected people worldwide.
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The COVID-19 pandemic has had a profound impact on individuals, societies, and economies worldwide. Its multifaceted nature presents a wealth of topics suitable for academic exploration. This essay provides guidance on developing engaging and insightful essay topics related to COVID-19, offering a comprehensive range of perspectives to choose from.
COVID-19 (Coronavirus) has affected day to day life and is slowing down the global economy. This pandemic has affected thousands of peoples, who are either sick or are being killed due to the spread of this disease. The most common symptoms of this viral infection are fever, cold, cough, bone pain and breathing problems, and ultimately leading ...
The transition to an online education during the coronavirus disease 2019 (COVID-19) pandemic may bring about adverse educational changes and adverse health consequences for children and young adult learners in grade school, middle school, high school, college, and professional schools. The effects may differ by age, maturity, and socioeconomic ...
This essay discusses the impact that these challenges have or could have on people with chronic disease now and in the future. Exploring the impact of COVID-19 should help the public health and health care communities effectively improve health outcomes. ... The effects of COVID-19, whether negative or positive, on health care and public health ...
As the coronavirus pandemic continues its deadly path, dramatic changes in how people live are reducing some instances of other medical problems. Bryn Nelson writes that the irony may hold valuable lessons for public health Doctors and researchers are noticing some curious and unexpectedly positive side effects of the abrupt shifts in human behaviour in response to the covid-19 pandemic.
As schools have been closed to cope with the global pandemic, students, parents and educators around the globe have felt the unexpected ripple effect of the COVID-19 pandemic. While governments, frontline workers and health officials are doing their best slowing down the outbreak, education systems are trying to continue imparting quality ...
In the U.S., COVID-19 deaths peaked at nearly 26,000 a week in January 2021, the month a wide rollout of COVID-19 vaccines began. U.S. hospitalizations reached a peak 1 year later at 35.4 per 100,000 people, after the highly transmissible Omicron had burst onto the scene, causing record numbers of infections.
The effect of the COVID-19 pandemic will be felt long after the last rapid test comes back positive. Millions today are still suffering from " long COVID "—a range of medical conditions that ...
Understanding these points helps us understand the wide-reaching effects of Covid-19 on our lives. Paragraph Writing on Covid 19 in 150 Words. The COVID-19 pandemic, caused by the SARS-CoV-2 virus, began in late 2019 and rapidly spread across the globe, becoming one of the most challenging public health crises in recent history.
The magnitude of effect on clinical outcomes was larger when metformin was started earlier in the course of infection at <4 days from symptom onset, with metformin reducing the odds of severe COVID-19 by 55% (OR, 0.45; 95% CI, .22 to .93) and of long COVID by 65% (hazard ratio = 0.35; 95% CI, .15 to .95; Figure 4).
It is found that expanding SOP for nurse practitioners during the pandemic causes adverse effects on patients measured by COVID‐19 mortality, but there is no evidence that expanding SOP for nurse practitioners during the pandemic causes adverse effects on patients measured by COVID‐19 mortality. Public safety is often used as an argument against expanding scope of practice (SOP) for nurse ...
Test for COVID-19. If you have COVID-19 symptoms, test for the infection. If you are exposed, test five days after you came in contact with the virus. In the United States, the Food and Drug Administration, also known as the FDA, approves or authorizes the tests.
The long-term effects of COVID-19 and COVID-19 vaccines are a concern for the U.S. military, which saw nearly 500,000 cases of the coronavirus in the first two years of the pandemic and required ...
Background: COVID-19 has changed family life, including employment status, financial security, the mental health of individual family members, children's education, family well-being, and family resilience. The aim of this study is to analyze the previous studies in relation to family well-being during the COVID-19 pandemic. Methods: A literature review was conducted on PubMed, Medline, Web of ...