自然杀伤(NK)细胞与2019冠状病毒病(COVID-19)发生发展的研究进展

自然杀伤(NK)细胞在清除病毒,执行免疫调节方面发挥着重要的作用,它通过分泌趋化因子以及与其他天然免疫细胞协同作用,被赋予天然免疫调节功能和获得性免疫反应。随着对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的2019冠状病毒病(COVID-19)的研究深入,发现NK细胞在其中发挥着重要作用。SARS-CoV-2感染会影响NK细胞的分布和效应功能,NK细胞的免疫应答或可影响新冠肺炎患者的预后。本文总结了近年来NK细胞在COVID-19感染中作用的研究现状,并且讨论了以NK细胞作为治疗剂的可能性,以期为防治SARS-CoV-2的免疫损害提供潜在思路。

Historical review and reflections on the participation of acupuncture and moxibustion in the treatment of epidemics in the People’s Republic of China (from 1950 until now)

Since the establishment of the People’s Republic of China, both the Communist Party and the government have placed great emphasis on the advancement of traditional Chinese medicine. Acupuncture and moxibustion have been actively involved in combating major epidemics such as malaria, schistosomiasis, and COVID-19. This article conducts a historical review of these three significant cases to elucidate how the acupuncture community has effectively utilized its unique advantages and characteristics through theoretical discussions, clinical practices, experimental research, as well as receiving administrative leadership and political support from the Communist Party of China and government. We provide an objective evaluation of their effectiveness while summarizing historical experiences to serve as a reference for future utilization of acupuncture and moxibustion therapy in epidemic relief efforts. Additionally, propose four suggestions: strengthening Party leadership and enhancing political support;timely summarization of experiences to establish programs and systems;deepening scientific research by integrating experimental findings with clinical practice;focusing on public awareness campaigns and education to solidify grassroots foundations.

Understanding the Treatment of COVID-19 and other Epidemics in Traditional Chinese Medicine

Epidemics spread quickly and are highly contagious.And there has been a profound understanding of etiology,pathogenesis,prevention,and treatment of these diseases in traditional Chinese medicine(TCM).Coronavirus disease 2019(COVID‑19)falls into the category of“epidemic dampness”,and the core pathogenesis is that latency of externally‑contracted dampness turbidity and epidemic toxin in pleurodiaphragmatic interspace provokes Shaoyang ministerial fire and causes concomitant attack of external and internal pathogens,resulting in wood fire tormenting metal and the upward rushing of dampness fire(toxin),ultimately leading to a syndrome of epidemic toxin blocking the lung.Throughout the treatment of COVID‑19,Professor Shiyun Yan uses the“harmonizing”method and sticks to the basic principles of“protecting middle qi,pectoral qi and yin fluid”to consolidate the root,dispersing externally and clearing internally and using in combination drugs cold and warm in property.The specific treatment approaches include ventilating lung and expelling pathogens,clearing heat and removing the toxin,tonifying qi and nourishing yin,activating blood and resolving stasis,resolving dampness,and dredging collaterals,to prevent the patient’s condition from getting worse and save the dying.

Understanding the Treatment of COVID-19 and other Epidemics in Traditional Chinese Medicine

Epidemics spread quickly and are highly contagious.And there has been a profound understanding of etiology,pathogenesis,prevention,and treatment of these diseases in traditional Chinese medicine(TCM).Coronavirus disease 2019(COVID-19)falls into the category of“epidemic dampness”,and the core pathogenesis is that latency of externally-contracted dampness turbidity and epidemic toxin in pleurodiaphragmatic interspace provokes Shaoyang ministerial fire and causes concomitant attack of external and internal pathogens,resulting in wood fire tormenting metal and the upward rushing of dampness fire(toxin),ultimately leading to a syndrome of epidemic toxin blocking the lung.Throughout the treatment of COVID-19,Professor Shiyun Yan uses the“harmonizing”method and sticks to the basic principles of“protecting middle qi,pectoral qi and yin fluid”to consolidate the root,dispersing externally and clearing internally and using in combination drugs cold and warm in property.The specific treatment approaches include ventilating lung and expelling pathogens,clearing heat and removing the toxin,tonifying qi and nourishing yin,activating blood and resolving stasis,resolving dampness,and dredging collaterals,to prevent the patient’s condition from getting worse and save the dying.

Partial Unlock for COVID-19-Like Epidemics Can Save 1 - 3 Million Lives Worldwide

Background: A large percentage of deaths in an epidemic or pandemic can be due to overshoot of population (herd) immunity, either from the initial peak or from planned or unplanned exit from lockdown or social distancing conditions. Objectives: We study partial unlock or reopening interaction with seasonal effects in a managed epidemic to quantify overshoot effects on small and large unlock steps and discover robust strategies for reducing overshoot. Methods: We simulate partial unlock of social distancing for epidemics over a range of replication factor, immunity duration and seasonality factor for strategies targeting immunity thresholds using overshoot optimization. Results: Seasonality change must be taken into account as one of the steps in an easing sequence, and a two-step unlock, including seasonal effects, minimizes overshoot and deaths. It may cause undershoot, which causes rebounds and assists survival of the pathogen. Conclusions: Partial easing levels, even low levels for economic relief while waiting on a vaccine, have population immunity thresholds based on the reduced replication rates and may experience overshoot as well. We further find a two-step strategy remains highly sensitive to variations in case ratio, replication factor, seasonality and timing. We demonstrate a three or more step strategy is more robust, and conclude that the best possible approach minimizes deaths under a range of likely actual conditions which include public response.

Dynamics of the coronavirus disease 2019(COVID-19)epidemic in Wuhan City,Hubei Province and China:a second derivative analysis of the cumulative daily diagnosed cases during the first 85 days

Background:Controlling the coronavirus disease 2019(COVID-19)epidemic requires information beyond new and cumulative cases.This study aims to conduct an in-depth analysis by geographic strata:Wuhan City(hereafter referred to as Wuhan)only,Hubei Province(hereafter referred to as Hubei)excluding Wuhan,and China excluding Hubei.Methods:Daily cumulative confirmed COVID-19 cases between December 8,2019(the date of symptom onset based on patients'recall during the investigation),and March 1,2020,from official sources and published studies were analyzed.The second derivative model was used for information extraction.Data analysis was conducted separately for the three strata.Results:A total of 80026 diagnosed COVID-19 cases were reported during the first 85 days of the epidemic,with 49315 cases from Wuhan,17788 from Hubei excluding Wuhan,and 12923 from China excluding Hubei.Analytical results indicate that the COVID-19 epidemic consists of an Acceleration,a Deceleration,and a Stabilization Phase in all three geographic strata,plus a Silent Attack Phase for Wuhan only.Given the reported incubation period of 14 days,effects of the massive anti-epidemic actions were revealed by both the Acceleration and Deceleration Phases.The Acceleration Phase signaled the effect of the intervention to detect the infected;the Deceleration Phase signaled the declines in new infections after the infected were detected,treated and quarantined.Conclusion:Findings of the study provide new evidence to better monitor the epidemic,evaluate its response to intervention,and predict the trend long.In addition to re-evaluating the control of the COVID-19 epidemic in China,this study provided a model for monitoring outbreaks of COVID-19 in different countries across the world.

突发公共卫生事件的应急管理机制探析--以COVID-2019疫情为例

突发公共卫生事件具有突发性、难以控制性、危害性、衍生性、扩散性等特点。应急管理包括事前预防、事发准备、事中响应和事后恢复四个阶段。新冠肺炎疫情对我国经济发展形成了较大冲击,疫情信息报送和舆论把控缺陷形成了新冠肺炎疫情防控冲击,导致部分民众产生心理误区。新冠肺炎疫情背景下我国公共卫生事件应急管理存在政府公共管理职能薄弱、信息管理机制不够完善、公共卫生领域存在隐患等主要问题。完善突发公共卫生事件应急管理机制必须重视公共卫生事件前期预警、完善公共卫生事件初期应对机制、强化公共卫生事件中期管理、促进公共卫生事件后期恢复。

普通发热门诊患者随访对COVID-2019筛查的临床价值

目的:探讨普通发热门诊患者随访对新型冠状病毒肺炎(COVID-2019)筛查的临床价值。方法:以800例急诊普通发热门诊患者作为研究对象,电话追踪随访患者并登录门诊及住院系统查询患者相关检查结果进行综合分析。结果:随访800名患者中,发热患者310例(38.75%),有呼吸道症状患者524例(65.5%),无呼吸道症状患者276例(34.5%),经初诊后回家症状缓解不明显患者18例(2.25%),其中4例患者复诊查肺部CT提示符合病毒性肺炎疑似病例特征,经新型冠状病毒核酸检测均为阴性。结论:普通发热门诊患者(非疫区)的随访对及时排查COVID-2019有重要意义,并能最大限度减少患者病情的扩散对社会造成的影响。

2019冠状病毒病(COVID-19)实验室诊断方法的应用现状

严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)系通过分析鉴定2019年武汉不明原因的肺炎病例而被发现。世界卫生组织将该新型冠状病毒感染的肺炎命名为2019冠状病毒病(corona virus disease 2019,COVID-19)。COVID-19的实验室诊断方法主要有基于病毒核酸的病原学检查、通过特异性抗体检测的血清学检测以及一般检查。目前,实时逆转录PCR是COVID-19确诊的金标准,但该方法存在漏检和假阴性的问题,因此,为了更有效防控COVID-19,有必要发展高质量、高敏感的诊断方法。本文综述了COVID-19实验室诊断方法的应用现状及最新进展,以期为快速准确诊断COVID-19提供参考。

NLRP3炎性体与2019冠状病毒病(COVID-19)肺损伤的研究进展

强烈的炎症反应是2019冠状病毒病(COVID-19)急性肺损伤的主要原因,严重急性呼吸综合征冠状病毒2(SARS-CoV-2)通过与受体血管紧张素转化酶2(ACE2)结合进入肺部上皮细胞等靶细胞,激活含pyrin结构域核苷酸结合寡聚结构域样受体家族蛋白3(NLRP3)炎性体,活化前体caspase-1,释放成熟的IL-1β和IL-18等炎性细胞因子,参与炎症反应及诱导细胞焦亡,从而导致COVID-19患者肺部炎症细胞浸润,充血,水肿,严重者可伴有急性呼吸窘迫综合征(ARDS)、弥散性血管内凝血(DIC)等多种并发症。目前尚无治疗COVID-19的特定药物,MCC950及秋水仙碱等NLRP3炎性体抑制已经广泛应用于治疗各种炎症性疾病,而目前这些药物也正处于治疗COVID-19患者的临床试验阶段。我们总结了COVID-19发病机制及SARS-CoV激活NLRP3炎性体途径,以期初步揭示NLRP3炎性体在SARS-CoV-2感染过程中所扮演的角色及其机制,为研发相关靶向药物提供理论基础。

The origin, transmission and clinical therapies on coronavirus disease 2019(COVID-19) outbreak——an update on the status

An acute respiratory disease,caused by a novel coronavirus(SARS-CoV-2,previously known as 2019-nCoV),the coronavirus disease 2019(COVID-19)has spread throughout China and received worldwide attention.On 30 January 2020,World Health Organization(WHO)officially declared the COVID-19 epidemic as a public health emergency of international concern.The emergence of SARS-CoV-2,since the severe acute respiratory syndrome coronavirus(SARSCoV)in 2002 and Middle East respiratory syndrome coronavirus(MERS-CoV)in 2012,marked the third introduction of a highly pathogenic and large-scale epidemic coronavirus into the human population in the twenty-first century.As of 1 March 2020,a total of 87,137 confirmed cases globally,79,968 confirmed in China and 7169 outside of China,with 2977 deaths(3.4%)had been reported by WHO.Meanwhile,several independent research groups have identified that SARS-CoV-2 belongs toβ-coronavirus,with highly identical genome to bat coronavirus,pointing to bat as the natural host.The novel coronavirus uses the same receptor,angiotensin-converting enzyme 2(ACE2)as that for SARS-CoV,and mainly spreads through the respiratory tract.Importantly,increasingly evidence showed sustained human-tohuman transmission,along with many exported cases across the globe.The clinical symptoms of COVID-19 patients include fever,cough,fatigue and a small population of patients appeared gastrointestinal infection symptoms.The elderly and people with underlying diseases are susceptible to infection and prone to serious outcomes,which may be associated with acute respiratory distress syndrome(ARDS)and cytokine storm.Currently,there are few specific antiviral strategies,but several potent candidates of antivirals and repurposed drugs are under urgent investigation.In this review,we summarized the latest research progress of the epidemiology,pathogenesis,and clinical characteristics of COVID-19,and discussed the current treatment and scientific advancements to combat the epidemic novel coronavirus.

Epidemiological and clinical characteristics of COVID-19 patients in Hengyang,Hunan Province,China

BACKGROUND In December 2019,an ongoing outbreak of coronavirus disease 2019(COVID-19)was first identified in Wuhan,China.The characteristics of COVID-19 patients treated in local hospitals in Wuhan are not fully representative of patients outside Wuhan.Therefore,it is highly essential to analyze the epidemiological and clinical characteristics of COVID-19 in areas outside Wuhan or Hubei Province.To date,a limited number of studies have concentrated on the epidemiological and clinical characteristics of COVID-19 patients with different genders,clinical classification,and with or without basic diseases.AIM To study the epidemiological and clinical characteristics of COVID-19 patients in Hengyang(China)and provide a reliable reference for the prevention and control of COVID-19.METHODS From January 16 to March 2,2020,a total of 48 confirmed cases of COVID-19 were reported in Hengyang,and those cases were included in this study.The diagnostic criteria,clinical classification,and discharge standard related to COVID-19 were in line with the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia(Trial Version 7)released by National Health Commission and National Administration of Traditional Chinese Medicine.The presence of SARS-CoV-2 in pharyngeal swab specimens was detected by quantitative reverse transcription polymerase chain reaction.All the data were imported into the excel worksheet and statistically analyzed by using SPSS 25.0 software.RESULTS A total of 48 cases of COVID-19 were collected,of which 1 was mild,38 were moderate,and 9 were severe.It was unveiled that there were 31(64.6%)male patients and 17(35.4%)female patients,with a female-to-male ratio of 1.82:1.The range of age of patients with COVID-19 was dominantly 30-49 years old[25(52.1%)of 48],followed by those aged over 60 years old[11(22.9%)].Besides,29.2%(14 of 48)of patients had basic diseases,and 57.2%(8 of 14)of patients with basic diseases were aged over 60 years old.The occupations of 48 COVID-19 patients were mainly farmers working in agricultural production[15(31.5%)of 48],rural migrant workers from Hengyang to Wuhan[15(31.5%)],and service workers operating in the service sector[8(16.7%)].The mean latent period was 6.86±3.57 d,and the median was 7[interquartile range(IQR):4-9]d.The mean time from onset of symptoms to the first physician visit was 3.38±2.98(95%CI:2.58-9.18)d,with a median of 2(IQR:1-5)d,and the mean time from hospital admission to confirmed diagnosis was 2.29±2.11(95%CI:1.18-6.42)d,with a median of 2(IQR:1-3)d.The main symptoms were fever[43(89.6%)of 48],cough and expectoration[41(85.4%)],fatigue[22(45.8%)],and chills[22(45.8%)].Other symptoms included poor appetite[13(27.1%)],sore throat[9(18.8%)],dyspnea[9(18.8%)],diarrhea[7(14.6%)],dizziness[5(10.4%)],headache[5(10.4%)],muscle pain[5(10.4%)],nausea and vomiting[4(8.3%)],hemoptysis[4(8.3%)],and runny nose[1(2.1%)].The numbers of peripheral blood leukocytes,lymphocytes,and eosinophils were significantly reduced in the majority of the patients.The levels of C-reactive protein,fibrinogen,blood glucose,lactate dehydrogenase,Ddimer,alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transferase(γ-GT),myoglobin(MB),and creatine kinase(CK)were increased in 64.6%,44.7%,43.2%,37.0%,29.5%,22.9%,20.8%,21.6%,13.6%,and 12.8%of patients,respectively.The incidence of ALT elevation in male patients was remarkably higher than that in females(P<0.01),while the incidences of AST,CK,and blood glucose elevations in severe patients were remarkably higher than those in moderate patients(P<0.05,respectively).Except for the mild patients,chest computed tomography showed characteristic pulmonary lesions.All the patients received antiviral drugs,38(79.2%)accepted traditional Chinese medicine,and 2(4.2%)received treatment of human umbilical-cord mesenchymal stem cells.On March 2,2020,48 patients with COVID-19 were all cured and discharged.CONCLUSION Based on our results,patients with COVID-19 often have multiple organ dysfunction or damage.The incidences of ALT elevation in males,and AST,CK,and blood glucose elevations in severe patients are remarkably higher.

The Sunspot Cycle Leads to Origin and Epidemic Mechanism of Novel Coronavirus COVID-19

Listed examples of virus transmission epidemics that can be strongly transmitted through the air caused by sunspot change cycle, analyzed the mechanism that promotes the generation of new viruses. From the schematic diagram of the changes in the combined force of the hydrodynamic effect of the sun sweeping the earth and the sweeping force, we obtain the places that are prone to light vortices are 30 degrees north latitude and 30 degrees south latitude on the east coast of the mainland creatively. The curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. And the curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. It is inferred that the light vortex produces the special amplified energy so that can make the virus mutate to produce a new highly infectious novel coronavirus. The earliest known place and time of the novel coronavirus origin are consistent with the reasoning of the new theory. Because the radius and frequency of the light vortex are different, the resulting virus strains are also different. Moreover, the fatality rate in the light vortex area is much higher than that in the non-light vortex area, indicating that the virus’s toxicity and lethality are higher in the light vortex area, so it can explain why Russia, India, and countries in the African equatorial region mortality are much lower than the United States, Italy, Spain and Brazil. Finally, preventive and recommended measures are proposed.

Coronavirus disease 2019 (COVID-19) and global mental health

The mental health effects of the coronavirus disease 2019(COVID-19)pandemic may shape population health for many years to come.Failure to address the mental health issues stemming from the pandemic is likely to prolong its impact.The COVID-19 pandemic has created a significant global challenge and,in lower-income countries,even a disruption of mental health services.Given our experience with previous pandemics,the present COVID-19 crisis can be expected to cause psychological trauma,and steps are needed to address this issue proactively.Policies focusing on the long-term mental health consequences of COVID-19 may equal the importance of those currently seeking to mitigate its physical effects.The implications of the GOVID-19 pandemic for mental health call for a greater focus on the needs of those with mental disorders and on mental health issues affecting health care workers and the general public.Timely preventive and therapeutic mental health care is essential in addressing the psychosocial needs of populations exposed to the pandemic.In addition to specialist care,"task-shifting"and digital technologies may provide cost-effective means of providing mental health care in lower-income countries worldwide as well as in higher-income countries with mental health services overwhelmed by the effects of the COVID-19 pandemic.In view of the ever-increasing pressure on global health systems resulting from the COVID-19 pandemic,adopting and adapting"task-shifting",i.e.,the delegation of psychotherapeutic interventions to trained non-specialists,as an element of the provision of mental health services,is overdue.Digital technologies can be used to enhance social support and facilitate resilience to the detrimental mental health effects of the pandemic;they may also offer an efficient and cost-effective way to provide easy access to mentalhealth care.

Coronavirus disease 2019 (COVID-19) pandemic: how countries shouldbuild more resilient health systems for preparedness and response

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.

Occupational health protection for health workers during the coronavirus disease 2019(COVID-19)pandemic:6P-approach in China

Health workers(HW)are on the frontline fighting against the COVID-19 pandemic,they are exposed to multiple occupational hazards.This article analyzed the comprehensive measures of protecting HWs during the COVID-19 response in China.Occupational health protection of HWs was one of the key strategies of the public health measures adopted against the COVID-19 outbreak from the earliest stage in China.This prioritization of HWs health protection was based on the technical and policy guidance of WHO and International Labor Organization as well as the experiences from previous outbreaks in China.The comprehensive measures in China can be summarized as‘6P-approach’:public health emergency response,prompt learning from lessons,proactive measures of occupational health,precaution strategies against occupational hazards,personal protective equipment and medical devices supply,and professional networking.Through this 6P-approach,China was able to minimize the incidence of COVID-19 infection among HWs,while successfully containing the outbreak dxuing the first quarter of 2020.Although the COVID-19 vaccines have been rolled out,however,the COVID-19 pandemic is still under rapidly evolving situation.Experiences from China may provide other countries with an example of prioritizing and incorporating occupational health protection of HWs in their public health measures responding to the COVID-19 pandemic.

Early stage risk communication and community engagement(RCCE)strategies and measures against the coronavirus disease 2019(COVID-19)pandemic crisi

Coronavirus disease 2019(COVID-19)pandemic has proven to be tenacious and shows that the global commu nity is still poorly prepared to handling such emerging pandemics.Enhancing global solidarity in emergency preparedness and response,and the mobilization of conscience and cooperation,can serve as an excellent source of ideas and measures in a timely manner.The article provides an overview of the key components of risk communication and community engagement(RCCE)strategies at the early stages in vulnerable nations and populations,and highlight contextual recommendations for strengthening coordinated and sustainable RCCE preventive and emergency response strategies against COVID-19 pandemic.Global solidarity calls for firming govemance,abundant community participation and enough trust to boost early pandemic preparedness and response.Promoting public RCCE response interventions needs crucially improving government health systems and security proactiveness,community to individual confinement,trust and resilience solutions.To better understand population risk and vulnerability,as well as COVID-19 transmission dynamics,it is important to build intelligent systems for monitoring isolation/quarantine and tracking by use of artificial intelligence and machine learning systems algorithms.Experiences and lessons learned from the international community is crucial for emerging pandemics prevention and control programs,especially in promoting evidence-based decision-making,integrating data and models to inform effective and sustainable RCCE strategies,such as local and global safe and effective COVID-19 vaccines and mass immunization programs.

Global health governance for travel health: lessons learned from thecoronavirus disease 2019 (COVID-19) outbreaks in large cruise ships

Background: The outbreak and global pandemic of coronavirus disease 2019 (COVID-19) attracts a great deal ofattentions to the problem of travel health. Cruise tourism is increasingly popular, with an estimated 30 millionpassengers transported on cruise ships worldwide each year. Safeguarding the health of cruise travelers duringthe entire travel is of ultimate importance for both the industry and global public health.Objective: This study aimed to explore the challenges and opportunities in travel health from the perspective ofglobal health governance.Methods: The global governance framework including problems, values, tools or regulations, and actors relatedto travel health were used to analyze the issues involved.Results: Up to April 2020, nearly thirty cruise ship voyages reported COVID-19 cases. The Diamond Princess,Grand Princess and Ruby Princess cruise ship had over 1,400 total reported COVID-19 cases, and more than 30deaths. A community with a common future in travel health is the core value of global health governance fortravel health. The travel-related international regulations, including the International Health Regulation (IHR[2005]), United Nations Convention on the Law of the Sea (UNCLOS) and the International Maritime Organization(IMO) conventions should be further updated to deal with the travel health problems. The roles andresponsibilities and the cooperation mechanisms of different actors are not clear in relation to the public healthemergencies during the travel.Conclusion: Travel health transcends national borders and involves multilevel actors, thus needs globalcooperation and governance. Regulations and legislation at global and country level are required to preventlarge-scale humanitarian crisis on travel health. Multilateral coordination, cooperation and collaborationmechanisms between governments, intergovernmental organizations, non-governmental organizations andindustry are needed to build a better community of common destiny for travel health.

Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019(COVID-19)pandemic in South Africa:a systematic review

Aims:To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019(COVID-19)and the challenges associated with their use.Metiiods:To determine the status of digital health utilization during COVID-19 in South Africa,the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study.We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021.Results:Total of 24 articles were included into this study.This study revealed that South Africa adopted digital technologies such as SMS-based solutions,mobile health applications,telemedicine and telehealth,WhatsApp-based systems,artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic.These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases,disease surveillance and monitoring,medication and treatment compliance,creating awareness and communication.The study also revealed that teleconsultation and e-prescription,telelaboratory and telepharmacy,teleeducation and teletraining,teledermatology,teleradiology,telecardiology,teleophthalmology,teleneurology,telerehabilitation,teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa.However,these smart digital health technologies face several impediments such as infrastructural and technological barriers,organization and financial barriers,policy and regulatory barriers as well as cultural barriers.Conclusion:Although COVID-19 has invigorated the use of digital health technologies,there are still some shortcomings.The outbreak of pandemics like COVID-19 in the future is not inevitable.Therefore,we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.

Public health preparedness and responses to the coronavirus disease 2019(COVID-19)pandemic in South Asia:a situation and policy analysis

Like rest of the world,the South Asian region is facing enormous challenges with the coronavirus disease 2019(COVID-19)pandemic.The socio-economic context of the eight South Asian countries is averse to any longterm lockdown program,but the region still observed stringent lockdown close to two months.This paper analyzed major measures in public health preparedness and responses in those countries in the pandemic.The research was based on a situation analysis to discuss appropriate plan for epidemic preparedness,strategies for prevention and control measures,and adequate response management mechanism.Based on the data from March 21 to June 26,2020,it appeared lockdown program along with other control measures were not as effective to arrest the exponential growth of fortnightly COVID-19 cases in Afghanistan,Bangladesh,India,Nepal and Pakistan.However,Bhutan,Maldives and Sri Lanka have been successfully limiting the spread of the disease.The in-depth analysis of prevention and control measures espoused densely populated context of South Asia needs community-led intervention strategy,such as case containment,in order to reverse the growing trend,and adopt the policy of mitigation instead of suppression to formulate COVID-19 action plan.On the other hand,mechanism for response management encompassed a four-tier approach of governance to weave community-led local bodies with state,national and international governance actors for enhancing the countries’emergency operation system.It is concluded resource-crunch countries in South Asia are unable to cope with the disproportionate demand of capital and skilled health care workforce at the time of the pandemic.Hence,response management needs an approach of governance maximization instead of resource maximization.The epidemiologic management of population coupled with suitable public health prevention and control measures may be a more appropriate strategy to strike a balance between economy and population health during the time of pandemic.