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      Concealment of Potential Exposure to COVID-19 and Its Impact on Outbreak Control: Lessons from the HIV Response

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          Abstract.

          Globally, more than 4 million people have been infected with COVID-19, and more than 300,000 deaths have been reported across 188 countries. Concealment of one’s potential exposure to the virus has negative implications for the spread of COVID-19 across the socio-ecological spectrum, including the futility of contact-tracing efforts, exposure of frontline staff, and the spread of COVID-19 in the community. We draw lessons learned from HIV to discuss stigma and the attribution of blame surrounding the phenomenon of concealment of one’s potential exposure to COVID-19 using a socio-ecological perspective. This article also illustrates the psychosocial aspect of the disease, and the negative repercussions of concealment of potential exposure on transmission in the community and to front-liners, healthcare resources, and outbreak containment.

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          Most cited references17

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          Presumed Asymptomatic Carrier Transmission of COVID-19

          This study describes possible transmission of novel coronavirus disease 2019 (COVID-19) from an asymptomatic Wuhan resident to 5 family members in Anyang, a Chinese city in the neighboring province of Hubei.
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            The outbreak of COVID-19 coronavirus and its impact on global mental health

            The current outbreak of COVID-19 coronavirus infection among humans in Wuhan (China) and its spreading around the globe is heavily impacting on the global health and mental health. Despite all resources employed to counteract the spreading of the virus, additional global strategies are needed to handle the related mental health issues. Published articles concerning mental health related to the COVID-19 outbreak and other previous global infections have been considered and reviewed. This outbreak is leading to additional health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger and fear globally. Collective concerns influence daily behaviors, economy, prevention strategies and decision-making from policy makers, health organizations and medical centers, which can weaken strategies of COVID-19 control and lead to more morbidity and mental health needs at global level.
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              COVID-19: protecting health-care workers

              The Lancet (2020)
              Worldwide, as millions of people stay at home to minimise transmission of severe acute respiratory syndrome coronavirus 2, health-care workers prepare to do the exact opposite. They will go to clinics and hospitals, putting themselves at high risk from COVID-2019. Figures from China's National Health Commission show that more than 3300 health-care workers have been infected as of early March and, according to local media, by the end of February at least 22 had died. In Italy, 20% of responding health-care workers were infected, and some have died. Reports from medical staff describe physical and mental exhaustion, the torment of difficult triage decisions, and the pain of losing patients and colleagues, all in addition to the infection risk. As the pandemic accelerates, access to personal protective equipment (PPE) for health workers is a key concern. Medical staff are prioritised in many countries, but PPE shortages have been described in the most affected facilities. Some medical staff are waiting for equipment while already seeing patients who may be infected or are supplied with equipment that might not meet requirements. Alongside concerns for their personal safety, health-care workers are anxious about passing the infection to their families. Health-care workers who care for elderly parents or young children will be drastically affected by school closures, social distancing policies, and disruption in the availability of food and other essentials. Health-care systems globally could be operating at more than maximum capacity for many months. But health-care workers, unlike ventilators or wards, cannot be urgently manufactured or run at 100% occupancy for long periods. It is vital that governments see workers not simply as pawns to be deployed, but as human individuals. In the global response, the safety of health-care workers must be ensured. Adequate provision of PPE is just the first step; other practical measures must be considered, including cancelling non-essential events to prioritise resources; provision of food, rest, and family support; and psychological support. Presently, health-care workers are every country's most valuable resource. © 2020 Denis Lovrovic/AFP/Getty Images 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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                Author and article information

                Journal
                Am J Trop Med Hyg
                Am. J. Trop. Med. Hyg
                tpmd
                tropmed
                The American Journal of Tropical Medicine and Hygiene
                The American Society of Tropical Medicine and Hygiene
                0002-9637
                1476-1645
                July 2020
                26 May 2020
                26 May 2020
                : 103
                : 1
                : 35-37
                Affiliations
                [1 ]Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore;
                [2 ]Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
                Author notes
                [* ]Address correspondence to Alvin Kuo Jing Teo, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, 12 Science Dr. 2, #10-01, Singapore, Singapore 117549. E-mail: alvin.teo@ 123456aol.com

                Financial support: R. K. J. T. is supported by the Courage Fund Ph.D. (Infectious Disease) Scholarship. A. K. J. T. is supported by the National University of Singapore President’s Graduate Fellowship.

                Authors’ addresses: Alvin Kuo Jing Teo and Rayner Kay Jin Tan, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore, E-mails: alvin.teo@ 123456aol.com and rayner.tan@ 123456u.nus.edu . Kiesha Prem, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore, and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: kiesha.prem@ 123456gmail.com .

                [†]

                These authors contributed equally to this work.

                Article
                tpmd200449
                10.4269/ajtmh.20-0449
                7356408
                32458787
                821370d4-fe9a-4032-9405-75a9e0e35f92
                © The American Society of Tropical Medicine and Hygiene

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 09 May 2020
                : 21 May 2020
                Page count
                Pages: 3
                Categories
                Perspective Piece

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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