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      Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic

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          Highlights

          • There is moderate awareness related to transmission and symptoms of COVID-19 among educated population in India.

          • There is adequate awareness among public regarding preventive measures for COVID-19 infection.

          • There is a positive attitude of public towards social-distancing, avoiding party and travel and maintaining hygiene.

          • People report anxiety, worries, paranoia about acquiring infection and sleep disturbances during this pandemic.

          • More the 80 % people perceive mental healthcare need to deal with their issues during this COVID-19 pandemic.

          Abstract

          Novel Corona Virus Disease (COVID-19) originating from China has rapidly crossed borders, infecting people throughout the whole world. This phenomenon has led to a massive public reaction; the media has been reporting continuously across borders to keep all informed about the pandemic situation. All these things are creating a lot of concern for people leading to heightened levels of anxiety. Pandemics can lead to heightened levels of stress; Anxiety is a common response to any stressful situation. This study attempted to assess the knowledge, attitude, anxiety experience, and perceived mental healthcare need among adult Indian population during the COVID-19 pandemic. An online survey was conducted using a semi-structured questionnaire using a non-probability snowball sampling technique. A total of 662 responses were received.

          The responders had a moderate level of knowledge about the COVID-19 infection and adequate knowledge about its preventive aspects. The attitude towards COVID-19 showed peoples' willingness to follow government guidelines on quarantine and social distancing. The anxiety levels identified in the study were high. More than 80 % of the people were preoccupied with the thoughts of COVID-19 and 72 % reported the need to use gloves, and sanitizers. In this study, sleep difficulties, paranoia about acquiring COVID-19 infection and distress related social media were reported in 12.5 %, 37.8 %, and 36.4 % participants respectively. The perceived mental healthcare need was seen in more than 80 % of participants. There is a need to intensify the awareness and address the mental health issues of people during this COVID-19 pandemic.

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          Most cited references 11

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          First Case of 2019 Novel Coronavirus in the United States

          Summary An outbreak of novel coronavirus (2019-nCoV) that began in Wuhan, China, has spread rapidly, with cases now confirmed in multiple countries. We report the first case of 2019-nCoV infection confirmed in the United States and describe the identification, diagnosis, clinical course, and management of the case, including the patient’s initial mild symptoms at presentation with progression to pneumonia on day 9 of illness. This case highlights the importance of close coordination between clinicians and public health authorities at the local, state, and federal levels, as well as the need for rapid dissemination of clinical information related to the care of patients with this emerging infection.
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            Rational use of face masks in the COVID-19 pandemic

            Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that caused coronavirus disease 2019 (COVID-19), the use of face masks has become ubiquitous in China and other Asian countries such as South Korea and Japan. Some provinces and municipalities in China have enforced compulsory face mask policies in public areas; however, China's national guideline has adopted a risk-based approach in offering recommendations for using face masks among health-care workers and the general public. We compared face mask use recommendations by different health authorities (panel ). Despite the consistency in the recommendation that symptomatic individuals and those in health-care settings should use face masks, discrepancies were observed in the general public and community settings.1, 2, 3, 4, 5, 6, 7, 8 For example, the US Surgeon General advised against buying masks for use by healthy people. One important reason to discourage widespread use of face masks is to preserve limited supplies for professional use in health-care settings. Universal face mask use in the community has also been discouraged with the argument that face masks provide no effective protection against coronavirus infection. Panel Recommendations on face mask use in community settings WHO 1 • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected SARS-CoV-2 infection. China 2 • People at moderate risk* of infection: surgical or disposable mask for medical use. • People at low risk† of infection: disposable mask for medical use. • People at very low risk‡ of infection: do not have to wear a mask or can wear non-medical mask (such as cloth mask). Hong Kong 3 • Surgical masks can prevent transmission of respiratory viruses from people who are ill. It is essential for people who are symptomatic (even if they have mild symptoms) to wear a surgical mask. • Wear a surgical mask when taking public transport or staying in crowded places. It is important to wear a mask properly and practice good hand hygiene before wearing and after removing a mask. Singapore 4 • Wear a mask if you have respiratory symptoms, such as a cough or runny nose. Japan 5 • The effectiveness of wearing a face mask to protect yourself from contracting viruses is thought to be limited. If you wear a face mask in confined, badly ventilated spaces, it might help avoid catching droplets emitted from others but if you are in an open-air environment, the use of face mask is not very efficient. USA 6 • Centers for Disease Control and Prevention does not recommend that people who are well wear a face mask (including respirators) to protect themselves from respiratory diseases, including COVID-19. • US Surgeon General urged people on Twitter to stop buying face masks. UK 7 • Face masks play a very important role in places such as hospitals, but there is very little evidence of widespread benefit for members of the public. Germany 8 • There is not enough evidence to prove that wearing a surgical mask significantly reduces a healthy person's risk of becoming infected while wearing it. According to WHO, wearing a mask in situations where it is not recommended to do so can create a false sense of security because it might lead to neglecting fundamental hygiene measures, such as proper hand hygiene. However, there is an essential distinction between absence of evidence and evidence of absence. Evidence that face masks can provide effective protection against respiratory infections in the community is scarce, as acknowledged in recommendations from the UK and Germany.7, 8 However, face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas. As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks. Recommendations on face masks vary across countries and we have seen that the use of masks increases substantially once local epidemics begin, including the use of N95 respirators (without any other protective equipment) in community settings. This increase in use of face masks by the general public exacerbates the global supply shortage of face masks, with prices soaring, 9 and risks supply constraints to frontline health-care professionals. As a response, a few countries (eg, Germany and South Korea) banned exportation of face masks to prioritise local demand. 10 WHO called for a 40% increase in the production of protective equipment, including face masks. 9 Meanwhile, health authorities should optimise face mask distribution to prioritise the needs of frontline health-care workers and the most vulnerable populations in communities who are more susceptible to infection and mortality if infected, including older adults (particularly those older than 65 years) and people with underlying health conditions. People in some regions (eg, Thailand, China, and Japan) opted for makeshift alternatives or repeated usage of disposable surgical masks. Notably, improper use of face masks, such as not changing disposable masks, could jeopardise the protective effect and even increase the risk of infection. Consideration should also be given to variations in societal and cultural paradigms of mask usage. The contrast between face mask use as hygienic practice (ie, in many Asian countries) or as something only people who are unwell do (ie, in European and North American countries) has induced stigmatisation and racial aggravations, for which further public education is needed. One advantage of universal use of face masks is that it prevents discrimination of individuals who wear masks when unwell because everybody is wearing a mask. It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene. WHO currently recommends that people should wear face masks if they have respiratory symptoms or if they are caring for somebody with symptoms. Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit. In parallel, urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. Taiwan had the foresight to create a large stockpile of face masks; other countries or regions might now consider this as part of future pandemic plans. © 2020 Sputnik/Science Photo Library 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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              Real estimates of mortality following COVID-19 infection

              As of March 1, 2020, 79 968 patients in China and 7169 outside of China had tested positive for coronavirus disease 2019 (COVID-19). 1 Among Chinese patients, 2873 deaths had occurred, equivalent to a mortality rate of 3·6% (95% CI 3·5–3·7), while 104 deaths from COVID-19 had been reported outside of China (1·5% [1·2–1·7]). However, these mortality rate estimates are based on the number of deaths relative to the number of confirmed cases of infection, which is not representative of the actual death rate; patients who die on any given day were infected much earlier, and thus the denominator of the mortality rate should be the total number of patients infected at the same time as those who died. Notably, the full denominator remains unknown because asymptomatic cases or patients with very mild symptoms might not be tested and will not be identified. Such cases therefore cannot be included in the estimation of actual mortality rates, since actual estimates pertain to clinically apparent COVID-19 cases. The maximum incubation period is assumed to be up to 14 days, 2 whereas the median time from onset of symptoms to intensive care unit (ICU) admission is around 10 days.3, 4 Recently, WHO reported that the time between symptom onset and death ranged from about 2 weeks to 8 weeks. 5 We re-estimated mortality rates by dividing the number of deaths on a given day by the number of patients with confirmed COVID-19 infection 14 days before. On this basis, using WHO data on the cumulative number of deaths to March 1, 2020, mortality rates would be 5·6% (95% CI 5·4–5·8) for China and 15·2% (12·5–17·9) outside of China. Global mortality rates over time using a 14-day delay estimate are shown in the figure , with a curve that levels off to a rate of 5·7% (5·5–5·9), converging with the current WHO estimates. Estimates will increase if a longer delay between onset of illness and death is considered. A recent time-delay adjusted estimation indicates that mortality rate of COVID-19 could be as high as 20% in Wuhan, the epicentre of the outbreak. 6 These findings show that the current figures might underestimate the potential threat of COVID-19 in symptomatic patients. Figure Global COVID-19 mortality rates (Feb 11 to March 1, 2020) Current WHO mortality estimates (total deaths divided by total confirmed cases), and mortality rates calculated by dividing the total number of deaths by the total number of confirmed cases 14 days previously.
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                Author and article information

                Contributors
                Journal
                Asian J Psychiatr
                Asian J Psychiatr
                Asian Journal of Psychiatry
                Elsevier B.V.
                1876-2018
                1876-2026
                8 April 2020
                8 April 2020
                Affiliations
                King George's Medical University, Lucknow, Lucknow, Uttar Pradesh, India
                Author notes
                [* ]Corresponding author. skkar1981@ 123456yahoo.com
                Article
                S1876-2018(20)30194-5 102083
                10.1016/j.ajp.2020.102083
                7139237
                efa27300-381e-4356-9f5a-2a75da56d3d4
                © 2020 Elsevier B.V. All rights reserved.

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

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