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Background: Fluvoxamine is a selective serotonin reuptake inhibitor that is known to be used as antidepressant. Repurposing of Fluvoxamine for the treatment of COVID-19 is theorized to help in the prevention of the clinical deterioration of SARS CoV-2 patients. In our systematic review and meta-analysis, we aim to assess the safety and efficacy of the drug under study in terms of its effect on the mortality and the risk of hospitalization and mechanical ventilation in non-critically ill COVID-19 patients. Methods: We performed a systematic search of seven electronic databases. The search results were screened based on the previously determined inclusion and exclusion criteria. We determined the data related to our objectives. The mortality rates, rates of hospitalization, risk of mechanical ventilation and serious side effects were extracted from the studies that successfully met our inclusion and exclusion criteria. Then, the extracted data from the included studies was included in the meta-analysis. Results: Three studies, two randomized clinical trials and one observational cohort study, with 1762 patients, were the final outcome of our search and screening processes. Among all participants, 886 patients received Fluvoxamine while 876 were controls. Follow up periods ranged from 7 days to 28 days. There was no significant difference in the intention-to-treat mortality rates between the two groups (RR = 0.66; 95% CI: 0.36 - 1.21, p-value = 0.18; I2 = 0%). However, Fluvoxamine decreased the per-protocol mortality compared to both placebo alone or placebo/standard care (RR = 0.09; 95% CI: 0.01 - 0.64, p-value = 0.02; I2 = 0% and RR = 0.09; 95% CI: 0.01 - 0.72, respectively). As compared to placebo or standard care, the all-cause hospitalization was significantly reduced in the fluvoxamine group (RR = 0.71; 95% CI: 0.54 - 0.93, p-value = 0.01; I2 = 61%). This risk reduction was not significant when compared to placebo alone (RR = 0.76; 95% CI: 0.57 - 1.00; p-value = 0.051; I2 = 48%). Furthermore, the risk of mechanical ventilation was not improved in the fluvoxamine group as compared to placebo (RR = 0.71; 95% CI: 0.43 - 1.16, p-value = 0.17; I2 = 0%). The serious adverse effects were almost the same in the treatment group and the control (13% and 12% respectively). Conclusion: Fluvoxamine does not significantly reduce the mortality rates or the risk of mechanical ventilation in SARS CoV-2 patients. Nonetheless, it was found to have a good impact on reducing all cause hospitalization among patients with COVID-19 disease. Therefore, further clinical studies are needed to determine the effectiveness of the drug and its mechanisms of action.

Introduction: COVID-19 spread globally, including across the Balkans, resulting in different morbidity and mortality outcomes in different countries. The aim of this study was to review the impact of COVID-19 over 17 months with regards to pandemic progression, implemented mitigation strategies, and COVID-19 vaccination programs across the Balkan countries, while identifying any valuable pieces of information acquired serendipitously throughout the pandemic that can be implemented in future action plans. Methods: A longitudinal ecological study was conducted across the Balkan countries from the onset of COVID-19 in these countries up until 1st August 2021. Epidemiological data was obtained from Our World in Data databases, while Ministry of Health websites for each respective country as well as local newspapers were utilized to review COVID-19-related mitigation and vaccination strategies. Comparisons of vaccination coverage, incident cases and mortality were made across neighboring countries, by converting the respective data to rates per 100,000 population for each country using Microsoft® Excel for mac (Version 16.59). Results: More than 10 million positive COVID-19 cases and 164,470 deaths were observed across the Balkan countries up until 1st August 2021. Trends in COVID morbidity and mortality outcomes were evident across neighbouring countries. A staggered vaccination rollout was observed, with various rollout speeds, although gradual decline in both morbidity and mortality occurred. Conclusion: Results obtained from this study strongly indicate that COVID-19 outcome for a particular country is not only dependent on the country’s own level of viral transmission, mitigations, and vaccination rates but also on neighbouring countries’ COVID-19 situation. Hence, cross-border governance action and recovery plans are recommended along with targeting vaccination hesitance.

Abstract Background: The COVID-19 pandemic spread across the globe, including across the Mediterranean basin. This region presents diversity in economy, culture, and societal affairs. We attempted to evaluate the impact of COVID-19 on the population and on the Sustainable Development Goals (SDGs), our aim being to aid in the development of COVID-19 national plans. Methods: Epidemiological data was obtained from ‘Our World in Data’ databases (January 2020 – July 2021). Case, mortality, and vaccination incidence comparisons were made across neighbouring countries. The SDG index, universal health coverage (UHC) and health workforce targets were collected for each country. Correlations between SDG targets and COVID-19 outcomes were analysed. Results: Similarities in morbidity and mortality outcomes were present across neighbouring countries, with a bidirectional relationship between cumulative fully vaccinated population and infectivity fatality rates. Positive relationships were present between SDG indexes, UHC and health workforces and COVID-19 cases, deaths, and vaccinations. Conclusion: At prima face, high-income countries seem to have sustained worse morbidity and mortality outcomes, despite having had better UHC and a greater health workforce in the pre-COVID-19 era however, one must also consider that factors such as health-seeking behaviour and underdiagnosis may have influenced this. Cross-border infectivity was, however, evident. Pan-Mediterranean action must therefore be taken to ensure COVID-19 transmissibility and mortality are reduced across borders, while ensuring an equitable health outcome across populations. Keywords: COVID-19; Mediterranean; Morbidity; Mortality; Vaccination; Sustainable Development Goals; Outcome Assessment.

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