In this article, we investigate the impact of COVID-19 through screening and surveillance methods adopted in India, as well as the potential health system, social, political, and economic consequences. The research was done in a chronological manner, and data was collected between 30 January 2020 till 12 June 2020. Initial containment measures, including point of entry screenings and testing protocols, appeared insufficient. However, testing capacity was gradually expanded after the commencement of a nation-wide lockdown. Modeling predictions have shown varying results on the emergence of cases depending on the infectiousness of asymptomatic individuals, with a peak predicted in mid-July having over two million cases. The country also faces risks of the economic plunge by losing approximately 4% of its gross domestic product, due to containment measures and reduction in goods importation. The low public health expenditure combined with a lack of infrastructure and low fiscal response implies several challenges to scale up the COVID-19 response and management. Therefore, an emergency preparedness and response plan is essential to integrate into the health system of India.

Background: Predominant infection sources and exposure pathways for Legionnaires’ disease (LD) remain uncertain. We conducted a national case-control and molecular source attribution study to assess risk factors and infection sources of community-acquired LD (CALD) in Switzerland.Methods: We enrolled 204 CALD patients and 198 matched controls (age, sex, residential area, time of infection) between August 2022 and March 2024. We conducted structured interviews, geospatial assessments, and environmental source investigations. Associations between host, behavioural, and environmental risk factors and CALD were assessed using conditional logistic regression. Clinical and environmental L. pneumophila isolates were characterised using whole-genome sequencing (WGS).Findings: Molecular typing attributed 7·4% of CALD cases to residential showers and confirmed a cluster linked to a carwash. Our epidemiological analyses suggest that some infections not attributable to household water systems likely originated from large outdoor sources (e.g., wastewater treatment plants). CALD risk was elevated among individuals with comorbidities, low household income, or occupational exposures. Most clinical isolates were MAb 3/1-positive, with ST23 being the most frequent sequence type. ST23 was less frequently detected in the environment. Infection occurred in households where we measured Legionella spp. concentrations well below 1,000 CFU/litre.Interpretation: CALD likely arises from interacting host, social, and environmental factors, and L. pneumophila strains likely vary in their pathogenicity. The multifactorial nature of CALD should be reflected in surveillance and Legionella control efforts. We suggest risk-based surveillance combining epidemiological, environmental, and genomic data to reflect the pathogen’s complex ecology.

BACKGROUND AND STUDY AIMS: Is there a post-acute infection syndrome for Legionnaires’ disease? Legionnaires’ disease is a form of primarily community-acquired pneumonia caused by Legionella spp. bacteria. Legionnaires’ disease and other forms of bacterial community-acquired pneumonia may lead to persistent health and wellbeing impairments. It remains unclear whether these are caused by the community-acquired pneumonia-causing pathogen or the pneumonia itself. We present the rationale and design of a matched cohort study to investigate the persistent health impacts of Legionnaires’ disease and compare them with persistent manifestations of other bacterial (Legionella test-negative) community-acquired pneumonia. We also present baseline characteristics of the study cohorts. METHODS: Legionnaires’ disease patients and Legionella test-negative community-acquired pneumonia patients with confirmed or clinically suspected bacterial aetiology were recruited from university and cantonal/regional hospitals and matched for sex, age, hospital type and date of diagnosis. Questionnaire-based interviews are conducted at baseline and 2, 6 and 12 months after the start of appropriate antibiotics. The questionnaires focus on patient-reported outcome measures and cover long-term symptoms, use of health services and health-related quality of life. RESULTS: Between June 2023 and June 2024, 59 patients with Legionnaires’ disease (59.3% male, median age 69 years [interquartile range [IQR]: 57–80]) and 60 patients with other bacterial (Legionella test-negative) community-acquired pneumonia (63.3% male, median age 69 years [IQR: 60–79]) were enrolled. Admission to the intensive care unit was required for 13.6 % of Legionnaires’ disease patients and 8.3 % of other bacterial community-acquired pneumonia patients. Chronic kidney failure was more prevalent among Legionnaires’ disease patients (15.3% vs 10.0%), while chronic obstructive pulmonary disease (20.0% vs 11.9%), malignancies (33.3% vs 13.6%) and an immunocompromised status (25.0% vs 13.6%) were more common in Legionella test-negative community-acquired pneumonia patients. Furthermore, Legionella test-negative community-acquired pneumonia patients reported lower baseline quality of life scores than Legionnaires’ disease patients. Differences in pneumonia severity, comorbidities and self-reported quality of life scores will be accounted for in future analyses. CONCLUSIONS: The LongLEGIO study will contribute to research on post-acute infection syndromes and provide the data for a more holistic assessment of the disease burden of Legionnaires’ disease.