First Case of 2019 Novel Coronavirus in the United States

Hepatic dysfunction in individuals with COVID-19 and its impact on pregnancy outcomes

This study aimed to describe the incidence of abnormal liver function tests (LFTs) in pregnant women post-2019 coronavirus disease (COVID-19) and investigate the characteristics of pregnant women with abnormal LFTs and its impact on pregnancy outcomes. The data for 168 pregnant women who were infected with COVID-19 in the late stages of pregnancy were collected in Hefei Maternal and Child Health Hospital from December 2022 to January 2023, and 86 pregnant women with abnormal liver function were divided into the research group and 82 pregnant women with normal liver function into the control group for retrospective analysis. Population and laboratory data were collected and statistical analysis was conducted. Among the 168 pregnant women with COVID-19, 86 (51.2%) had elevated liver enzymes. In the control group, 4 (4.5%) had elevated liver enzymes. Differences between the 2 groups were statistically significant (P < .05). Single-factor analysis revealed that age, gestational week, and body mass index (BMI) exhibited statistically significant differences (P < .001) as potential factors influencing abnormal LFTs. Logistic regression analysis demonstrated that age (OR: 1.526), gestational week (OR: 1.321), and BMI (OR: 1.159) remained independent risk factors for liver injury (P < .05). Furthermore, the cesarean section rate, postpartum hemorrhage rate, rupture of membranes rate, and fetal intrauterine distress rate in the observation group were all significantly higher than those in the control group (P < .05). Additionally, the incidence of neonatal asphyxia, preterm birth, and low birth weight in the observation group were all significantly higher than those in the control group (P < .05). Pregnant individuals are at an elevated risk of hepatic injury following severe acute respiratory syndrome coronavirus 2 infection. Furthermore, the likelihood of hepatic injury escalates with advancing maternal age, gestational age, and BMI. Hepatic functional aberrations in the latter stages of pregnancy may precipitate adverse pregnancy outcomes.

Embracing Controversy: A Second Look at CDC Reform Efforts in the Wake of COVID-19

The US Centers for Disease Control and Prevention (CDC) has responded to criticism claiming that the agency's COVID-19 response was lacking by proposing internal reforms intended to improve its performance during the next pandemic. The reforms are aimed at improving surveillance, analytic capacity, and agency communications. This article conducts a counterfactual analysis of the CDC's proposed reforms to ask how they might have changed outcomes in four cases of guidance controversy during the pandemic if they had been completed in advance of COVID-19. Although the CDC's planned reforms have merit, they are predicated on the ability to come to scientific closure in a highly charged political environment. To improve outcomes in a future pandemic, the agency should consider how it plans to communicate with the public when recovering from error and when addressing controversy spurred by criticism from credible experts. However, the ability of future presidents to limit CDC performance and communications in the next pandemic and the lack of political consensus around the value of independent public health expertise are likely to threaten any effort to improve pandemic response.

Evaluation of the effect of the COVID-19 pandemic on depression, anxiety and psychological resilience in patients with primary immunodeficiency

BACKGROUND

Primary immunodeficiencies (PIDs) are a group of diseases that develop as a result of primary or congenital malfunction of the immune system and progress with chronic and/or recurrent bacterial, fungal, protozoal and/or viral infections. In this study, we aimed to examine the effects of the COVID-19 pandemic on depression, anxiety levels and psychological resilience in patients with PID and to compare them with those in controls.

METHODS

Seventy patients, aged 18-65 years, who were being followed up with a diagnosis of PID and 69 people as healthy control group, participated in our study. The participants were evaluated cross-sectionally once; sociodemographic data form, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Resilience Scale for Adults (RSA), and COVID-19 Evaluation form were administered to the participants.

RESULTS

HAM-A and HAM-D scores were significantly higher in PID patients compared to controls (HAM-D: 5.5 vs. 3.0, p < 0.001; HAM-A: 6.0 vs. 4.0, p = 0.008). RSA was significantly lower in the patient group (RSA total: 122.5 vs. 136.0, p < 0.001), and pandemic-related risk perception was higher (PRPS: 33.9 vs. 28.3, p < 0.001). Sleep, appetite, and attention-related disturbances were also more common in the patient group. Multivariate regression analyses revealed that PID diagnosis was an independent predictor of increased depression severity (HAM-D), lower psychological resilience (RSA), and greater pandemic-related risk perception. Female sex was independently associated with higher anxiety severity (HAM-A). A personal psychiatric history and greater number of comorbidities were also significant predictors of psychological vulnerability, particularly in relation to depression and anxiety.

CONCLUSION

Given the observed associations between PID and increased levels of depression, anxiety, and reduced psychological resilience during the pandemic, clinicians may consider heightened vigilance for psychological symptoms in this population during times of public health crisis.

Telehealth and Emergency Department Use Among Commercially Insured, Medicaid, and Medicare Patients Receiving Systemic Cancer Therapy in Washington State After COVID-19

PURPOSE

In oncology, telehealth services were adopted as a means of mitigating the risk of COVID-19 transmission. We hypothesized that Medicaid enrollees would have less access to telehealth than commercially insured or Medicare enrollees during the pandemic, resulting in higher rates of emergency department (ED) visits during systemic cancer treatment.

METHODS

Linking Washington State SEER records with commercial, Medicaid, and Medicare records, we evaluated adults with new solid tumor malignancies who received initial systemic treatment before the COVID-19 pandemic (January 1, 2017-December 31, 2019) and after the pandemic (March 1, 2020-November 30, 2021). Poisson and logistic regressions were used to evaluate differences in the number of office visits, telehealth visits, and ED visits in the 3 months after starting systemic anticancer treatment between insurance groups before versus after the pandemic.

RESULTS

Among 2,936 commercial, 2,039 Medicaid, and 7,333 Medicare enrollees who met inclusion criteria, office-based visits fell substantially for all groups during the COVID-19 period. Medicare enrollees had fewer telehealth visits while Medicaid had more telehealth visits, compared with commercial enrollees. ED visits declined for all patients, but there were no differences between insurance groups.

CONCLUSION

In Washington State, COVID-19 resulted in a substantial decrease in office-based visits, with an accompanying increase in telehealth visits partially offsetting the difference in overall access to care. ED visit rates fell substantially, without differences between insurance groups.

Artificial Intelligence Assessment of Chest Radiographs for COVID-19

BACKGROUND

The sensitivity of reverse-transcription polymerase chain reaction (RT-PCR) is limited for diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest computed tomography (CT) is reported to have high sensitivity; however, given the limited availability of chest CT during a pandemic, the assessment of more readily available imaging, such as chest radiographs, augmented by artificial intelligence may substitute for the detection of the features of coronavirus disease 2019 (COVID-19) pneumonia.

METHODS

We trained a deep convolutional neural network to detect SARS-CoV-2 pneumonia using publicly available chest radiography imaging data including 8,851 normal, 6,045 pneumonia, and 200 COVID-19 pneumonia radiographs. The entire cohort was divided into training (n = 13,586) and test groups (n = 1510). We assessed the accuracy of prediction with independent external data.

RESULTS

The sensitivity and positive predictive values of the assessment by artificial intelligence were 96.8% and 90.9%, respectively. In the first external validation of 204 chest radiographs among 107 patients with confirmed COVID-19, the artificial intelligence algorithm correctly identified 174 (85%) chest radiographs as COVID-19 pneumonia among 97 (91%) patients. In the second external validation with 50 immunocompromised patients with leukemia, the higher probability of the artificial intelligence assessment for COVID-19 was correlated with suggestive features of COVID-19, while the normal chest radiographs were closely correlated with the likelihood of normal chest radiographs by the artificial intelligence prediction.

CONCLUSIONS

The assessment method by artificial intelligence identified suspicious lung lesions on chest radiographs. This novel approach can identify patients for confirmatory chest CT before the progression of COVID-19 pneumonia.

The Assessment of Perceived Stress, Anxiety, Depression, Insomnia, Sleep Quality, and Drug Adherence in Patients with Systemic Lupus Erythematosus During the COVID-19 Pandemic

Background

Pandemics can increase psychosocial distresses. We evaluated both medication nonadherence and the incidence of perceived stress, anxiety, depression, sleep quality, and insomnia during the coronavirus disease 2019 (COVID-19) pandemic in systemic lupus erythematosus (SLE) patients.

Methods

A total of 211 participants, including 160 SLE patients and 51 healthy volunteers, were included. Questionnaire of Medication Adherence Reporting Scale (MARS-5), Perceived Stress Scale (PSS), Hospital Anxiety and Depression Scale (HADS-A, HADS-D), Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) were assessed. Perceived stress related to the COVID-19 pandemic and its associations were investigated.

Results

The mean age of patients was 41.85±12.97 years. Fifty-nine (36.9%) patients had high perceived stress, 16 (10.0%) had anxiety, 45 (28.1%) had depression, 77 (48.1%) had poor sleep quality, and 62 (38.8%) patients had insomnia. Perceived Stress Scale (23.64 ± 7.86 vs. 19.73 ± 4.80, P=.001), HADS-D (5.60 ± 3.40 vs. 4.08 ± 2.21, P=.003), PSQI (6.31 ± 3.62 vs. 4.43 ± 2.20, P=.001), and ISI (6.81 ± 4.98 vs. 4.53 ± 2.83, P=.002) were higher in the patient group. The presence of anxiety, depression, poor sleep quality, and insomnia was higher in patients with high PSS. High PSS was correlated with HADS-A, HADS-D, PSQI, and ISI. Medication non-adherence was detected in 79 (49.4%) of patients. Regression analysis revealed that high perceived stress is an independent predictor of depression [Exp(β) 95% CI: 1.488 (1.245-1.779), P < .001], and anxiety [Exp(β) 95% CI: 1.235 (1.026-1.487), P=.026].

Conclusion

Systemic lupus erythematosus patients demonstrated increased levels of perceived stress, depression, poor sleep quality and insomnia compared to the healthy population during the COVID19 pandemic. Systemic lupus erythematosus patients with high perceived stress had more depression, anxiety, poor sleep quality, and insomnia than those without. Furthermore, high perceived stress was associated with depression and anxiety.

Case to Vignette: A Framework to Elevate Narrative by Embracing Vignette-Based Learning in Medicine

Clinical vignettes play many roles in the practice of medicine and are a near-universal method of sharing stories in clinical medicine. The act of preparing clinical vignettes is also highly valuable: organizing a case into narrative form promotes active learning, anticipating and answering clinical questions that occur in real-life practice. Clinical vignettes are integral to instructional techniques such as morning report and case-based learning, where they are utilized to foster clinical reasoning, illustrate key points, and apply medical knowledge to clinical practice. Developing a vignette facilitates reflection and deliberate practice, which are crucial for lifelong learning. Clinical vignettes are also important entries to scholarship, particularly for those earlier in their careers. They are highly adaptable to different formats like clinical vignette abstract and poster presentations, case reports, case series, clinical images, or specific clinical reasoning submissions. While these benefits are familiar to many practitioners, they may lack a structured framework to leverage vignettes' full potential as agents of professional and scientific development. We propose a framework to describe the value of clinical vignette development through four different lenses: 1) vignettes as curriculum; 2) vignettes for professional advancement; 3) vignettes for scientific advancement; and 4) vignettes for joy in practice.

Cannabis to cope with COVID-19 in college

Objective: Cannabis use in college students has increased over time and is linked to negative consequences. During the COVID-19 pandemic, many students experienced greater stress, which could heighten cannabis use and related consequences. This study was designed to clarify motivations for cannabis use that may link pandemic-related stressors to time spent high and cannabis-related consequences.

Participants: A total of 488 cannabis-using college students (75% women) participated.

Methods: A cross-sectional survey was administered in Fall 2020 and Spring 2021 to examine students' experiences during the pandemic.

Results: Indirect effects revealed that pandemic-related social stressors were linked to coping and boredom motives, and in turn, more hours spent high and cannabis-related consequences. Similarly, pandemic-related distress was associated with more coping motives and in turn, more hours spent high and cannabis-related consequences.

Conclusions: Findings suggest prevention and intervention efforts may benefit from emphasizing alternative coping methods, including enhanced social support, during prolonged stressors.

Impact of the COVID-19 pandemic on college students' mental health and lifestyle factors

Objective: This study examines how mental health and health behaviors evolved among college students nationwide before and during the onset of the COVID-19 pandemic. Participants: Data collected from college students across various campuses in Fall 2019 (N = 33,372) and Fall 2020 (N = 34,168) as part of the Healthy Minds Study. Methods: The online survey was delivered via Qualtrics. Data was analyzed through an unpaired two-samples T-test and a two-proportion Z-test. Results: The results show a significant difference of depression and anxiety symptoms in college students during Fall 2020 compared to Fall 2019. Sleep patterns significantly shifted during the pandemic. Substance use, perceived need for counseling, and the amount of time students spent exercising all significantly differed during the COVID-19 pandemic. Conclusion: In the context of declines in mental health among college students, college campuses should implement mental health support models addressing students' individual health risk and lifestyle behaviors.

Longitudinal humoral immunity against SARS-CoV-2 Spike following infection in individuals from Cameroon

In May 2023 the World Health Organization (WHO) declared the end of COVID-19 as a public health emergency. Seroprevalence studies performed in African countries, such as Cameroon, depicted a much higher COVID-19 burden than reported by the WHO. To better understand humoral responses kinetics following infection, we enrolled 333 participants from Yaoundé, Cameroon between March 2020 and January 2022. We measured the levels of antibodies targeting the SARS-CoV-2 receptor-binding-domain (RBD) and the Spike glycoproteins of Delta, Omicron BA.1 and BA.4/5 and the common cold coronavirus HCoV-OC43. We also evaluated plasma capacity to neutralize authentic SARS-CoV-2 virus and to mediate Antibody-Dependent Cellular Cytotoxicity (ADCC). Most individuals mounted a strong antibody response against SARS-CoV-2 Spike. Plasma neutralization waned faster than anti-Spike binding and ADCC. We observed differences in humoral responses by age and circulating variants. Altogether, we show a global overview of antibody dynamics and functionality against SARS-CoV-2 in Cameroon.

Gut bacterial lactate stimulates lung epithelial mitochondria and exacerbates acute lung injury

Acute respiratory distress syndrome (ARDS) is an often fatal critical illness where lung epithelial injury leads to intrapulmonary fluid accumulation. ARDS became widespread during the COVID-19 pandemic, motivating a renewed effort to understand the complex etiology of this disease. Rigorous prior work has implicated lung endothelial and epithelial injury in response to an insult such as bacterial infection; however, the impact of microorganisms found in other organs on ARDS remains unclear. Here, we use a combination of gnotobiotic mice, cell culture experiments, and re-analyses of a large metabolomics dataset from ARDS patients to reveal that gut bacteria impact lung cellular respiration by releasing metabolites that alter mitochondrial activity in lung epithelium. Colonization of germ-free mice with a complex gut microbiota stimulated lung mitochondrial gene expression. A single human gut bacterial species, Bifidobacterium adolescentis, was sufficient to replicate this effect, leading to a significant increase in mitochondrial membrane potential in lung epithelial cells. We then used genome sequencing and mass spectrometry to confirm that B. adolescentis produces L -lactate, which was sufficient to increase mitochondrial activity in lung epithelial cells. Finally, we found that serum lactate was significantly associated with disease severity in patients with ARDS from the Early Assessment of Renal and Lung Injury (EARLI) cohort. Together, these results emphasize the importance of more broadly characterizing the microbial etiology of ARDS and other lung diseases given the ability of gut bacterial metabolites to remotely control lung cellular respiration. Our discovery of a single bacteria-metabolite pair provides a proof-of-concept for systematically testing other microbial metabolites and a mechanistic biomarker that could be pursued in future clinical studies. Furthermore, our work adds to the growing literature linking the microbiome to mitochondrial function, raising intriguing questions as to the bidirectional communication between our endo- and ecto-symbionts.

Spatial Associations of Anti-Asian Hate on Social Media in the USA During COVID-19

Since the first confirmed case of COVID-19 in the USA on January 19, 2020, the anti-Asian racist and xenophobic rhetoric began to surge on social media, followed by acts of discrimination and harassment against Asians and Asian Americans. In this study, we identified anti-Asian hate language from 17 million geotagged social media posts between December 2019 and August 2022 using an established keyword-based approach, illustrated their spatial and temporal distributions, and explored relationships between socioeconomic and demographic characteristics of places and hate. We found clusters of hate using the spatial relative risk (SPARR) function and used Bayesian hierarchical modeling to draw associations of hate with multiple covariates. We identified 16 clusters, especially in the southern and eastern USA, where anti-Asian hateful tweets surged around March/April 2020. Increased hate was associated with higher COVID-19 death rates, a higher share of the foreign-born population, and a lower share of the Asian population in poverty compared to the White population. There was no indication that spatial structure affected hate. Our results can inform decision-makers in public health and safety for allocating resources for place-based preparedness and response to the pandemic-induced racism as a public health threat.

Decoding the SARS-CoV-2 infection process: Insights into origin, spread, and therapeutic approaches

Globally, over 768 million confirmed cases and 6.9 million deaths had been documented as of July 17, 2023. Coronaviruses have a relatively large RNA genome. As with other viruses, SARS-CoV-2 does have an envelope film produced from host cells that are assisted by virally encoded glycoproteins that are required for infectivity, immunological assault, and viral particle production. Although the intermediate source of origin and transmission to humans is unexplained, rapid transmission from human to human has been established. This review focuses on the mechanistic framework for understanding the SARS-CoV-2 viral infection. Additionally, it discusses the origins and implications of COVID-19 using direct quotations from the published scientific literature to avoid misinterpretation of this catastrophic event that resulted in a massive loss of human life and impact on the global economy. The current available information unfolds large number of topics related with COVID-19 and/or the coronavirus (SARS-CoV-2) responsible of the disease. This review article also delves into the multifaceted aspects of COVID-19 and SARS-CoV-2, with a specific focus on a controversial yet essential issue: the possible association between SARS-CoV-2's origin and aldose reductase, an enzyme known for its role in diabetic retinopathy. Exploring this connection holds utmost significance, offering valuable insights into COVID-19's pathogenesis and unlocking new avenues for therapeutic interventions. It is important to trace back the evolution of coronaviruses and reveal the possible origin of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the coronavirus disease 2019 (COVID-19).

Artificial intelligence in respiratory pandemics-ready for disease X? A scoping review

OBJECTIVES

This study aims to identify repeated previous shortcomings in medical imaging data collection, curation, and AI-based analysis during the early phase of respiratory pandemics. Based on the results, it seeks to highlight essential steps for improving future pandemic preparedness.

MATERIALS AND METHODS

We searched PubMed/MEDLINE, Scopus, and Cochrane Reviews for articles published from January 1, 2000, to December 31, 2021, using the terms "imaging" or "radiology" or "radiography" or "CT" or "x-ray" combined with "SARS," "MERS," "H1N1," or "COVID-19." WHO and CDC Databases were searched for case definitions.

RESULTS

Over the last 20 years, the world faced several international health emergencies caused by respiratory diseases such as SARS, MERS, H1N1, and COVID-19. During the same period, major technological advances enabled the analysis of vast amounts of imaging data and the continual development of artificial intelligence algorithms to support radiological diagnosis and prognosis. Timely availability of data proved critical, but so far, data collection attempts were initialized only as individual responses to each outbreak, leading to long delays and hampering unified guidelines and data-driven technology to support the management of pandemic outbreaks. Our findings highlight the multifaceted role of imaging in the early stages of SARS, MERS, H1N1, and COVID-19, and outline possible actions for advancing future pandemic preparedness.

CONCLUSIONS

Advancing international cooperation and action on these topics is essential to create a functional, effective, and rapid counteraction system to future respiratory pandemics exploiting state of the art imaging and artificial intelligence.

KEY POINTS

Question What has been the role of radiological data for diagnosis and prognosis in early respiratory pandemics and what challenges were present? Findings International cooperation is essential to developing an effective rapid response system for future respiratory pandemics using advanced imaging and artificial intelligence. Clinical relevance Strengthening global collaboration and leveraging cutting-edge imaging and artificial intelligence are crucial for developing rapid and effective response systems. This approach is essential for improving patient outcomes and managing future respiratory pandemics more effectively.

Early Identification of Severe COVID-19 Cases and the Need for ICU Care Based on Clinical and Laboratory Risk Factors

Background and objective Treatment in ICUs became extremely difficult due to the growing number of coronavirus disease 2019 (COVID-19) patients at the height of the pandemic. Consequently, prompt patient triage depends on the early categorization of severe cases in such scenarios. This study aimed to provide an evidence-based strategy to ensure the best use of resources by triaging patients based on objective risk factors. Methods This retrospective observational study comprised 500 inpatients (>age 18 years) who were hospitalized between March 20 and April 19, 2020, at the Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC) in Peshawar, Pakistan. The clinical, laboratory, and radiological parameters were assessed. Real-time polymerase chain reaction (RT-PCR) findings were used to confirm the diagnosis of COVID-19. Results A total of 19 potential clinical and laboratory risk factors associated with ICU admissions were identified. At least one comorbidity among chronic lung disease, cardiovascular disease (CVD), and diabetes was the factor with the strongest association with ICU admission with a univariable odds ratio (OR) of over 27, followed by renal disease and other COVID-19 sequelae such as diarrhea, respiratory rate (>24 breaths/minute), and positive RT-PCR (vs. negative) with an univariable OR between 9 and 15. Furthermore, a multivariate logistic regression model was further developed with five risk factors, including comorbidity, presence of chronic lung disease, presence of diabetes, and RT-PCR (positive vs. negative), male sex (vs. female), and older age (65.0-80.5 years), suggesting a good fit of the model to the data shown by the area under the receiver operator characteristic curve (AUC) of 0.943 (95% CI: 0.917, 0.969). Additionally, a chest CT scan showed the typical COVID-19 pneumonia with pulmonary involvement of 30-40%, which was further evaluated by the COVID-19 Reporting and Data System (CO-RADS). The typical COVID-19 pneumonia was on a scale of four (15/25) or five (19/25) lung lesions. Conclusions Based on our findings, this approach could be used to screen the severe cases of COVID-19 patients and help them to be treated in ICUs on time while preventing others from unnecessarily using ICUs in the setting of limited medical resources, such as the outbreak of a pandemic.

Frk positively regulates innate antiviral immunity by phosphorylating TBK1

Type I interferons (IFN-I) are crucial for the initial defense against viral infections. TBK1 serves as a key regulator in the production of IFN-I, with its phosphorylation being essential for the regulation of its activity. However, the regulatory mechanisms governing its activation remain incompletely elucidated. In this study, we validated the function of Fyn-related kinase (Frk) in the antiviral innate immune response and identified the direct target molecule of Frk in the IFN-β signaling pathway. Furthermore, we elucidated the mechanism by which Frk phosphorylates TBK1 during infection and the role of Frk in IFN-β production. We discovered that Frk enhances the activation of the IFN-I production pathway by targeting TBK1. Mechanistically, Frk promotes the K63 ubiquitination of TBK1 and subsequent activation of the transcription factor IRF3 by phosphorylating TBK1 at tyrosine residues 174 and 179, thereby enhancing the production of IFN-β in macrophages. Employing both in vivo and in vitro viral infection assays, we demonstrated that IFN-β mediated by Frk inhibits the replication of VSV or HSV-1 and alleviates lung lesions. Our findings indicate that Frk functions as a key regulator of TBK1 to strengthen antiviral immunity and represents a promising target for the development of antiviral drugs.

Impact of moral distress on burn-out: a cross-sectional survey of front-line family physicians during the initial wave of the COVID-19 pandemic

OBJECTIVES

Primary care clinicians are especially prone to burn-out. The primary objective of this study was to investigate factors contributing to burn-out and moral distress and their relationship among practising family physicians (FPs) in California early in the COVID-19 pandemic.

DESIGN

Cross-sectional study, online survey evaluating burn-out, moral distress and associated factors.

SETTING

California FPs between July and August 2020 practising in community health centres, hospital systems, private clinics and university systems were surveyed with a 22-item online questionnaire.

PARTICIPANTS

FPs practising in California were eligible. The final sample included 218 physicians.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary independent variable was frequency of moral distress and the primary outcome variable was worsening burn-out. Moderator variables included gender and employer support.

RESULTS

FPs experiencing higher burn-out and moral distress were more likely to report concerns regarding personal COVID-19 risk and lack of personal protective equipment. Practising self-care and personal wellness were associated with decreased moral distress. Female physicians were 3.86-fold more likely to report worsening burn-out compared with male physicians. Employer support was associated with a 59% reduced burn-out risk and 54% reduction in frequent moral distress. Frequent moral distress was associated with a 3.12- fold higher burn-out risk. Gender moderated the relationship between moral distress and burn-out. Moral distress was associated with a 3.55-fold increase in burn-out risk among females.

CONCLUSIONS

Female FPs experienced greater levels of moral distress and burn-out than male physicians. Moral distress was differentially associated with increased burn-out among female physicians. Employer support was a protective factor against moral distress and burn-out.

Water remediation with a dielectric-free portable triple-electrode cold plasma discharge system

This paper presents the design and application of a portable multi-electrode cold plasma corona discharge system for pollutant degradation in wastewater. The system generated stable plasma without a dielectric barrier, producing active species such as hydroxyl radicals, hydrogen peroxide, nitrite, and nitrate. The experimental results presented a pollutant degradation efficiency of 100%, reducing methylene blue as a model pollutant from 6 ppm to 0 ppm within 125 s at an optimized electrode distance of 0.20 cm. This optimization minimizes the risks associated with the arcing and self-collision of plasma streams while sustaining continuous plasma discharge, ensuring the maximum breakdown voltage and high ion density for efficient plasma production. The system further demonstrated its application in treating hand washing as a target pollutant to reduce the risk of infection during the COVID-19 pandemic. A comparative analysis highlighted the advantages of the system in terms of rapid treatment, energy efficiency, and low-cost operation. The processed water met the World Health Organization (WHO) wastewater discharge standards and WHO guidelines for virus elimination, with residual nitrogen compounds maintained below 50 ppm and hydrogen peroxide levels kept under 5,000 ppm, confirming the effectiveness of the system in pathogen reduction and wastewater purification.

COVID-19 clinical presentation, management, and epidemiology: a concise compendium

Coronavirus Disease 2019, caused by severe acute respiratory coronavirus 2, has been an ever-evolving disease and pandemic, profoundly impacting clinical care, drug treatments, and understanding. In response to this global health crisis, there has been an unprecedented increase in research exploring new and repurposed drugs and advancing available clinical interventions and treatments. Given the widespread interest in this topic, this review aims to provide a current summary-for interested professionals not specializing in COVID-19-of the clinical characteristics, recommended treatments, vaccines, prevention strategies, and epidemiology of COVID-19. The review also offers a historical perspective on the pandemic to enhance understanding.

T-cell immunobiology and cytokine storm of COVID-19

The 2019 coronavirus illness (COVID 2019) first manifests as a newly identified pneumonia and may quickly escalate to acute respiratory distress syndrome, which has caused a global pandemic. Except for individualized supportive care, no curative therapy has been steadfastly advised for COVID-19 up until this point. T cells and virus-specific T lymphocytes are required to guard against viral infection, particularly COVID-19. Delayed immunological reconstitution (IR) and cytokine storm (CS) continue to be significant barriers to COVID-19 cure. While severe COVID-19 patients who survived the disease had considerable lymphopenia and increased neutrophils, especially in the elderly, their T cell numbers gradually recovered. Exhausted T lymphocytes and elevated levels of pro-inflammatory cytokines, including IL6, IL10, IL2, and IL17, are observed in peripheral blood and the lungs. It implies that while convalescent plasma, IL-6 blocking, mesenchymal stem cells, and corticosteroids might decrease CS, Thymosin α1 and adaptive COVID-19-specific T cells could enhance IR. There is an urgent need for more clinical research in this area throughout the world to open the door to COVID-19 treatment in the future.

The Impact of Viral Concentration Method on Quantification and Long Amplicon Nanopore Sequencing of SARS-CoV-2 and Noroviruses in Wastewater

Wastewater-based surveillance has gained attention in the four years following the start of the COVID-19 pandemic. Accurate pathogen detection, quantification and characterisation rely on the selection of appropriate methodologies. Here, we explore the impact of viral concentration method on RT-qPCR inhibition and quantification of norovirus genogroups I and II (GI and GII), crAssphage, phi6 and SARS-CoV-2. Additionally, their impact on long amplicon sequencing for typing noroviruses and whole-genome sequencing (WGS) SARS-CoV-2 was explored. RT-qPCR inhibition for each viral concentration method was significantly different apart from the two ultrafiltration methods, InnovaPrep® concentrating pipette (IP) and Vivaspin® (VS) centrifugal concentrators. Using an ultrafiltration method reduced inhibition by 62.0% to 96.0% compared to the ammonium sulphate (AS) and polyethylene glycol (PEG) precipitation-based methods. Viral quantification was significantly impacted by concentration method with the highest concentrations (copies/L) observed for VS with 7.2- to 83.2-fold differences from AS depending on the target. Norovirus long amplicon sequencing showed genotype-dependent differences with IP performing best for GI and VS for GII although IP performance gains for GI were relatively small. VS outperformed AS and IP across all metrics during SARS-CoV-2 WGS. Overall, VS performed the best when considering all the areas of investigation.

Comparative Analysis of Viral Load Quantification Using Reverse Transcription Polymerase Chain Reaction and Digital Droplet Polymerase Chain Reaction

In the year 2019, a highly virulent coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged, precipitating the outbreak of the illness known as coronavirus disease 2019 (COVID-19). The commonly employed reverse transcription polymerase chain reaction (RT-qPCR) methodology serves to estimate the viral load in each patient's sample by employing a standard curve. However, it is imperative to recognize that this technique exhibits limitations with respect to clinical diagnosis and therapeutic applications, since an advancement of the conventional polymerase chain reaction methods, digital polymerase chain reaction (digital PCR or DDPCR), enables the direct quantification and clonal amplification of nucleic acid strands. The primary divergence between dPCR and traditional PCR resides in their approaches to measuring nucleic acid quantities. In this study, we investigated the viral loads of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) within 461 participants. By employing both RT-qPCR and DDPCR techniques, we established a comparison between the quantification methodologies of the two approaches. Our findings illustrate that the quantification through DDPCR affords a superior means of monitoring viral load within lower respiratory tract samples, thus enhancing the assessment of disease progression, particularly in scenarios characterized by low viral loads.

Laboratory readiness and genomic surveillance of Covid-19 in the capital of Brazil

This study aims to analyze the diagnostic readiness to Covid-19 and the genomic surveillance of SARS-CoV-2 in Brasília, the capital of Brazil. This is a retrospective, cross-sectional study, with data from: cases/deaths-Ministry of Health; RT-PCR analyses Brasília Central Public Health Laboratory (LACEN); genomics-Global Initiative on Sharing All Influenza Data (GISAID). It was found that in March 2021, with the Gamma variant was predominant, RT-PCR diagnostic tests administered by LACEN reached their peak, followed by a reduction, possibly due to the start of vaccination. New peaks were observed in September 2021 and January 2022. The average time for releasing RT-PCR results was reduced from eight days (July 2020), to around eight hours in 2023. The participation of private laboratories was evident in sequencing the SARS-CoV-2 variants of concern in Brasília (n = 1,897). LACEN sequenced 50% of the samples received (571). A decrease in the incidence of cases and deaths due to Covid-19 was noted in the years 2022 to 2023, following the national trend. LACEN maintained RT-PCR diagnostic tests administered satisfactorily throughout the period. Regarding the genomic surveillance of SARS-CoV-2, the vast majority of samples were sequenced by private laboratories when compared to the public laboratory.

Long-Term Lung Sequelae in Survivors of Severe/Critical COVID-19 Pneumonia: The "Non-Steroid", "Non-Interventional" Approach

Introduction: Long-term lung sequelae in severe COVID-19 survivors, as well as their treatment, are poorly described in the current literature. Objective: To investigate lung fibrotic sequelae in survivors of severe/critical COVID-19 pneumonia and their fate according to a "non-interventional" approach. Methods: Prospective study of the above COVID-19 survivors after hospital discharge from March 2020 to October 2022. Re-evaluation lasted 3-12 months and included chest HRCT, PFTs, dyspnea, and overall health evaluation by modified Medical Research Council (mMRC) and St. George's Respiratory Questionnaire (SGRQ), respectively. Results: In this study, 198 patients (61.1% male) with a median age of 57 years (IQR 49-66). After 3 months, 187 (94.4%) patients were assessed; after 6 months, 82 (41.1%) patients were assessed; and after 12 months, 16 (8%) patients were assessed. At each time point, a significant reduction was observed in the extent of COVID-19-associated opacities (p < 0.001 and p = 0.002) and of parenchymal bands (p = 0.014 and p = 0.025). Persisting fibrotic-like changes were observed in 18 (9%) patients (apical findings in 2 patients, fibrotic non-specific interstitial pneumonia-like changes in 14 patients, minimal fibrotic changes in 2 patients). At 3 months, the predicted median FVC% was 93% (80-100%) and the predicted DLCO% was 65% (58-78%) with a statistically significant improvement at 6 months in both (p = 0.001). Moreover, 81.1% had mMRC ≤ 1 and the median SGRQ was 11.65 [0-24.3] with a significant reduction at 6 months in both dyspnea (p < 0.001) and SGRQ (p = 0.027) persisting at 12 months. Conclusions: This prospective study, including only survivors of severe/critical COVID-19 pneumonia, documented the significant improvement in all imaging, functional, and clinical parameters by applying the "non-interventional" approach. These data do not indicate any post-COVID-19 severe/critical pneumonia and "epidemic of widespread pulmonary fibrosis".

Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study

Background

The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions.

Objective

This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated.

Methods

To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated.

Results

Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal.

Conclusions

This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation.

Schools and Wastewater Surveillance: Practical Implications for an Emerging Technology to Impact Child Health

Since the start of the COVID-19 pandemic, wastewater surveillance has emerged as a public health tool that supplements traditional surveillance methods used to detect the prevalence of the SARS-CoV-2 virus in communities. In May 2020, the Houston Health Department (HHD) partnered with a coalition of municipal and academic partners to develop a wastewater monitoring and reporting system for the city of Houston, Texas. The HHD subsequently launched a program to conduct targeted wastewater sampling at 52 school sites located in a large, urban school district in Houston. Data generated by this program are shared with school district officials and nurses from participating schools. Although initial feedback from these stakeholders indicated that they considered the wastewater data valuable, the emergency nature of the pandemic prevented a systematic evaluation of the program. To address this gap in knowledge, the HHD and Rice University conducted a study to determine how wastewater data are used to make decisions about COVID-19 prevention and mitigation practices in schools. Our findings indicate that maximizing the utility of wastewater data in the school context will require the development of communication strategies and education efforts tailored to the needs of specific audiences and improving collaboration between local health departments, school districts, and school nurses.

Regionally differentiated responses of chlorophyll-a concentrations to reduced human activity during COVID-19 lockdown in the San Francisco Bay area

The COVID-19 lockdown created a unique opportunity to study the impact of reduced human activities on water quality. This study aimed to explore how changes in human activities, specifically reduced traffic emissions, influenced water quality in the San Francisco Bay Area from 2019 to 2021. Using chlorophyll-a (Chl-a) concentration as an indicator of water quality and NO₂ concentration as a proxy for traffic emissions, we analyzed the effects of reduced emissions on water quality across different regions of the Bay. This study combined traffic flow, satellite remote sensing, and meteorological data. Pearson correlation analysis was used to assess the time-lag effects between NO₂ and Chl-a concentrations. Additionally, a random forest regression model was applied to analyze the drivers of Chl-a concentrations across different regions. The findings revealed that NO₂'s impact on Chl-a exhibited significant spatial heterogeneity: positive correlations increased in the Upper Bay region, a general positive correlation was observed in the Central Bay region, the Coastal Zone shifted from positive to negative correlations, and there was no significant correlation in the Lower South Bay region. The random forest regression analysis demonstrated that the main drivers of Chl-a varied by region. In Upper Bay and Central Bay, NO₂ concentration was the most significant driver of Chl-a, whereas temperature was the primary influence in the Coastal Zone and Lower South Bay. These findings offer insights into the spatially variable impacts of traffic emissions on water quality and suggest strategies for targeted management of water quality in urban estuarine environments.

A Glimpse for the subsistence from pandemic SARS-CoV-2 infection

COVID-19 is an emerging viral pandemic caused by SARS-CoV-2, which is the causative agent of unprecedented disease-causing public health threats globally. Worldwide, this outbreak is wreaking havoc due to failure in risk assessment regarding the urgency of the pandemic. As per the reports, many secondary complications which include neurological, nephrological, gastrointestinal, cardiovascular, immune, and hepatic abnormalities, are linked with COVID -19 infection which is associated with prominent respiratory disorders including pneumonia. Hindering the initial binding of the virus with Angiotensin-converting enzyme 2 (ACE2) through the spike protein is one potential boulevard of monoclonal antibodies. Although some drug regimens and vaccines have shown safety in trials, none have been entirely successful yet. This review highlights, some of the potential antibodies (tocilizumab, Sarilumab, Avdoralimab, Lenzilumab, Interferon (alfa /beta /gamma)) screened against SARS-CoV-2 and the most promising drugs (Favipiravir, Hydroxychloroquine, Niclosamide, Ribavirin, Baricitinib, Remdesivir, Arbidol Losartan, Ritonavir, Lopinavir, Baloxavir, Nitazoxanide, Camostat) in various stages of development with their synthetic protocol and their clinical projects are discussed to counter COVID -19.

The impact of the COVID-19 pandemic on clinical practices related to colorectal cancer and colonoscopy in South Korea: a nationwide population-based study

BACKGROUND/AIMS

Despite of the coronavirus disease 2019 (COVID-19) pandemic, there is little data regarding its impact on colorectal cancer (CRC)-related clinical practice. This study aimed to assess the changes in its impact during the COVID-19 pandemic.

METHODS

This was a retrospective national population-based study using the Health Insurance Review and Assessment database from January 2019 to December 2021. The number of patients in 2020 and 2021 was compared with those in 2019 for the diagnostic and therapeutic colonoscopy, CRC-related operation, and any treatment for CRC.

RESULTS

The annual number of patients undergoing diagnostic colonoscopies decreased by 6.9% in 2020 but increased 8.1% in 2021, compared to those in 2019; number of patients undergoing therapeutic colonoscopies increased by 6.0% and 37.7% in 2020 and 2021, respectively; number of patients operated for CRC decreased by 4.2% in 2020 and increased by 2.3% in 2021. The number of patients treated for CRC decreased by 2.8% in 2020 and increased by 4.4% in 2021. Diagnostic and therapeutic colonoscopies and any CRC-related treatment decreased by 43.8%, 37.5%, and 11.3% in March 2020, during the first surge of COVID-19, but increased by 26.0%, 58.1%, and 9.5% in June 2021, respectively. CRC-related operations decreased by 24.1% in April 2020 and increased by 12.6% in August 2021.

CONCLUSIONS

Negative impact of the COVID-19 pandemic on clinical practices related to CRC completely recovered within second year. It could be considered for the development of an optimal strategy on CRC management in response to the pandemic-driven crisis.

Comparison of the Frequency in Changing and Using Personal Protective Equipment Among Dental Staff After Coronavirus Disease 2019

OBJECTIVE

This study was conducted to identify changes in the personal protective equipment (PPE)-wearing behaviour of dental staff after the coronavirus disease (COVID-19) outbreak in Korea.

METHODS

This study used a self-administered questionnaire for 257 dental staff (dentists, dental hygienists and other assistants) in regions of Korea. The questionnaire investigated the change in the frequency of wearing of PPE after COVID-19 (masks, gloves, goggles, face shields and protective clothing), and the PPE change cycle of dental staff compared with that before COVID-19.

RESULTS

In the case of masks, if there was an infection control manager, the change in wearing was 4.583(1.658-12.667) times higher. In case of goggles and face shields, those with infection control education experienced a 2.982(1.087-8.178) increase in wearing these. Regarding protective clothing, it was 3.831(1.537-9.553) times higher when there was an infection control manager and it was 3.103(1.481-6.504) times higher when there was a visit to a patient with confirmed COVID-19.

CONCLUSIONS

It is necessary to prepare guidelines for wearing PPE in consideration of the type of infectious disease and the institution's characteristics, to periodically conduct infection control education to maintain this state of alert, and to prepare for personal protection to prevent the spread of new infectious diseases.

[Good practices in epidemiological surveillance for the sustainability of measles, rubella, and congenital rubella syndrome elimination in El Salvador, 2019-2023Boas práticas de vigilância epidemiológica para a sustentabilidade da eliminação do sarampo, da rubéola e da síndrome da rubéola congênita em El Salvador, 2019-2023]

Objective

Describe good practices in epidemiological surveillance implemented in El Salvador between 2019 and 2023 to sustain the elimination of measles, rubella, and congenital rubella syndrome.

Methods

Special descriptive report on the implementation of good epidemiological and laboratory surveillance practices for measles, rubella, and congenital rubella syndrome from 2019 to 2023.

Results

During the period 2019 to 2023, El Salvador reported no confirmed cases of measles, rubella, or congenital rubella syndrome. The national measles and rubella notification rate was 8.4 per 100 000 population in 2023; 9 in 2022; 5.6 in 2021; 2.9 in 2020; and 8.2 in 2019. Between the report of the first confirmed case of COVID-19 in the country and the declaration of the end of the international health emergency by the World Health Organization on 5 May 2023, the rate of reported suspected cases of measles and rubella remained above the indicator.

Conclusions

The implementation of permanent and mandatory epidemiological surveillance strategies allowed the sustainability of measles and rubella elimination in El Salvador during the COVID-19 pandemic.

Outdoor social distancing behaviors changed during a pandemic: A longitudinal analysis using street view imagery

Social distancing, defined as maintaining a minimum interpersonal distance (often 6 ft or 1.83 m), is a non-pharmaceutical intervention to reduce infectious disease transmission. While numerous quantitative studies have examined people's social distancing behaviors using mobile phone data, large-scale quantitative analyses of adherence to suggested minimum interpersonal distances are lacking. We analyzed pedestrians' social distancing behaviors of using 3 years of street view imagery collected in a metropolitan city (Seattle, WA, USA) during the COVID-19 pandemic. We employed computer vision techniques to locate pedestrians in images, and a geometry-based algorithm to estimate physical distance between them. Our results indicate that social distancing behaviors correlated with key factors such as vaccine availability, seasonality, and local socioeconomic data. We also identified behavioral differences at various points of interest within the city (e.g., parks, schools, faith-based organizations, museums). This work represents a first of its kind longitudinal study of outdoor social distancing behaviors using computer vision. Our findings provide key insights for policymakers to understand and mitigate infectious disease transmission risks in outdoor environments.

Assessment of the Attitude, Anxiety Episodes and Perceived Psychological Impact of the Pandemic on Medical Undergraduate Students - a Retrospective Study

BACKGROUND

The COVID-19 pandemic has caused widespread public concern and stress, particularly among medical undergraduates, who faced heightened anxiety due to the uncertainty of the disease resurgence. This study aimed to assess the knowledge, attitudes, anxiety experiences and perceived mental healthcare needs of undergraduate medical students in India through an online multicentric survey.

METHODS

A semi-structured pilot-tested questionnaire was administered online via Google Forms and distributed through social media platforms. The survey was carried out over a period of three months during the pandemic (2020-2021). Students were given five days to respond and incomplete or late submissions were excluded. Data were collected and analyzed using MS Excel and appropriate statistical tests, with a significance level of 0.05.

RESULTS

Out of all respondents to the survey, 55.3% reported frequently thinking about the pandemic, while 5.9% were always paranoid about infection. Social contact avoidance was common, with 40.5% of respondents always avoiding contact and 36.3% avoiding large gatherings. Sleep disturbances were reported by 16.9% occasionally and 3.8% regularly. Social media posts about COVID-19 affected 56.1% of participants. Notably, 62.4% expressed a desire to discuss pandemic-related worries and 85.2% acknowledged the need for mental health support during periods of heightened panic. Most respondents (86.5%) agreed that mental health professionals should assist in managing pandemic-related stress.

CONCLUSION

The study highlights significant psychological impacts of COVID-19 on medical students, with emphasizing the need for targeted mental health interventions. Raising awareness and providing accessible mental health resources are crucial to addressing their needs, particularly as the threat of new COVID-19 variants persists. Studying mental health impacts across diverse populations will aid in planning effective strategies for broader pandemic-related mental health challenges.

Impact of prior oral anticoagulation therapies on post-discharge outcomes after COVID-19: Results from a global federated health network analysis

BACKGROUND

The impact of chronic oral anticoagulant (OACs) use on long-term post-discharge outcomes after coronavirus disease 2019 (COVID-19) hospitalisation remains unclear. Herein, we compared clinical outcomes up to 2-years after COVID-19 hospitalisation between patients on vitamin K antagonists (VKAs), direct-acting OACs (DOACs) and no OAC therapy.

METHODS

Data from TriNetX, a global federated health research network, were used. Adult patients on VKAs, DOACs or no OAC therapy at diagnosis of COVID-19 between 20 January 2020 and 31 December 2021, who were hospitalised for COVID-19, were included. The primary outcomes were all-cause mortality, ischaemic stroke/transient ischaemic attack (TIA)/systemic embolism (SE) and the composite of intracranial haemorrhage (ICH)/gastrointestinal bleeding, at 2 years after COVID-19 hospitalisation.

RESULTS

We included 110,834 patients with COVID-19. Following propensity score matching (PSM), we identified a decreased mortality risk in DOAC-treated patients compared to the no OAC cohort (RR .808, 95% CI .751-.870). A higher risk of ischaemic stroke/TIA/SE was observed in VKA users compared to DOAC users (RR 1.100, 95% CI 1.020-1.220) and in VKA users compared to patients not taking OAC (RR 1.400, 95% CI 1.140-1.720). VKA use was associated with a greater risk of ICH/gastrointestinal bleeding than DOAC users (RR 1.198, 95% CI 1.066-1.347), while DOAC users had a lower risk compared to no OAC-treated patients (RR .840, 95% CI .754-.936).

CONCLUSION

COVID-19 patients taking prior DOACs were associated with lower long-term mortality risk and ICH/gastrointestinal bleeding than patients not taking OAC. Compared to patients on DOACs, VKA users were associated with higher risks of mortality, ischaemic stroke/TIA/SE and ICH/gastrointestinal bleeding.

Nucleic Acid Lateral Flow Assay Implemented with Isothermal Gene Amplification of SARS-CoV-2 RNA

We developed a rapid and sensitive diagnostic platform that integrates isothermal viral gene amplification with a nucleic acid lateral flow assay (NALFA) to detect SARS-CoV-2 RNA. Isothermal gene amplification was performed by combining reverse transcription of viral RNA with recombinase polymerase amplification (RPA). In our diagnostic platform, DNA primers for the RPA reaction were modified by appending DNA tails, enabling the synthesis of tailed amplicon DNAs. These tailed amplicon DNAs were subsequently annealed to the complementary capture DNA probe affixed to the lateral flow strip during the NALFA of the reaction samples. The other side of each amplicon DNA tail was annealed to the reporter probe DNA conjugated with gold nanoparticles to visually detect the test line in the strip. This diagnostic platform reduces the time required to obtain readouts to within 1 h and can detect viral RNA concentrations as low as 3.1 cp/μL. Furthermore, when applied to nasopharyngeal clinical samples, our NALFA diagnostic platform yielded highly reliable molecular diagnostic readouts that were 100% consistent with the results of conventional RT-qPCR.

Navigating the COVID-19 Therapeutic Landscape: Unveiling Novel Perspectives on FDA-Approved Medications, Vaccination Targets, and Emerging Novel Strategies

Amidst the ongoing global challenge of the SARS-CoV-2 pandemic, the quest for effective antiviral medications remains paramount. This comprehensive review delves into the dynamic landscape of FDA-approved medications repurposed for COVID-19, categorized as antiviral and non-antiviral agents. Our focus extends beyond conventional narratives, encompassing vaccination targets, repurposing efficacy, clinical studies, innovative treatment modalities, and future outlooks. Unveiling the genomic intricacies of SARS-CoV-2 variants, including the WHO-designated Omicron variant, we explore diverse antiviral categories such as fusion inhibitors, protease inhibitors, transcription inhibitors, neuraminidase inhibitors, nucleoside reverse transcriptase, and non-antiviral interventions like importin α/β1-mediated nuclear import inhibitors, neutralizing antibodies, and convalescent plasma. Notably, Molnupiravir emerges as a pivotal player, now licensed in the UK. This review offers a fresh perspective on the historical evolution of COVID-19 therapeutics, from repurposing endeavors to the latest developments in oral anti-SARS-CoV-2 treatments, ushering in a new era of hope in the battle against the pandemic.

Impact of neighborhood-level COVID-19 mortality on the increase in drug overdose mortality in New York City during the COVID-19 pandemic

BACKGROUND

Overdose mortality increased substantially during the COVID-19 pandemic, but it is unclear to what extent the COVID-19 mortality had contributed to this increase at the neighborhood level.

METHODS

This was an ecological study based on New York City United Hospital Fund (NYC UHF) neighborhood-level data from 2019 to 2021, split into two time-windows: pre-COVID (2019) and during-COVID (2020 and 2021). Linear regression models were used to estimate the effect of cumulative COVID-19 mortality on the increase in drug overdose mortality from the pre-COVD to during-COVID periods at the neighborhood level, with and without adjusting for neighborhood characteristics.

RESULTS

Drug overdose mortality rate increased from 21.3 to 33.4 deaths per 100,000 person-years across NYC UHF neighborhoods from pre-COVID to during-COVID. For each additional COVID-19 death per 1,000 person-years at the neighborhood level, the increase in drug overdose mortality rose 2.4 (95% CI: 1.7, 3.3) times. Furthermore, neighborhoods with a higher percentage of Hispanic residents, a higher percentage of single-person households, and a higher percentage of residents with health insurance experienced significantly larger increases in drug overdose mortality. In contrast, neighborhoods with a higher percentage of residents aged 75 and older had a smaller increase in drug overdose mortality.

CONCLUSIONS

NYC neighborhoods with higher cumulative COVID-19 mortality experienced a greater increase in drug overdose mortality during the first two years of the COVID-19 pandemic.

NK Cell and Monocyte Dysfunction in Multisystem Inflammatory Syndrome in Children

Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection characterized by multiorgan involvement and inflammation. Testing of cellular function ex vivo to understand the aberrant immune response in MIS-C is limited. Despite strong Ab production in MIS-C, SARS-CoV-2 nucleic acid testing can remain positive for 4-6 wk postinfection. Therefore, we hypothesized that dysfunctional cell-mediated Ab responses downstream of Ab production may be responsible for delayed clearance of viral products in MIS-C. In MIS-C, monocytes were hyperfunctional for phagocytosis and cytokine production, whereas NK cells were hypofunctional for both killing and cytokine production. The decreased NK cell cytotoxicity correlated with an NK exhaustion marker signature and systemic IL-6 levels. Potentially providing a therapeutic option, cellular engagers of CD16 and SARS-CoV-2 proteins were found to rescue NK cell function in vitro. Taken together, our results reveal dysregulation in Ab-mediated cellular responses of myeloid and NK cells that likely contribute to the immune pathology of this disease.

Potent neutralization by a RBD antibody with broad specificity for SARS-CoV-2 JN.1 and other variants

SARS-CoV-2 continues to be a public health burden, driven in-part by its continued antigenic diversification and resulting emergence of new variants. By increasing herd immunity, current vaccines have improved infection outcomes for many. However, prophylactic and treatment interventions that are not compromised by viral evolution of the Spike protein are still needed. Using a differential staining strategy with a rationally designed SARS-CoV-2 Receptor Binding Domain (RBD) - ACE2 fusion protein and a native Omicron RBD protein, we developed a recombinant human monoclonal antibody (hmAb) from a convalescent individual following SARS-CoV-2 Omicron infection. The resulting hmAb, 1301B7 potently neutralized a wide range of SARS-CoV-2 variants including the original Wuhan-1, the more recent Omicron JN.1 strain, and SARS-CoV. 1301B7 contacts the ACE2 binding site of RBD exclusively through its VH1-69 heavy chain. Broad specificity is achieved through 1301B7 binding to many conserved residues of Omicron variants including Y501 and H505. Consistent with its extensive binding epitope, 1301B7 is able to potently diminish viral burden in the upper and lower respiratory tract and protect mice from challenge with Omicron XBB1.5 and Omicron JN.1 viruses. These results suggest 1301B7 has broad potential to prevent or treat clinical SARS-CoV-2 infections and to guide development of RBD-based universal SARS-CoV-2 prophylactic vaccines and therapeutic approaches.

Detection of SARS-CoV-2 in wastewater as an earlier predictor of COVID-19 epidemic peaks in Venezuela

Wastewater-based epidemiological surveillance has proven to be a useful and cost-effective tool for detecting COVID-19 outbreaks. Here, our objective was to evaluate its potential as an early warning system in Venezuela by detecting SARS-CoV-2 RNA in wastewater and its correlation with reported cases of COVID-19. Viral RNA was concentrated from wastewater collected at various sites in Caracas (northern Venezuela), from September 2021 to July 2023, using the polyethylene glycol (PEG) precipitation method. Viral quantification was performed by RT-qPCR targeting the N1 and ORF1ab genes. A significant association (p < 0.05) was found between viral load in wastewater and reported cases of COVID-19 up to six days after sampling. During the whole study, two populated areas of the city were persistent hotspots of viral infection. The L452R mutation, suggestive of the presence of the Delta variant, was identified in the only sample where a complete genomic sequence could be obtained. Significant differences (p < 0.05) between the physicochemical conditions of the wastewater samples positive and negative for the virus were found. Our results support proof of concept that wastewater surveillance can serve as an early warning system for SARS-CoV-2 outbreaks, complementing public health surveillance in those regions where COVID-19 is currently underreported.

Phytocompounds as versatile drug-leads targeting mProtease in the SARS-CoV-2 virus: insights from a molecular dynamics study

SARS-CoV-2 is one of the deadly outbreaks in the present era and still showing its presence around the globe. Researchers have produced various vaccines that offer protection against infection, but we have not yet found a cure for COVID-19. Currently, efforts are focused on identifying effective therapeutic approaches to treat this infectious disease. In the present work, we investigated the main protease (Mpro) protein, a crucial component in SARS-CoV-2 viral particle formation, as a drug target and proposed phytocompounds with therapeutic potential against SARS-CoV-2. Initially, several plant-based resources were exploited to screen around one thousand phytocompounds and further their physiochemical characterization and assessment of drug likeliness were performed using SwissADME. Eventually, we screened 95 compounds based on docking analysis using AutoDock Vina. Five compounds were selected having the highest affinity for Mpro for the analysis of ligand-receptor interaction using molecular dynamic (MD) simulation. Docking and MD simulation studies elucidated the promising stable interaction of selected 5 ligands with Mpro. During MD simulation of 100 ns, Abacopterin F showed the lowest binding energy (-37.13 kcal/mol) with the highest affinity towards Mpro and this compound may be proposed as a lead molecule for further investigation. This interaction may result in modulation of the Mpro activity, consequently leading to hindrance in viral particle formation. However, in-vitro and in-vivo experimental validation would be needed to process the selected phytomolecules as a therapeutic lead against SARS-CoV-2.

Harnessing the power of infection prevention and public health data systems to support health care in Washington State during the COVID-19 pandemic

BACKGROUND

State health departments' (SHD) role in infection prevention and control (IPC) includes robust educational and consultative services for various health care settings. During the COVID-19 pandemic, Washington-SHD (W-SHD) IPC staff conducted remote and on-site Infection Control Assessment and Response (ICAR) consultations for long-term care (LTC) and non-LTC health care facilities.

METHODS

ICAR consultations were classified as "reactive" in response to a COVID-19 outbreak or "proactive" to help facilities improve IPC protocols. Facility addresses were geocoded to census tracks, classifying urban or rural areas. Facility types and characteristics were analyzed, assessing the impacts of repeat visits. All descriptive statistics, Pearson's χ2 tests, and odds ratios were calculated.

RESULTS

Between March 2020 and December 2022, W-SHD conducted 3,093 ICARs at 1,703 health care facilities in 94.9% (37/39) of Washington counties. Of the total visits, most were in LTC (90.5%) and 48.9% were reactive. Facilities with initial on-site ICARs had 1.5 times the odds of having a repeat visit than facilities with initial remote visit (95% CI: 1.21, 1.87).

DISCUSSION

Maintaining strong connections with health care facilities can help bolster infection prevention practices and minimize loss of information at the facility level.

CONCLUSIONS

Evidence-based findings on the sustainability of the W-SHD's ICAR services during the COVID-19 pandemic illustrated the value of public health IPC programs.

The Effectiveness of Mini-Pulse Methylprednisolone in the Treatment of Patients With COVID-19 in the Intensive Care Unit

OBJECTIVE

To investigate the effect of mini-pulse methylprednisolone in the treatment of patients with COVID-19 hospitalized in the intensive care units (ICU).

METHODS

This is a single-blind parallel non-randomized clinical trial that will be carried out on 60 hospitalized COVID-19 patients and conducted between February 2020 and December 2020 in Ardabil City Hospital, Ardabil, Iran. The t-test and chi-square test were used to compare the results of the two groups. A p-value of less than 0.05 was considered statistically significant. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26 software.

RESULTS

The mean (±SD) age of patients was 57.53 ± 13.71 years. Thirty-five patients (58.3%) were male and 25 (14.7%) were female. Twenty-eight patients had fever. During admission, the mean (±SD) of the oxygen saturation was 80.73 ± 8.31. No significant relationship was observed between the study variables in the two groups at baseline.

CONCLUSION

The results of the present study showed that in patients treated with methylprednisolone, blood oxygen saturation increased and heart rate and breathing rate decreased significantly. Also, mini-pulse treatment with methylprednisolone significantly reduced the number of days of hospitalization and the incidence of mortality.

Exploring Reddit conversations about mental health difficulties among college students during the COVID-19 pandemic

Objective: We aimed to explore conversations about mental health difficulties by Reddit users who posted within college subreddits during the COVID-19 pandemic. Participants: Data were collected from the subreddits of 22 California campuses, representing 113,579 anonymous members. Using the following search terms, we retrieved 577 posts (ie, 268 original posts and 309 replies): COVID, Coronavirus, Quarantine, Pandemic, Anxiety, Anxious, Depressed, Depression, Overwhelmed, Stress, and Stressed. Methods: We used inductive, thematic data analysis to explore themes within posts and replies dated from 3/16/2020 to 3/16/2021. Results: We identified the following themes: 1) the COVID-19 pandemic has negatively impacted engagement with learning; 2) remote learning has exacerbated students' mental health difficulties; and 3) students provide and receive social support online. Conclusions: These findings have implications that are particularly relevant as campuses are faced with continuous decisions related to repopulation.

Efficacy and safety of interim oncology treatments introduced for solid cancers during the COVID-19 pandemic in England: a retrospective evidence-based analysis

Background

The COVID-19 global pandemic placed unprecedented pressure on cancer services, requiring new interim Systemic Anti-Cancer Treatments (SACT) options to mitigate risks to patients and maintain cancer services. In this study we analyse interim COVID-19 SACT therapy options recommended in England, evaluating the evidence supporting inclusion and delineating how these have been integrated into routine cancer care.

Methods

We performed a retrospective analysis of interim Systemic Anti-Cancer Treatments endorsed by NHS England during the COVID-19 pandemic. Interim therapy options were compared to baseline (replacement) therapies by comparing data from the key pivotal trial(s) in terms of clinical efficacy and potential benefits (e.g., reduced immunosuppression or improved adverse effect profile) within the context of the pandemic. Furthermore, we evaluated the evolution of these interim SACT options, exploring if these have been integrated into current treatment pathways or are no longer accessible at the pandemic end.

Findings

31 interim oncology treatment options, across 36 indications, for solid cancers were endorsed by NHS England between March 2020 and August 2021. Interim therapies focused on the metastatic setting (83%; 30/36), allowing greater utilisation of immune checkpoint inhibitors (45%; 14/31) and targeted therapies (26%; 8/31), in place of cytotoxic chemotherapy. Overall, 36% (13/36) of therapies could not have efficacy compared with baseline treatments due to a paucity of evidence. For those which could, 39% (9/23) had superior efficacy (e.g., overall survival), 26% (6/23) had equivocal efficacy and 35% (8/23) lower efficacy. 53% (19/36) of interim therapies had better or equivocal toxicity profiles (when assessable), and/or were associated with reduced immunosuppression. Almost half (47%; 17/36) of interim therapies did not have UK market authorisation, being classified as 'off label' use. Analysing access to interim options at the end of the pandemic (May 2023) identified 19 (53% 19/36) interim options were fully available, and a further four (11% 4/36) therapies were partially available.

Interpretation

Interim SACT options, introduced in England, across a range of solid cancers supported delivery of cancer services during the pandemic. Most interim therapies did not demonstrate superior efficacy, but provided other important benefits (e.g., reduced immunosuppression) in the context of the pandemic.

Funding

None.

Intention to adherence to social distancing for prevention of Covid-19 in the urban areas of southern Iran: a structural equation modeling (SEM) analysis of theory of planned behavior

BACKGROUND

Social distancing is a key behavior to minimize and controlling COVID-19 infections. The current study applied an integrated Theory of Planned Behavior to identify the determinants of social distancing behavior, and the processes involved, in the context of the COVID-19 pandemic.

METHODS

a cross-sectional study was conducted in Southern Iran among 1000 people from Shiraz by employing a convenience sampling technique. Data were collected using a pre-tested and structured questionnaire based on the main constructs of the Theory of Planned Behavior. Statistical analysis was done using IBM SPSS software version 22 and Amos version 24. Level of statistical significance was declared at a P-value of less than 0.05.

RESULTS

according to the results, the subjective norms (F = 2.696, effect size = 0.139) and attitude (F = 3.582, effect size = 0.155) play an important role in the samples' PBC (P ≤ 0.05). Final adjusted structural equation model of the effects of independent variables (Gender, subjective norms, attitude) on samples' intention to adherence social distancing for prevention of Covid-19 with the mediating role of one main variable of PBC. The PBC alone can be an important factor in creating intensive behavior in the samples (F = 3.560, effect size = 0.18).

CONCLUSION

current findings highlight the importance of "attitude, subjective norms and PBC" as determinants of social distancing intention. Future research on long-range predictors of social distancing behavior and reciprocal effects in the integrated model is warranted. This evidence is relevant to public and private organizations in the process of developing strategies to promote and engage the population in adopting the behavior of "Adherence to Social Distancing" in Iran.

Performance of the Flash10 COVID-19 point-of-care molecular test

After the COVID-19 pandemic, fever clinics urgently require rapid nucleic acid tests to enhance their capacity for timely pathogen detection. This study evaluated the analytical performance and clinical utility of the Flash10 SARS-CoV-2 point-of-care test (Flash10 POCT) for detecting SARS-CoV-2 in patients with fever in the adult fever clinic in Beijing Tsinghua Changgung Hospital from August 1 to August 30, 2023. The analytical performance and clinical utility of the Flash10 POCT for detecting SARS-CoV-2 were assessed in 125 patients with fever syndrome in the adult fever clinic. The Flash10 POCT demonstrated an analytical precision of 3.1% for the Ct values of the ORF1ab gene and 2.9% for the Ct values of the N gene in SARS-CoV-2 nucleic acid testing. Furthermore, the Flash10 POCT demonstrated a lower limit of detection (LoD) of 100 copies/mL, with no detected aerosol contamination leakage. Of the 125 patients (median age 61.9 years, 52% male and 48% female), both the Flash10 POCT and RT-PCR tests yielded positive results for 100 patients and negative results for 25 patients (Fisher's exact test, p < 0.0001). The median turn-around-time for the Flash10 POCT was significantly shorter, at 1.05 h, compared to 16.15 h required for RT-PCR tests (Wilcoxon signed rank test, p < 0.0001). The Flash10 POCT showed high analytical performance, achieving a 100% detection rate for SARS-CoV-2 compared to RT-PCR tests, while also exhibiting a significantly shorter turn-around-time. Implementing the Flash10 POCT had the potential to expedite the care of adults presenting with fever.

Strategies to Minimize Virus Transmission During Anesthesia Procedures in COVID-19 Patients

Anesthesiologists and the critical care team may be at increased risk of contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, COVID-19) due to airway manipulations and intubations performed during anesthesia administration and management of patient undergoing surgery. SARS-CoV-2 infections have been reported among healthcare workers. The virus is transmitted by close personal contact and aerosols. During intubation and other procedures involving the airway, the anesthesiologist is especially susceptible to aerosols. We performed a systematic analysis of the published reports on potential effects of COVID-19 during surgery on the anesthesiologist and critical care team. and identified potential immunomodulatory effects of general anesthetics in the presence of COVID-19 infection in patients. The article also provides critical discussion on the current medical management of COVID-19 and highlights the evidence-based key points for a safer practice during anesthesia administration and surgeries both in children and adults, including obstetric procedures and how it could affect pregnant women receiving anesthesia. With regional anesthesia, airway manipulation is not necessary, and healthcare workers and other patients are less likely to contract the same infection.

Effects of non-pharmaceutical interventions on COVID-19 transmission: rapid review of evidence from Italy, the United States, the United Kingdom, and China

Background

Prior to the development of COVID-19 vaccines, policymakers instituted various non-pharmaceutical interventions (NPIs) to limit transmission. Prior studies have attempted to examine the extent to which these NPIs achieved their goals of containment, suppression, or mitigation of disease transmission. Existing evidence syntheses have found that numerous factors limit comparability across studies, and the evidence on NPI effectiveness during COVID-19 pandemic remains sparse and inconsistent. This study documents the magnitude and variation in NPI effectiveness in reducing COVID-19 transmission (i.e., reduction in effective reproduction rate [Reff] and daily contact rate) in Italy, the United States, the United Kingdom, and China.

Methods

Our rapid review and narrative synthesis of existing research identified 126 studies meeting our screening criteria. We selected four contexts with >5 articles to facilitate a meaningful synthesis. This step yielded an analytic sample of 61 articles that used data from China, Italy, the United Kingdom, and the United States.

Results

We found wide variation and substantial uncertainty around the effectiveness of NPIs at reducing disease transmission. Studies of a single intervention or NPIs that are the least stringent had estimated Reff reductions in the 10-50% range; those that examined so-called "lockdowns" were associated with greater Reff reductions that ranged from 40 to 90%, with many in the 70-80% range. While many studies reported on multiple NPIs, only six of the 61 studies explicitly used the framing of "stringency" or "mild versus strict" or "tiers" of NPIs, concepts that are highly relevant for decisionmakers.

Conclusion

Existing evidence suggests that NPIs reduce COVID-19 transmission by 40 to 90 percent. This paper documents the extent of the variation in NPI effectiveness estimates and highlights challenges presented by a lack of standardization in modeling approaches. Further research on NPI effectiveness at different stringency levels is needed to inform policy responses to future pandemics.