Rapid real-time tracking of non-pharmaceutical interventions and their association with SARS-CoV-2 positivity: The COVID-19 Pandemic Pulse Study

Physician Trust in the News Media and Attitudes toward COVID-19

CONTEXT

Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients independent of partisan affiliation or media trust.

METHODS

The authors conducted an online survey of 625 primary care physicians and used the results to test (1) whether physician trust in media outlets is consistent with their political partisanship, and (2) whether trust in media outlets influences (a) personal concern that someone in their family will get sick, (b) perceptions about the seriousness of the pandemic as portrayed in the media, and (c) trust in federal government agencies and scientists.

FINDINGS

Physicians are better positioned to critically evaluate health-related news, but they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust, and media trust influences concern that a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists.

CONCLUSIONS

Physician trust in specific media outlets shapes their understanding of the pandemic, and-to the extent that they trust conservative media outlets-it may limit their effectiveness as health policy messengers.

Imperfect messengers? An analysis of vaccine confidence among primary care physicians

BACKGROUND

Growing narratives emphasize using primary care physicians as leaders in efforts to promote COVID-19 vaccination among the vaccine hesitant. Critically however, little is known about vaccine confidence among primary care physicians themselves. The objective of this study was to assess both physician confidence that in general, vaccines are safe, effective, and important, as well as physician confidence in each COVID-19 vaccine in the United States.

METHODS

We rely on data from a national survey of primary care physicians conducted from May 14-May 25, 2021. We assess the influence of demographic, social, and political factors on physician beliefs that in general, vaccines are safe, effective, and important, as well as physician confidence in the safety of the Moderna, Pfizer, and Johnson & Johnson COVID-19 vaccines.

RESULTS

10.1% of primary care physicians do not agree that, in general, vaccines are safe, 9.3% do not agree they are effective, and 8.3% do not agree they are important. While 68.7% of physicians were 'very confident' in the safety of the Moderna vaccine and 72.7% were 'very confident' in the safety of the Pfizer vaccine, only 32.1% of physicians were 'very confident' in the safety of the Johnson & Johnson COVID-19 vaccine.

CONCLUSION

A troubling proportion of primary care physicians lack high levels of vaccine confidence. These physicians may not be well positioned to actively promote COVID-19 vaccination even as political and media narratives push physicians to lead this effort. Interventions aimed at improving vaccine confidence among some physicians may be needed so that all physicians can fulfill needed roles as trusted vaccine communicators.

Using a cultural and social identity lens to understand pandemic responses in the US and India

The world over, countries have been racing to control the spread of the Covid-19 pandemic. Central to the mitigation of the virus spread is the ability of nations to ensure behavior of its people adheres to the constraints imposed in the wake of the pandemic. However, there has been much variation in how individuals and collectives have responded in conformance to expected behavioral changes necessitated by the pandemic. The paper offers a cross-cultural and social identity perspective based on group categorizations to understand the variation in pandemic responses in the context of two different countries, that of India and the United States. Relevant cultural dimensions of difference shaping behavior such as individualism-collectivism, power distance, and other cultural norms shaping divergent behavioral responses in the US and India are examined. Differing group categorizations relevant for each country are also explored to understand the dynamics of behavioral response, be it adherence to mask wearing and following norms of social distancing, or the migrant labor exodus in India from urban to rural areas amidst the first wave of the pandemic. Implications for managing behavioral responses considering cross-cultural differences and group categorization processes are also discussed.

Comparison of clinical and echocardiographic features of first and second waves of COVID-19 at a large, tertiary medical center serving a predominantly African American patient population

As clinicians have gained experience in treating patients with the novel SARS-CoV-2 (COVID-19) virus, mortality rates for patients with acute COVID-19 infection have decreased. The Centers for Disease Control (CDC) has identified the African American population as having increased risk of COVID-19 associated mortality, however little is known about echocardiographic markers associated with increased mortality in this patient population. We aimed to compare the clinical and echocardiographic features of a predominantly African American patient cohort hospitalized with acute COVID-19 infection during the first (March–June 2020) and second (September–December 2020) waves of the COVID-19 pandemic, and to investigate which parameters are most strongly associated with composite all-cause mortality. We performed consecutive transthoracic echocardiograms (TTEs) on 105 patients admitted with acute COVID-19 infection during the first wave and 129 patients admitted during the second wave. TTE parameters including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LVGLS), right ventricular global longitudinal strain (RVGLS), right ventricular free-wall strain (RVFWS), and right ventricular basal diameter (RVBD) were compared between the two groups. Clinical and demographic characteristics including underlying co-morbidities, biomarkers, in-hospital treatment regimens, and outcomes were collected and analyzed. Univariable and multivariable analyses were performed to determine variables associated with all-cause mortality. There were no significant differences between the two waves in terms of age, gender, BMI, or race. Overall all-cause mortality was 35.2% for the first wave compared to 14.7% for the second wave (p < 0.001). Previous medical conditions were similar between the two waves with the exception of underlying lung disease (41.9% vs. 29.5%, p = 0.047). Echocardiographic parameters were significantly more abnormal in the first wave compared to the second: LVGLS (− 17.1 ± 5.0 vs. − 18.9 ± 4.8, p = 0.02), RVGLS (− 15.7 ± 5.9% vs. − 19.0 ± 5.9%, p < 0.001), RVFWS (− 19.5 ± 6.8% vs. − 23.2 ± 6.9%, p = 0.001), and RVBD (4.5 ± 0.8 vs. 3.9 ± 0.7 cm, p < 0.001). Stepwise multivariable logistic analysis showed mechanical ventilation, RVFWS, and RVGLS to be independently associated with mortality. In a predominantly African American patient population on the south side of Chicago, the clinical and echocardiographic features of patients hospitalized with acute COVID-19 infection demonstrated marked improvement from the first to the second wave of the pandemic, with a significant decrease in all-cause mortality. Possible explanations include implementation of evidence-based therapies, changes in echocardiographic practices, and behavioral changes in our patient population. Mechanical ventilation and right-sided strain-based markers were independently associated with mortality.

SARS-CoV-2 Testing in Florida, Illinois, and Maryland: Access and Barriers

Objective

To characterize the SARS-CoV-2 testing cascade and associated barriers in three US states.

Methods

We recruited participants from Florida, Illinois, and Maryland (~1000/state) for an online survey September 16 - October 15, 2020. The survey covered demographics, COVID-19 symptoms, and experiences around SARS-CoV-2 PCR testing in the prior 2 weeks. Logistic regression was used to analyze associations with outcomes of interest.

Results

Overall, 316 (10%) of 3,058 respondents wanted/needed a test in the two weeks prior to the survey. Of these, 166 (53%) were able to get tested and 156 (94%) received results; 53% waited ≥ 8 days to get results from when they wanted/needed a test. There were no significant differences by state. Among those wanting/needing a test, getting tested was significantly less common among men (aOR: 0.46) and those reporting black race (aOR: 0.53) and more common in those reporting recent travel (aOR: 3.35).

Conclusions

There is an urgent need for a national communication strategy on who should get tested and where one can get tested. Additionally, measures need to be taken to improve access and reduce turn-around-time.

Effectiveness of face masks worn in community settings at reducing the transmission of SARS-CoV-2: A rapid review

Background: The use of face masks is part of a suite of infection prevention and control measures intended to limit the transmission of respiratory viral diseases. The use of face masks by the general public has been subject to ongoing debate, with limited direct evidence on the effectiveness of face masks in the community during the COVID-19 pandemic. The aim of this review was to synthesise direct evidence on the effectiveness of wearing face masks at reducing the transmission of SARS-CoV-2 in community settings. Methods: A rapid review was conducted. PubMed, Embase, NHS Evidence and Europe PMC were searched systematically from 1 January to 27 August 2020. Clinical trials, cohort, case control, and cross-sectional studies were included if they reported on the effectiveness of face masks in community settings at reducing the transmission of SARS-CoV-2. Studies were critically appraised and synthesised narratively. Results:  Seven observational studies were identified, including one study set in households and six in community settings, that reported on the effectiveness of wearing face masks compared with not wearing face masks at reducing the transmission of SARS-CoV-2. Results suggested that face masks reduce the risk of SARS-CoV-2 infection; however, all studies were at high risk of bias and the quality of the evidence was low. Conclusions: This is to date the most comprehensive review of direct evidence on the effectiveness of wearing face masks in the community during the COVID-19 pandemic. There is limited, low certainty direct evidence that wearing face masks reduces the risk of transmission of SARS-CoV-2 in community settings. Further high quality studies are required to confirm these findings.