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Wei D, Xie Y, Liu X, Chen R, Zhou M, Zhang X, Qu J. Pathogen evolution, prevention/control strategy and clinical features of COVID-19: experiences from China. Front Med 2023; 17:1030-1046. [PMID: 38157194 DOI: 10.1007/s11684-023-1043-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported at the end of 2019 as a worldwide health concern causing a pandemic of unusual viral pneumonia and many other organ damages, which was defined by the World Health Organization as coronavirus disease 2019 (COVID-19). The pandemic is considered a significant threat to global public health till now. In this review, we have summarized the lessons learnt during the emergence and spread of SARS-CoV-2, including its prototype and variants. The overall clinical features of variants of concern (VOC), heterogeneity in the clinical manifestations, radiology and pathology of COVID-19 patients are also discussed, along with advances in therapeutic agents.
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Affiliation(s)
- Dong Wei
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yusang Xie
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Xuefei Liu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Rong Chen
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China
| | - Xinxin Zhang
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, 200025, China.
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Clemente I, Santini SJ, Vittorini P, Pallotta E, Sinatti G, Fontana A, Mammarella L, Rancitelli E, Balsano C. Fall of viral and bacterial pneumonia hospitalizations following COVID-19 pandemic mitigation strategies: a central Italian Region retrospective study. Intern Emerg Med 2023; 18:1181-1189. [PMID: 36750536 PMCID: PMC9904871 DOI: 10.1007/s11739-023-03213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
Community-Acquired Pneumonia (CAP) represents one of the first causes of hospitalization and death in the elderly all over the world and weighs heavily on public health system. Since the beginning of the COVID-19 (CoronaVirus Disease-19) pandemic, everybody's behavior was forced to change, as the result of a global lockdown strategy and the obligation of using personal protection equipment (PPE). We aimed to evaluate how the mitigation strategies adopted to fight SARS-CoV-2 (Severe Acute Respiratory Coronavirus Syndrome 2) infection have influenced hospitalizations due to CAP in two different Local Health Boards (LHBs) of central Italy. We considered two main periods of observation: before and after the national start of lockdown, in two Abruzzo's LHBs. We analyzed 19,558 hospital discharge records of bacterial and viral CAP. Excluding SARS-CoV2 infection, a significant decrease in CAP hospitalizations was observed. Through the analysis of Diagnosis Related Group (DRG) values, we highlighted a significant saving of founds for the Regional Health Service. The enactment of social distancing measures to contain COVID-19 spread, brought down admissions for bacterial and viral pneumonia. Our study emphasizes that costs for hospitalizations due to CAP could be drastically reduced by mask wearing and social distancing.
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Affiliation(s)
- Irma Clemente
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvano Junior Santini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| | - Pierpaolo Vittorini
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Enrico Pallotta
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gaia Sinatti
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonella Fontana
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy
| | - Leondino Mammarella
- U.O.S.D. Servizio Gestione Flussi Informativi e Statistica Sanitaria, L'Aquila, Italy
| | | | - Clara Balsano
- Department of Life, Health and Environmental Sciences-MESVA, School of Emergency-Urgency Medicine, University of L'Aquila, 67100, L'Aquila, Italy.
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy.
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Abstract
To date, a total of seven human coronaviruses (HCoVs) have been identified, all of which are important respiratory pathogens. Recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has led to a global pandemic causing millions of infections and deaths. Here, we summarize the discovery and fundamental virology of HCoVs, discuss their zoonotic transmission and highlight the weak species barrier of SARS-CoV-2. We also discuss the possible origins of SARS-CoV-2 variants of concern identified to date and discuss the experimental challenges in characterizing mutations of interest and propose methods to circumvent them. As the COVID-19 treatment and prevention landscape rapidly evolves, we summarize current therapeutics and vaccines, and their implications on SARS-CoV-2 variants. Finally, we explore how interspecies transmission of SARS-CoV-2 may drive the emergence of novel strains, how disease severity may evolve and how COVID-19 will likely continue to burden healthcare systems globally.
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Affiliation(s)
- Magan Solomon
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Chen Liang
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Equbal A, Masood S, Equbal I, Ahmad S, Khan NZ, Khan ZA. Artificial Intelligence against COVID-19 Pandemic: A Comprehensive Insight. Curr Med Imaging 2022; 19:1-18. [PMID: 34607548 DOI: 10.2174/1573405617666211004115208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/11/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
COVID-19 is a pandemic initially identified in Wuhan, China, which is caused by a novel coronavirus, also recognized as the Severe Acute Respiratory Syndrome (SARS-nCoV-2). Unlike other coronaviruses, this novel pathogen may cause unusual contagious pain, which results in viral pneumonia, serious heart problems, and even death. Researchers worldwide are continuously striving to develop a cure for this highly infectious disease, yet there are no well-defined absolute treatments available at present. Several vaccination drives using emergency use authorisation vaccines have been held across many countries; however, their long-term efficacy and side-effects studies are yet to be studied. Various analytical and statistical models have been developed, however, their outcome rate is prolonged. Thus, modern science stresses the application of state-of-the-art methods to combat COVID-19. This paper aims to provide a deep insight into the comprehensive literature about AI and AI-driven tools in the battle against the COVID-19 pandemic. The high efficacy of these AI systems can be observed in terms of highly accurate results, i.e., > 95%, as reported in various studies. The extensive literature reviewed in this paper is divided into five sections, each describing the application of AI against COVID-19 viz. COVID-19 prevention, diagnostic, infection spread trend prediction, therapeutic and drug repurposing. The application of Artificial Intelligence (AI) and AI-driven tools are proving to be useful in managing and fighting against the COVID-19 pandemic, especially by analysing the X-Ray and CT-Scan imaging data of infected subjects, infection trend predictions, etc.
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Affiliation(s)
- Azhar Equbal
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Sarfaraz Masood
- Department of Computer Engineering, Jamia Millia Islamia, New Delhi, India
| | - Iftekhar Equbal
- Department of Rural Management, Xavier Institute of Social Service, Jharkhand, India
| | - Shafi Ahmad
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
| | - Noor Zaman Khan
- National Institute of Technology Srinagar, Hazratbal, Srinagar, Jammu, and Kashmir, India
| | - Zahid A Khan
- Department of Mechanical Engineering, Jamia Millia Islamia, New Delhi, India
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Abstract
Smoking, TB and Covid-19 are high prevalence entities with public health consequences. All three of them have a possible complex interaction at cellular level. Smoking behavior makes it difficult to maintain infection control measures. Smoking is known to increase TB infection and also adversely affect treatment outcomes in TB. There is also upcoming evidence which suggests that smoking and TB increase the risk of severe Covid-19 symptoms. Simple infection control measures like, social distancing, cough etiquette, isolation, hand hygiene, quarantine, use of masks etc. play a pivotal role in prevention of these diseases. There is need of strengthening of the public health policies and incorporation of the Covid-19 safety awareness measures into the various national programmes.
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Affiliation(s)
- Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, 110007, India
| | - Amitesh Gupta
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India
| | - Ritika Jha
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India
| | - Pranjal Singla
- iDEFEAT TB Project, International Union Against Tuberculosis and Lung Diseases, India
| | - Rupak Singla
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India.
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Ralli M, Arcangeli A, Soave PM, Carbone L, Ercoli L, De‐Giorgio F. Impact of COVID-19 pandemic on the medical activities of the Directorate of Health and Hygiene, Vatican City State. J Intern Med 2021; 290:213-219. [PMID: 33713500 PMCID: PMC8251324 DOI: 10.1111/joim.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report the changes in volume and characteristics of medical activities in the Vatican City State during COVID-19 pandemic. METHODS Data for general / emergency procedures , specialty consultations, radiology examinations and diagnostic procedures delivered by the Directorate of Health and Hygiene of the Vatican City State were retrospectively analysed. Analysis focused on the entire year 2020 and on the lockdown period 9 March - 18 May 2020. RESULTS In 2020, 73.932 procedures were performed compared to 95.218 in 2019 (-22.4%). During lockdown, general / emergency activities decreased by 61.1%, specialty consultations by 85.3%, radiology examinations by 95.8%, and diagnostic procedures by 96.5%. A decrease was found for nearly all specialties; the most affected were occupational medicine and dermatology, whilst an increase was found for legal medicine, psychiatry and angiology. CONCLUSION Medical activities of the Vatican City State have been severely impacted, especially during the first months of the pandemic. However, organizational efforts allowed rapid restoration to near-normal volumes.
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Affiliation(s)
- Massimo Ralli
- Department of Sense OrgansSapienza University of RomeItaly
- Directorate of Health and HygieneVatican City StateItaly
| | - Andrea Arcangeli
- Directorate of Health and HygieneVatican City StateItaly
- Department of Anesthesiology, Intensive Care and Emergency MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Paolo Maurizio Soave
- Directorate of Health and HygieneVatican City StateItaly
- Department of Anesthesiology, Intensive Care and Emergency MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Luigi Carbone
- Directorate of Health and HygieneVatican City StateItaly
- Department of Anesthesiology, Intensive Care and Emergency MedicineFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Lucia Ercoli
- Directorate of Health and HygieneVatican City StateItaly
- Department of Biomedicine and PreventionTor Vergata UniversityRomeItaly
| | - Fabio De‐Giorgio
- Directorate of Health and HygieneVatican City StateItaly
- Department of Health Care Surveillance and BioethicsSection of Legal MedicineUniversità Cattolica del Sacro CuoreRomeItaly
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
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Staibano P, Levin M, McHugh T, Gupta M, Sommer DD. Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:646-655. [PMID: 34042963 PMCID: PMC8160928 DOI: 10.1001/jamaoto.2021.0930] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
Importance Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve. Objective To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs). Data Sources EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021. Study Selection English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review. Data Extraction and Synthesis We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis. Main Outcomes and Measures SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy. Results Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting. Conclusions and Relevance The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.
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Affiliation(s)
- Phillip Staibano
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Marc Levin
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tobial McHugh
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Michael Gupta
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Doron D. Sommer
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Muang, Nonthaburi 11000, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jeremy Fung Yen Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- HealthServe, Singapore
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Saudamini Dabak
- Health Intervention and Technology Assessment Program (HITAP), Department of Health, Muang, Nonthaburi 11000, Thailand
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Affiliation(s)
- Reshma Ramachandran
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare System and Yale University, West Haven, CT, USA
| | | | - Joseph S Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Jason L Schwartz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Lombini M, Diolaiti E, De Rosa A, Lessio L, Pareschi G, Bianco A, Cortecchia F, Fiorini M, Fiorini G, Malaguti G, Zanutta A. Design of optical cavity for air sanification through ultraviolet germicidal irradiation. Opt Express 2021; 29:18688-18704. [PMID: 34154120 DOI: 10.1364/oe.422437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 05/19/2023]
Abstract
The transmission of airborne pathogens represents a major threat to worldwide public health. Ultraviolet light irradiation can contribute to the sanification of air to reduce the pathogen transmission. We have designed a compact filter for airborne pathogen inactivation by means of UVC LED sources, whose effective irradiance is enhanced thanks to high reflective surfaces. We used ray-tracing and computational fluid dynamic simulations to model the device and to maximize the performance inside the filter volume. Simulations also show the inhibition of SARS-Cov-2 in the case of high air fluxes. This study demonstrates that current available LED technology is effective for air sanification purposes.
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Savage MP, Fischman DL, Mamas MA. Social Intervention by the Numbers: Evidence Behind the Specific Public Health Guidelines in the COVID-19 Pandemic. Popul Health Manag 2021; 24:299-303. [PMID: 32882149 PMCID: PMC8215400 DOI: 10.1089/pop.2020.0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Michael P. Savage
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David L. Fischman
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mamas A. Mamas
- Centre for Prognosis Research and Department of Cardiology, Keele University, Stoke-on-Trent, United Kingdom
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Shabu SA, M-Amin K, Mahmood KI, Shabila NP. Risk Perception and Behavioral Response to COVID-19: A Survey of University Students and Staff in the Iraqi Kurdistan Region. Soc Work Public Health 2021; 36:474-485. [PMID: 33866952 DOI: 10.1080/19371918.2021.1915909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study explores the risk perceptions and behavioral responses of university academics and students toward the COVID-19 pandemic. All universities in Iraqi Kurdistan were invited to take part in a self-administered online survey; 976 individuals ultimately completed it. The survey included eight main questions about personal risk perception and behavioral response to COVID-19 based on a five- or nine-point ordinal scale. A high percentage of the respondents perceived it as highly unlikely they were at risk of getting infection (26.9%), serious illness (29.7%), and death (41.7%). The percentage of the respondents who applied protective measures frequently or always was high for most protective behavior types, except for wearing masks, wearing gloves, and avoiding touching the face. There was a significant (P < .001) weak positive correlation between risk perception and protective behaviors. The respondents followed protective behavior measures reasonably, but the frequency of undertaking some important protective behaviors was relatively low.
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Affiliation(s)
- Sherzad A Shabu
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Karwan M-Amin
- College of Nursing, Hawler Medical University, Erbil, Iraq
| | | | - Nazar P Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
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Abstract
To provide valuable experience for other countries currently fighting the COVID-19 pandemic by systematically analyzing the effects of control policies on coping with COVID-19 in Guangdong Province of China. Integrating qualitative and quantitative methods to systematically analyze the effects of control policies on fighting COVID-19 with official data in Guangdong Province. Between January 19, 2020 and February 26, 2020, Guangdong Province issued 6 critical control policies to cope with COVID-19 and achieved effects in the following 3-phase. 1. Phase 1: from January 19 to February 7, 2020, Guangdong Province issued the following 4 policies: activating the first-level response to public health emergencies; holding press conferences during the epidemic; carrying out grid investigation; and taking the lead in covering the treatment expenses of suspected patients in basic medical insurance. In this phase, the number of confirmed cases increased rapidly and the number of recovered cases increased gradually. 2. Phase 2: from February 8 to 14, Guangdong Province issued the following 2 polices: applying Toujie Quwen granules to 30 designated hospitals and launching a registration and report system for the sale of fever and cough drugs. In this phase, the growth trend of confirmed cases had slowed down on February 10 and then increased slowly on February 14. The number of recovered cases increased rapidly on February 10 and then increased rapidly on February 14. 3. Phase 3: from February 15 to 26, the increase number of confirmed cases was a small in magnitude on February 20 and then increased slowly on February 26. The number of recovered cases increased rapidly on February 20 and then increased rapidly on February 26. Guangdong Province implemented 6 control policies in 3-phase and finally successfully defeated the COVID-19. In the first phase, the first 4 control policies showed initial effects on COVID-19 epidemic control. In the second phase, the last 2 control policies greatly contributed to containing the COVID-19 epidemic. In the third phase, the 6 control policies completely overcame the COVID-19 in Guangdong Province, China.
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Affiliation(s)
- Haiqian Chen
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Yuyao Zhang
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaohan Wang
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Gang Sun
- Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, Guangdong, PR China
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Nanda A, Hung I, Kwong A, Man VC, Roy P, Davies L, Douek M. Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial. J Evid Based Med 2021; 14:97-111. [PMID: 33565274 PMCID: PMC8014575 DOI: 10.1111/jebm.12424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recommendations for widespread use of face mask, including suggested type, should reflect the current published evidence and concurrently be studied. This review evaluates the preclinical and clinical evidence on use of cloth and surgical face masks in SARS-CoV-2 transmission and proposes a trial to gather further evidence. METHODS PubMed, EMbase, and the Cochrane Library were searched. Studies of SARS-CoV-2 and face masks and randomized controlled trials (RCTs) of n ≥ 50 for other respiratory illnesses were included. RESULTS Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. CONCLUSION There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance.
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Affiliation(s)
- Akriti Nanda
- Oxford University Clinical Academic Graduate School, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Ivan Hung
- Division of Infectious Diseases, Department of Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Vivian Chi‐Mei Man
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Pankaj Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Lucy Davies
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Michael Douek
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
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15
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Nambulli S, Xiang Y, Tilston-Lunel NL, Rennick LJ, Sang Z, Klimstra WB, Reed DS, Crossland NA, Shi Y, Duprex WP. Inhalable Nanobody (PiN-21) prevents and treats SARS-CoV-2 infections in Syrian hamsters at ultra-low doses. Sci Adv 2021; 7:eabh0319. [PMID: 34039613 PMCID: PMC8153718 DOI: 10.1126/sciadv.abh0319] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/05/2021] [Indexed: 05/18/2023]
Abstract
Globally, there is an urgency to develop effective, low-cost therapeutic interventions for coronavirus disease 2019 (COVID-19). We previously generated the stable and ultrapotent homotrimeric Pittsburgh inhalable Nanobody 21 (PiN-21). Using Syrian hamsters that model moderate to severe COVID-19 disease, we demonstrate the high efficacy of PiN-21 to prevent and treat SARS-CoV-2 infection. Intranasal delivery of PiN-21 at 0.6 mg/kg protects infected animals from weight loss and substantially reduces viral burdens in both lower and upper airways compared to control. Aerosol delivery of PiN-21 facilitates deposition throughout the respiratory tract and dose minimization to 0.2 mg/kg. Inhalation treatment quickly reverses animals' weight loss after infection, decreases lung viral titers by 6 logs leading to drastically mitigated lung pathology, and prevents viral pneumonia. Combined with the marked stability and low production cost, this innovative therapy may provide a convenient and cost-effective option to mitigate the ongoing pandemic.
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Affiliation(s)
- Sham Nambulli
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yufei Xiang
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Natasha L Tilston-Lunel
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda J Rennick
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhe Sang
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA
- University of Pittsburgh-Carnegie Mellon University Program in Computational Biology, Pittsburgh, PA, USA
| | - William B Klimstra
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas S Reed
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicholas A Crossland
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- National Emerging Infectious Diseases Laboratories, Boston University, Boston, MA, USA
| | - Yi Shi
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA.
- University of Pittsburgh-Carnegie Mellon University Program in Computational Biology, Pittsburgh, PA, USA
| | - W Paul Duprex
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Abstract
As COVID vaccines roll out, internists and other health care providers are being turned to as trusted sources of information for patients and communities. Here, experts from NIAID outline the current state of knowledge regarding such vaccines. They contrast vaccine platforms, summarize clinical trial data regarding efficacy and safety, and comment on key questions including the ability of current vaccines to protect against infection and to decrease the prevalence of virus in the community.
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Affiliation(s)
- Mark Connors
- the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (M.C., H.C.L., A.S.F.)
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (B.S.G.)
| | - H Clifford Lane
- the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (M.C., H.C.L., A.S.F.)
| | - Anthony S Fauci
- the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland (M.C., H.C.L., A.S.F.)
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17
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Abstract
Cuba has five COVID-19 vaccines in clinical trials and is on track to receive emergency use authorization from the country's regulatory agency to begin mass vaccination with two of those candidates: Abdala and SOBERANA 02. Results from phase 1 and 2 trials of these vaccines, the first developed and produced in Latin America, have been encouraging, both in terms of safety and immunogenicity. The ongoing phase 3 trials will continue to look at safety, together with efficacy; parallel intervention studies involving over a million people in Havana will begin generating data on effectiveness. Coordination between Cuba's biotechnology sector and its public health system-particularly throughout the different levels of primary care-to control and treat COVID-19 is a cornerstone of the Cuban strategy and one that could serve as a blueprint for future pandemics. Another Cuban product, itolizumab, is showing positive results mitigating cytokine release syndrome (CRS) in COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Developed in collaboration with Biocon (India), itolizumab is administered under an expanded access program to treat vulnerable populations in Cuba. Marshaling complementary capacities of dozens of institutions belonging to BioCubaFarma-the country's biotech conglomerate-and developing therapies, vaccines and medical technologies together, is another cornerstone of Cuba's strategy to combat COVID-19 and improve population health. The Molecular Immunology Center (CIM) is a key player in this strategy. Founded in 1992, CIM is a powerhouse in monoclonal antibody research and production, with 6 registered products and 22 in the pipeline. Known for several novel therapeutic cancer treatments, CIM has over two decades' experience producing complex recombinant proteins in mammalian cells on an industrial scale. Once Cuba's Innovation Committee (convened in January 2020 as part of the National COVID-19 Prevention & Control Plan) determined Cuban researchers would pursue protein subunit vaccine candidates, they turned to CIM to produce the required receptor-binding domain (RBD) of the SARS-CoV-2 spike protein, among other responsibilities. CIM's General Director, Dr Eduardo Ojito-Magaz, is a chemical engineer and holds a master's degree in biotechnology. He spoke with MEDICC Review just days before 1.7 million Havana residents began participating in the country's largest intervention study with the COVID-19 vaccines his center helped make possible.
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18
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Losina E, Leifer V, Millham L, Panella C, Hyle EP, Mohareb AM, Neilan AM, Ciaranello AL, Kazemian P, Freedberg KA. College Campuses and COVID-19 Mitigation: Clinical and Economic Value. Ann Intern Med 2021; 174:472-483. [PMID: 33347322 PMCID: PMC7755069 DOI: 10.7326/m20-6558] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Colleges in the United States are determining how to operate safely amid the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE To examine the clinical outcomes, cost, and cost-effectiveness of COVID-19 mitigation strategies on college campuses. DESIGN The Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation model, was used to examine alternative mitigation strategies. The CEACOV model tracks infections accrued by students and faculty, accounting for community transmissions. DATA SOURCES Data from published literature were used to obtain parameters related to COVID-19 and contact-hours. TARGET POPULATION Undergraduate students and faculty at U.S. colleges. TIME HORIZON One semester (105 days). PERSPECTIVE Modified societal. INTERVENTION COVID-19 mitigation strategies, including social distancing, masks, and routine laboratory screening. OUTCOME MEASURES Infections among students and faculty per 5000 students and per 1000 faculty, isolation days, tests, costs, cost per infection prevented, and cost per quality-adjusted life-year (QALY). RESULTS OF BASE-CASE ANALYSIS Among students, mitigation strategies reduced COVID-19 cases from 3746 with no mitigation to 493 with extensive social distancing and masks, and further to 151 when laboratory testing was added among asymptomatic persons every 3 days. Among faculty, these values were 164, 28, and 25 cases, respectively. Costs ranged from about $0.4 million for minimal social distancing to about $0.9 million to $2.1 million for strategies involving laboratory testing ($10 per test), depending on testing frequency. Extensive social distancing with masks cost $170 per infection prevented ($49 200 per QALY) compared with masks alone. Adding routine laboratory testing increased cost per infection prevented to between $2010 and $17 210 (cost per QALY gained, $811 400 to $2 804 600). RESULTS OF SENSITIVITY ANALYSIS Results were most sensitive to test costs. LIMITATION Data are from multiple sources. CONCLUSION Extensive social distancing with a mandatory mask-wearing policy can prevent most COVID-19 cases on college campuses and is very cost-effective. Routine laboratory testing would prevent 96% of infections and require low-cost tests to be economically attractive. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Elena Losina
- Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts (E.L.)
| | - Valia Leifer
- Brigham and Women's Hospital, Boston, Massachusetts (V.L.)
| | - Lucia Millham
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (L.M.)
| | | | - Emily P Hyle
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (E.P.H., A.M.N., A.L.C.)
| | - Amir M Mohareb
- Massachusetts General Hospital, Boston, Massachusetts (C.P., A.M.M.)
| | - Anne M Neilan
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (E.P.H., A.M.N., A.L.C.)
| | - Andrea L Ciaranello
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (E.P.H., A.M.N., A.L.C.)
| | - Pooyan Kazemian
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio (P.K.)
| | - Kenneth A Freedberg
- Massachusetts General Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (K.A.F.)
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19
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Sønderskov KM, Dinesen PT, Østergaard SD. Sustained COVID-19 vaccine willingness after safety concerns over the Oxford-AstraZeneca vaccine. Dan Med J 2021; 68:A03210292. [PMID: 33870886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Prompted by reports of thromboembolic events - some with fatal outcomes - among people who had received the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against COVID-19, a number of European countries paused vaccination with this vaccine in early and mid-March 2021. Prior studies have suggested that vaccine willingness is highly dependent on public trust in the safety of vaccines. We therefore investigated whether vaccine willingness dropped in the wake of the reported cases of thromboembolic events in relation to the Oxford-AstraZeneca COVID-19 vaccine. METHODS Using longitudinal survey data from Denmark, we compared vaccine willingness shortly before and after the reported cases of thromboembolic events, as well as the perceived safety of the two most widely used COVID-19 vaccines in Denmark - those from Pfizer-BioNTech and Oxford-AstraZeneca - in the wake of these events. RESULTS We found sustained vaccine willingness after the reported cases of thromboembolic events (89% both before and after). However, the safety of the Oxford-AstraZeneca COVID-19 vaccine was perceived to be significantly and substantially lower than the safety of the vaccine from Pfizer-BioNTech, and this difference was particularly pronounced among those who were vaccine-hesitant. CONCLUSIONS The vaccine willingness of Danes does not seem to have been affected by the reports of thromboembolic events in relation to the Oxford-AstraZeneca COVID-19 vaccine. FUNDING The study was funded by a grant from the Novo Nordisk Foundation (grant number: NNF20SA0062874). TRIAL REGISTRATION not relevant.
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20
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Abstract
In a recent report, the British Broadcasting Company (BBC) introduced South Korea's measures to manage COVID-19 as role model for the world. Screening centers serve as frontiers for preventing community transmission of infectious diseases. COVID-19 screening centers in Korea operate 24 h a day, always open for individuals with suspected COVID-19 symptoms. South Korea concentrated COVID-19 screening centers around cities with high population density. Advanced screening centers (models C, D, and E) proved more effective and efficient in the prevention of COVID-19 than the traditional screening centers (models A and B). Particularly, screening centers at Incheon Airport in South Korea prevent transmission through imported cases effectively. It will be important elsewhere, as in South Korea, to establish an infectious disease delivery system that can lead to 'Test-Treat-Track' using an adequate model of screening centers.
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Affiliation(s)
- Ji Eon Kim
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Ji Ho Lee
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Hocheol Lee
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Seok Jun Moon
- Department of Health Administration, Yonsei University Graduate School, Wonju, Republic of Korea
| | - Eun Woo Nam
- Yonsei Global Health Center, Yonsei University, Wonju, Republic of Korea.
- Department of Health Administration, Yonsei University, Changjo Hall 412, Yonseidae-gil 1, Wonju, 26493, Republic of Korea.
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21
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Davidson BL, Tapson VF, Irwin RS, French CL, Elliott CG, Levi M. Pharyngeal Antisepsis to Reduce COVID-19 Pneumonia. Am J Med 2021; 134:297-298. [PMID: 33338507 PMCID: PMC7836691 DOI: 10.1016/j.amjmed.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Victor F Tapson
- Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif
| | - Richard S Irwin
- Pulmonary and Critical Care Medicine, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester
| | - Cynthia L French
- University of Massachusetts Medical School and Graduate School of Nursing, Worcester
| | - C Gregory Elliott
- Pulmonary Medicine, Intermountain Healthcare and University of Utah School of Medicine, Murray
| | - Marcel Levi
- University College London Hospitals NHS Foundation Trust and Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK
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22
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Abstract
INTRODUCTION The fourth sudden acute respiratory syndrome (SARS) virus, COVID-19, emerged in late 2019, leading to the most devastating pandemic since the Spanish influenza (H1N1) of 1918, which seized 50 million lives worldwide (https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html). Elected officials must make critical system-level decisions for stymieing the spread of the virus. Businesspersons must make personnel, financial, and operational decisions to minimize transmission while preserving their business's vitality. Members of the public must make personal decisions about personal protective equipment and changing social, recreational, occupational, and spiritual behavior to protect themselves and others. The scientific community can shift how they illustrate the virus's behavior to the public in an appropriate and understandable way so that the public can make informed decisions. This article suggests the use of a single-case design and logarithmic analyses to improve the current methodologies for COVID-19 analysis and illustration. METHOD The Standard Celeration Chart was used with Theil's incomplete regression and a 7-point change analysis; the authors demonstrate a suitable virus-tracking and mitigation methodology. RESULTS Analysis and data visualization are standardized, providing an accurate depiction of the virus's growth for public dissemination and decision-making. An analytic strategy is demonstrated for retrospectively detecting meaningful changes in viral growth or prospectively measuring such changes that coincide with known mitigation strategies. DISCUSSION The authors suggest improvements in bridging science to application by making COVID-19 informatics more meaningful and actionable by lawmakers, businesspersons, and the public. Limitations and future directions for COVID-19 informatics are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Kristopher Kielbasa
- Department of Applied Behavior Analysis, The Chicago School of Professional Psychology
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23
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Turcotte-Tremblay AM, Gali Gali IA, Ridde V. The unintended consequences of COVID-19 mitigation measures matter: practical guidance for investigating them. BMC Med Res Methodol 2021; 21:28. [PMID: 33568054 PMCID: PMC7873511 DOI: 10.1186/s12874-020-01200-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND COVID-19 has led to the adoption of unprecedented mitigation measures which could trigger many unintended consequences. These unintended consequences can be far-reaching and just as important as the intended ones. The World Health Organization identified the assessment of unintended consequences of COVID-19 mitigation measures as a top priority. Thus far, however, their systematic assessment has been neglected due to the inattention of researchers as well as the lack of training and practical tools. MAIN TEXT Over six years our team has gained extensive experience conducting research on the unintended consequences of complex health interventions. Through a reflexive process, we developed insights that can be useful for researchers in this area. Our analysis is based on key literature and lessons learned reflexively in conducting multi-site and multi-method studies on unintended consequences. Here we present practical guidance for researchers wishing to assess the unintended consequences of COVID-19 mitigation measures. To ensure resource allocation, protocols should include research questions regarding unintended consequences at the outset. Social science theories and frameworks are available to help assess unintended consequences. To determine which changes are unintended, researchers must first understand the intervention theory. To facilitate data collection, researchers can begin by forecasting potential unintended consequences through literature reviews and discussions with stakeholders. Including desirable and neutral unintended consequences in the scope of study can help minimize the negative bias reported in the literature. Exploratory methods can be powerful tools to capture data on the unintended consequences that were unforeseen by researchers. We recommend researchers cast a wide net by inquiring about different aspects of the mitigation measures. Some unintended consequences may only be observable in subsequent years, so longitudinal approaches may be useful. An equity lens is necessary to assess how mitigation measures may unintentionally increase disparities. Finally, stakeholders can help validate the classification of consequences as intended or unintended. CONCLUSION Studying the unintended consequences of COVID-19 mitigation measures is not only possible but also necessary to assess their overall value. The practical guidance presented will help program planners and evaluators gain a more comprehensive understanding of unintended consequences to refine mitigation measures.
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Affiliation(s)
- Anne-Marie Turcotte-Tremblay
- School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
- Department and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Boston, MA, 02115, USA.
| | | | - Valéry Ridde
- IRD (French Institute for Research on Sustainable Development), CEPED, Université de Paris, 45 Rue des Saints-Pères, 75006, Paris, France
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24
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Affiliation(s)
- Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Tiwanon Road, Muang District, Nonthaburi 11000, Thailand
| | - Poonam Singh
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Anne Mills
- London School of Hygiene & Tropical Medicine, University of London, London, England
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25
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Affiliation(s)
- Xing Wang
- West China HospitalSichuan UniversityChengduChina
| | - Yu Zhang
- West China HospitalSichuan UniversityChengduChina
- Affiliated Hospital & Clinical Medical College of Chengdu UniversityChengduChina
| | - Fang Fang
- West China HospitalSichuan UniversityChengduChina
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26
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Schmitt J, Jones LS, Aeby EA, Gloor C, Moser B, Wang J. Protection Level and Reusability of a Modified Full-Face Snorkel Mask as Alternative Personal Protective Equipment for Healthcare Workers during the COVID-19 Pandemic. Chem Res Toxicol 2021; 34:110-118. [PMID: 33331780 PMCID: PMC7771246 DOI: 10.1021/acs.chemrestox.0c00371] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Indexed: 01/26/2023]
Abstract
The worldwide outbreak of COVID-19 has drastically increased pressure on medical resources and highlighted the need for rapidly available, large-scale, and low-cost personal protective equipment (PPE). In this work, an alternative full-face mask is adapted from a modified snorkel mask to be used as PPE with two medical-grade filters and a 3D-printed adapter. Since the mask covers the eyes, mouth, and nose, it acts as a full-face shield, providing additional protection to healthcare workers. The SARS-CoV-2 has a size between 60 nm and 140 nm, and airborne viral particles can be carried by larger droplets with sizes up to several millimeters. The minimum filtration efficiency of mechanical and electrostatic filters is usually reached between 30 nm and 300 nm. The filtration efficiency of different medical filters is measured for particles below 300 nm to cover the size of the SARS-CoV-2 and small virus-laden droplets, and determine the minimum efficiency. The filtration performance of the adapted full-face mask is characterized using NaCl particles below 500 nm and different fitting scenarios to determine the minimum protection efficiency. The mask is compared to a commercial respirator and characterized according to the EN 149 standard, demonstrating that the protection fulfills the requirements for the FFP2 level (filtering face-piece 2, stopping at least 94% of airborne particles). The device shows a good resistance to several cycles of decontamination (autoclaving and ethanol immersion), is easy to be produced locally at low cost, and helps to address the shortage in FFP2 masks and face shields by providing adequate protection to healthcare workers against particles <500 nm in size.
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Affiliation(s)
- Jean Schmitt
- Institute of Environmental Engineering, Department of
Civil, Environmental and Geomatic Engineering, ETH Zurich,
Zurich 8093, Switzerland
- Laboratory for Advanced Analytical Technologies,
EMPA, Swiss Federal Laboratories for Materials Science and
Technology, Dubendorf 8600, Switzerland
| | - Lewis S. Jones
- Institute for Chemical- and Bioengineering, Department
of Chemistry and Applied Biosciences, ETH Zurich, Zurich 8093,
Switzerland
| | - Elise A. Aeby
- Laboratory of Applied Mechanobiology, Department of
Health Sciences and Technology, ETH Zurich, Zurich 8093,
Switzerland
| | - Christian Gloor
- Spiez Laboratory Division CBRNe Protection Systems,
Federal Office of Civil Protection, Spiez 3700,
Switzerland
| | - Berthold Moser
- Department of Anesthesia and Intensive Care,
Medical University of Innsbruck, Innsbruck 6020
Austria
| | - Jing Wang
- Institute of Environmental Engineering, Department of
Civil, Environmental and Geomatic Engineering, ETH Zurich,
Zurich 8093, Switzerland
- Laboratory for Advanced Analytical Technologies,
EMPA, Swiss Federal Laboratories for Materials Science and
Technology, Dubendorf 8600, Switzerland
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27
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Panfili FM, Roversi M, D'Argenio P, Rossi P, Cappa M, Fintini D. Possible role of vitamin D in Covid-19 infection in pediatric population. J Endocrinol Invest 2021; 44:27-35. [PMID: 32557271 PMCID: PMC7299247 DOI: 10.1007/s40618-020-01327-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Covid-19 is a pandemic of unprecedented proportion, whose understanding and management is still under way. In the emergency setting new or available therapies to contrast the spread of COVID-19 are urgently needed. Elderly males, especially those affected by previous diseases or with comorbidities, are more prone to develop interstitial pneumonia that can deteriorate evolving to ARDS (acute respiratory distress syndrome) that require hospitalization in Intensive Care Units (ICUs). Even children and young patients are not spared by SARS-CoV 2 infection, yet they seem to develop a milder form of disease. In this setting the immunomodulatory role of Vitamin D, should be further investigated. METHODS We reviewed the literature about the immunomodulatory role of Vitamin D collecting data from the databases Medline and Embase. RESULTS Vitamin D proved to interact both with the innate immune system, by activating Toll-like receptors (TLRs) or increasing the levels of cathelicidins and β-defensins, and adaptive immune system, by reducing immunoglobulin secretion by plasma cells and pro-inflammatory cytokines production, thus modulating T cells function. Promising results have been extensively described as regards the supplementation of vitamin D in respiratory tract infections, autoimmune diseases and even pulmonary fibrosis. CONCLUSIONS In this review, we suggest that vitamin D supplementation might play a role in the prevention and/or treatment to SARS-CoV-2 infection disease, by modulating the immune response to the virus both in the adult and pediatric population.
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Affiliation(s)
- F M Panfili
- Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - M Roversi
- Pediatric Academic Department, University of Rome Tor Vergata, Rome, Italy
| | - P D'Argenio
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - P Rossi
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - M Cappa
- Endocrinology Unit, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - D Fintini
- Endocrinology Unit, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children's Hospital, IRCSS, Rome, Italy.
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28
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Freeman CM, Rank MA, Bolster LaSalle CM, Grys TE, Lewis JC. Effectiveness of Physical Distancing: Staying 6 Feet Over to Put Respiratory Viruses 6 Feet Under. Mayo Clin Proc 2021; 96:148-151. [PMID: 33413811 DOI: 10.1016/j.mayocp.2020.10.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023]
Abstract
Community transmission of severe acute respiratory illness Coronavirus-2 (SARS-CoV-2) in Arizona was noted in March 2020. It was our hypothesis that the associated implementation of physical distancing and masking led to a decline in circulation and detection of common respiratory viruses. Nasopharyngeal swabs processed with the Biofire, Film Array respiratory panel at Mayo Clinic Arizona were reviewed from January 1, 2017, to July 31, 2020. A total of 13,324 nasopharyngeal swabs were analyzed. Between April and July 2017- 2019 (Period A) a mean of 262 tests were performed monthly, falling to 128 for the corresponding months of 2020 (Period B). A reduction in the monthly mean number of positive tests (Period A 71.5; Period B 2.8) and mean positivity rate (Period A 25.04%; Period B 2.07%) was observed. Rhinovirus/enterovirus was the most prevalent virus, with a monthly mean of 21.6 cases (30.2% of positives) for Period A and 2 cases (72.7% of positives) for Period B. Positivity for a second virus occurred in a mean of 2.1 positive tests (3.3%) in Period A but was absent in Period B. Implementation of distancing and masking coincides with a marked reduction in respiratory virus detection and likely circulation. Data from the fall/winter of 2020 will help clarify the potential role for distancing and masking as a mitigation strategy, not only for SARS-CoV-2 but also in the seasonal battle against common respiratory viruses.
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Affiliation(s)
| | - Matthew A Rank
- Division of Allergy, Asthma and Immunology, Mayo Clinic, Scottsdale, AZ
| | | | - Thomas E Grys
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ
| | - John C Lewis
- Division of Allergy, Asthma and Immunology, Mayo Clinic, Scottsdale, AZ
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29
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Sun X, Xiao Y, Ji X. When to lift the lockdown in Hubei province during COVID-19 epidemic? An insight from a patch model and multiple source data. J Theor Biol 2020; 507:110469. [PMID: 32866494 PMCID: PMC7455524 DOI: 10.1016/j.jtbi.2020.110469] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/28/2022]
Abstract
After diagnosed in Wuhan, COVID-19 spread quickly in mainland China. Though the epidemic in regions outside Hubei in mainland China has maintained a degree of control, evaluating the effectiveness and timeliness of intervention strategies, and predicting the transmission risk of work resumption as well as lifting the lockdown in Hubei province remain urgent. A patch model reflecting the mobility of population between Hubei and regions outside Hubei is formulated, and parameterized based on multiple source data for Hubei and regions outside Hubei. The effective reproduction numbers for Hubei and regions outside Hubei are estimated as 3.59 and 3.26 before Jan 23rd, 2020, but decrease quickly since then and drop below 1 after Jan 31st and Jan 28th, 2020. It is predicted that the new infections in Hubei province will decrease to very low level in mid-March, and the final size is estimated to be about 68,500 cases. The simulations reveal that contact rate after work resumption or lifting the lockdown in Hubei plays a critical role in affecting the epidemic. If the contact rate could be kept at a relatively low level, work resumption starting as early as on March 2nd in Hubei province may not induce the secondary outbreak, and the daily new infectious cases can be controlled at a low level if the lockdown in Hubei is liftted after March 9th, otherwise both work resumption and lifting the lockdown in Hubei should be postponed.
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Affiliation(s)
- Xiaodan Sun
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China.
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Ajibola G, Bennett K, Powis KM, Hughes MD, Leidner J, Kgole S, Batlang O, Mmalane M, Makhema J, Lockman S, Shapiro R. Decreased diarrheal and respiratory disease in HIV exposed uninfected children following vaccination with rotavirus and pneumococcal conjugate vaccines. PLoS One 2020; 15:e0244100. [PMID: 33347474 PMCID: PMC7751865 DOI: 10.1371/journal.pone.0244100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Rotavirus vaccine (RV) and pneumococcal vaccine (PCV) decrease diarrheal and respiratory disease incidence and severity, but there are few data about the effects of these vaccines among HIV-exposed uninfected (HEU) children. METHODS We recorded RV and PCV vaccination history in a placebo-controlled trial that studied the need for cotrimoxazole among HEU infants in Botswana (the Mpepu Study). We categorized infants by enrollment before or after the simultaneous April 2012 introduction of RV and PCV, and compared diagnoses of diarrhea and pneumonia (grade 3/4), hospitalizations, and deaths from both disease conditions through the 12-month study visit by vaccine era/status across two sites (a city and a village) by Kaplan-Meier estimates. RESULTS Two thousand six hundred and thirty-five HEU infants were included in this secondary analysis, of these 1689 (64%) were enrolled in Gaborone (344 pre-vaccine, 1345 vaccine) and 946 (36%) in Molepolole (209 pre-vaccine, 737 vaccine). We observed substantial reduction in hazard of hospitalization or death for reason of diarrhea and pneumonia in the vaccine era versus the pre-vaccine era in Molepolole (hazard ratio, HR = 0.44, 95% confidence interval, CI = 0.28, 0.71) with smaller reduction in Gaborone (HR = 0.91, 95% CI = 0.57, 1.45). Similar downward trends were observed for diagnoses of diarrhea and pneumonia separately during the vaccine versus pre-vaccine era. CONCLUSIONS Although temporal confounding cannot be excluded, significant declines in the burden of diarrheal and respiratory illness were observed among HEU children in Botswana following the introduction of RV and PCV. RV and PCV may maximally benefit HEU children in rural areas with higher disease burden.
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Affiliation(s)
| | - Kara Bennett
- Bennett Statistical Consulting, Inc, Ballston Lake, NY, United States of America
| | - Kathleen M. Powis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michael D. Hughes
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Jean Leidner
- Goodtables Data Consulting, LLC, Norman, Oklahoma, United States of America
| | - Samuel Kgole
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Oganne Batlang
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Shahin Lockman
- Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Roger Shapiro
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Zhang XS, Duchaine C. SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles. Clin Microbiol Rev 2020; 34:e00184-20. [PMID: 33115724 PMCID: PMC7605309 DOI: 10.1128/cmr.00184-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2's mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission-taken in its traditional definition (long-distance and respirable aerosols)-are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of "airborne," going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.
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Affiliation(s)
- X Sophie Zhang
- Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
- CHSLD Bruchési and CHSLD Jean De La Lande, Montreal, Canada
- GMF-U Faubourgs, Montreal, Canada
- Centre de Recherche et d'Aide aux Narcomanes, Montreal, Canada
| | - Caroline Duchaine
- Department of Biochemistry, Microbiology, and Bioinformatics, Université Laval, Quebec City, Canada
- Quebec Heart and Lung Institute-Université Laval (CRIUCPQ), Quebec City, Canada
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Liné C, Andrieu B, Moro MR, Lachal J. Étude qualitative de l’expérience psychocorporelle des autotouchers faciaux spontanés chez des infirmiers portés volontaires en renfort covid. Rech Soins Infirm 2020:77-85. [PMID: 33319720 DOI: 10.3917/rsi.142.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction : The COVID-19 pandemic has warranted the implementation of barrier actions and the wearing of personal protective equipment (PPE). These behavioral adaptations counteract spontaneous self-touching reflex gestures. I propose to explore the mind-body experience generated by these gesture changes in this health context.Method : I conducted a qualitative study with nine nurses who volunteered as reinforcements. The semistructured interviews I carried out were analyzed using the interpretative phenomenological analysis approach.Results : The perception of the risk of self-inoculation is not related to the level of virus exposure. Facial PPE is perceived both as reassuring and difficult to put up with. The experience of self-touches is influenced by the level of attention the subject pays to his or her face and by the medical background related to this. Three kinds of mind-body adaptations are used to control self-touching : control by avoidance, control by keeping one’s hands busy, and compensatory bodily strategies. The representations of the bodily self are modified in terms of gestures and of the feeling of humanness. This generates a form of bodily abandonment and a lived experience of soiled bodies.Conclusion : The results highlight the cognitive load involved in refraining from self-touching and with the wearing of facial PPE. They emphasize the importance of questioning the implications of these sensorimotor modifications. Supporting health professionals in assessing the mind-body repercussions in a pandemic situation appears key.
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Su JY, Huang TJ, Ming JL, Mu PF. [The Readiness and Mental Construction of Nurses Caring for Patients With COVID-19: An Example From a Medical Center in Northern Taiwan]. Hu Li Za Zhi 2020; 67:18-24. [PMID: 33274422 DOI: 10.6224/jn.202012_67(6).04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 epidemic continues to spread, and frontline health professionals have unfortunately contracted this virus because of exposure while providing clinical care. Based on the painful experience of the previous SARS epidemic in Taiwan, nurses have adopted a standard of care for infection protection that incorporates early prevention and detection. However, international public health experts remain unable to control the infectivity and variability of the COVID19 virus, which increases the mental stress on frontline nurses when performing care. In this paper, which uses a medical center in the north of Taiwan as an example, JBI clinical guidelines, infection control experience, and nurses' awareness, perceived support, and self-efficacy are applied to suggest ways to improve epidemic prevention and mental construction, enhance nurses' psychological empowerment and refection, promote role identity in nursing and self-value, establish health team awareness, strengthen infection protection concepts, and integrate infection control concepts into the nursing models to develop effective standard operating procedures for epidemic prevention management and effectively prevent the spread of the virus and maintain public health.
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Affiliation(s)
- Jui-Yuan Su
- MSN, RN, Head Nurse, Department of Nursing, Taipei Veterans General Hospital, and Doctoral Candidate, Department of Nursing, National Yang-Ming University, Taiwan, ROC
| | - Tzyy-Jen Huang
- MSN, RN, Supervisor, Department of Nursing, Taipei Veterans General Hospital, and Doctoral Candidate, Department of Nursing, National Yang-Ming University, Taiwan, ROC
| | - Jin-Lain Ming
- PhD, RN, Director, Department of Nursing, Taipei Veterans General Hospital, and Adjunct Assistant Professor, Department of Nursing, National Yang-Ming University, and Deputy Director, Taiwan Evidence Based Practice Center: A JBI Centre of Excellence, National Yang-Ming University, Taiwan, ROC
| | - Pei-Fan Mu
- PhD, RN, FAAN, Distinguished Professor, Institute of Clinical Nursing, National Yang-Ming University, and Director, Taiwan Evidence Based Practice Center: A JBI Centre of Excellence, National Yang-Ming University, Taiwan, ROC.
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34
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Mamun MA, Syed NK, Griffiths MD. Indian celebrity suicides before and during the COVID-19 pandemic and their associated risk factors: Evidence from media reports. J Psychiatr Res 2020; 131:177-179. [PMID: 32979693 PMCID: PMC7477604 DOI: 10.1016/j.jpsychires.2020.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022]
Affiliation(s)
| | - Nabeel Kashan Syed
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, Faculty of Pharmacy, Jazan University, Saudi Arabia
| | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, 50 Shakespeare Street, Nottingham, NG1 4FQ, Nottingham, Trent University, United Kingdom
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35
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Goldman RD, Grafstein E, Barclay N, Irvine MA, Portales-Casamar E. Paediatric patients seen in 18 emergency departments during the COVID-19 pandemic. Emerg Med J 2020; 37:773-777. [PMID: 33127743 PMCID: PMC7604790 DOI: 10.1136/emermed-2020-210273] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Public health mitigation strategies in British Columbia during the pandemic included stay-at-home orders and closure of non-essential services. While most primary physicians' offices were closed, hospitals prepared for a pandemic surge and emergency departments (EDs) stayed open to provide care for urgent needs. We sought to determine whether ED paediatric presentations prior and during the COVID-19 pandemic changed and review acuity compared with seasonal adjusted prior year. METHODS We analysed records from 18 EDs in British Columbia, Canada, serving 60% of the population. We included children 0-16 years old and excluded those with no recorded acuity or discharge disposition and those left without being seen by a physician. We compared prepandemic (before the first COVID-19 case), early pandemic (after first COVID-19 case) and peak pandemic (during public health emergency) periods as well as a similar time from the previous year. RESULTS A reduction of 57% and 70% in overall visits was recorded in the children's hospital ED and the general hospitals EDs, respectively. Average daily visits declined significantly during the peak-pandemic period (167.44±40.72) compared with prepandemic period (543.53±58.8). Admission rates increased mainly due to the decrease in the rate of visits with lower acuity. Children with complaints of 'fever' and 'gastrointestinal' symptoms had both the largest overall volume and per cent reduction in visits between peak-pandemic and prior year (79% and 74%, respectively). CONCLUSION Paediatric emergency medicine attendances were reduced to one-third of normal numbers during the 2020 COVID-19 lockdown in British Columbia, Canada, with the reduction mainly seen in minor illnesses that do not usually require admission.
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MESH Headings
- Adolescent
- Betacoronavirus/pathogenicity
- British Columbia/epidemiology
- COVID-19
- Child
- Child, Preschool
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Emergencies/epidemiology
- Emergency Medicine/organization & administration
- Emergency Medicine/statistics & numerical data
- Emergency Service, Hospital/organization & administration
- Emergency Service, Hospital/statistics & numerical data
- Female
- Health Services Accessibility/organization & administration
- Health Services Accessibility/statistics & numerical data
- Hospitals, Pediatric/organization & administration
- Hospitals, Pediatric/statistics & numerical data
- Humans
- Infant
- Infant, Newborn
- Male
- Pandemics/prevention & control
- Patient Admission/statistics & numerical data
- Patient Discharge/statistics & numerical data
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- SARS-CoV-2
- Triage/organization & administration
- Triage/statistics & numerical data
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Affiliation(s)
- Ran D Goldman
- The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Neil Barclay
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
- Fraser Health, Vancouver, British Columbia, Canada
| | - Michael A Irvine
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Elodie Portales-Casamar
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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36
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Hamed H. Underwater-seal evacuation of surgical smoke in laparoscopy during the COVID-19 pandemic: A feasibility report of a simple technique. Br J Surg 2020; 107:e640-e641. [PMID: 33010040 PMCID: PMC7675420 DOI: 10.1002/bjs.11987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 04/27/2023]
Affiliation(s)
- Hosam Hamed
- Gastrointestinal surgical center (GISC), Faculty of Medicine, Mansoura University, Egypt
- Correspondence to: and requests for reprints to: Hosam Hamed, Lecturer of surgery, Gastrointestinal Surgical Center, Mansoura University. Jehan street, Mansoura, Dakahleyya, Egypt. Postal code 35516, , Mobile: +201006178599
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Abstract
The emergences of coronaviruses have caused a serious global public health problem because their infection in humans caused the severe acute respiratory disease and deaths. The outbreaks of lethal coronaviruses have taken place for three times within recent two decades (SARS-CoV in 2002, MERS-CoV in 2012 and SARS-CoV-2 in 2019). Much more serious than SARS-CoV in 2002, the current SARS-CoV-2 infection has been spreading to more than 213 countries, areas or territories and causing more than two million cases up to date (17 April 2020). Unfortunately, no vaccine and specific anti-coronavirus drugs are available at present time. Current clinical treatment at hand is inadequate to suppress viral replication and inflammation, and reverse organ failure. Intensive research efforts have focused on increasing our understanding of viral biology of SARS-CoV-2, improving antiviral therapy and vaccination strategies. The animal models are important for both the fundamental research and drug discovery of coronavirus. This review aims to summarize the animal models currently available for SARS-CoV and MERS-CoV, and their potential use for the study of SARS-CoV-2. We will discuss the benefits and caveats of these animal models and present critical findings that might guide the fundamental studies and urgent treatment of SARS-CoV-2-caused diseases.
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Affiliation(s)
- Lunzhi Yuan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, PR People's Republic of China
| | - Qiyi Tang
- Department of Microbiology, Howard University College of Medicine, Washington, DC, USA
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, PR People's Republic of China
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, PR People's Republic of China
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38
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Ballivian J, Alcaide ML, Cecchini D, Jones DL, Abbamonte JM, Cassetti I. Impact of COVID-19-Related Stress and Lockdown on Mental Health Among People Living With HIV in Argentina. J Acquir Immune Defic Syndr 2020; 85:475-482. [PMID: 33136748 DOI: 10.1097/qai.0000000000002493] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The spread of severe acute respiratory syndrome coronavirus 2, causative agent of the coronavirus disease 2019 (COVID-19), has necessitated widespread lockdown to mitigate the pandemic. This study examines the influence of resilience on the impact of COVID-related stress and enforced lockdown on mental health, drug use, and treatment adherence among people living with HIV (PLWH) in Argentina. SETTING PLWH residing predominantly in Buenos Aires Metropolitan Area and urban regions of Argentina were identified from a private clinic electronic database. METHODS Participants completed an anonymous online survey to evaluate the impact of COVID-19 on economic disruption, resilience, mental health outcomes (depression, anxiety, stress, and loneliness), adherence to HIV treatment, and substance use. We performed ordinary least squares and logistic regressions to test whether resilient coping buffered the impact of economic disruption on mental health and drug use during quarantine. RESULTS A total of 1336 PLWH aged 18-82 were enrolled. The impact of economic disruption on mental health ΔF(1,1321) = 8.86, P = 0.003 and loneliness ΔF(1,1326) = 5.77, P = 0.016 was buffered by resilience. A 3-way interaction between resilient buffering, stress, and sex was significant ΔF(1,1325) = 4.76, P = 0.029. Participants reported less than excellent adherence to medication (33%), disruption to mental health services (11%), and disruption to substance abuse treatment (1.3%) during lockdown. DISCUSSION The impact of COVID-stress and lockdown on emotional distress seemed mitigated by resilience coping strategies, and the buffering impact of resilience on perceived stress was greater among women. Results highlight PLWH's capacity to adhere to treatment in challenging circumstances and the importance of developing resilience skills for better coping with stress and adversity.
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MESH Headings
- Adaptation, Psychological
- Adult
- Aged
- Aged, 80 and over
- Argentina
- Betacoronavirus
- COVID-19
- Coronavirus Infections/complications
- Coronavirus Infections/economics
- Coronavirus Infections/prevention & control
- Coronavirus Infections/psychology
- Female
- HIV Infections/complications
- HIV Infections/psychology
- Humans
- Intimate Partner Violence/trends
- Least-Squares Analysis
- Logistic Models
- Loneliness
- Male
- Mental Health/trends
- Mental Health Services/standards
- Middle Aged
- Pandemics/economics
- Pandemics/prevention & control
- Pneumonia, Viral/complications
- Pneumonia, Viral/economics
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/psychology
- Resilience, Psychological
- SARS-CoV-2
- Sex Factors
- Social Isolation/psychology
- Social Support
- Stress Disorders, Traumatic, Acute/etiology
- Stress Disorders, Traumatic, Acute/psychology
- Substance-Related Disorders/etiology
- Substance-Related Disorders/therapy
- Surveys and Questionnaires
- Treatment Adherence and Compliance
- Young Adult
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Affiliation(s)
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; and
| | | | - Deborah L Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - John M Abbamonte
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
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Náraigh LÓ, Byrne Á. Piecewise-constant optimal control strategies for controlling the outbreak of COVID-19 in the Irish population. Math Biosci 2020; 330:108496. [PMID: 33075364 PMCID: PMC7566875 DOI: 10.1016/j.mbs.2020.108496] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022]
Abstract
We introduce a deterministic SEIR model and fit it to epidemiological data for the COVID-19 outbreak in Ireland. We couple the model to economic considerations - we formulate an optimal control problem in which the cost to the economy of the various non-pharmaceutical interventions is minimized, subject to hospital admissions never exceeding a threshold value corresponding to health-service capacity. Within the framework of the model, the optimal strategy of disease control is revealed to be one of disease suppression, rather than disease mitigation.
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Affiliation(s)
- Lennon Ó Náraigh
- School of Mathematics and Statistics, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Áine Byrne
- School of Mathematics and Statistics, University College Dublin, Belfield, Dublin 4, Ireland
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40
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Abstract
The recent outbreak of the SARS-CoV-2 coronavirus is posing many different challenges to local communities, directly affected by the pandemic, and to the global community, trying to find how to respond to this threat in a larger scale. The history of the Eyam Plague, read in light of Ross Upshur's Four Principles for the Justification of Public Health Intervention, and of the Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights, could provide useful guidance in navigating the complex ethical issues that arise when quarantine measures need to be put in place.
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Affiliation(s)
- Giovanni Spitale
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006, Zurich, Switzerland.
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Abstract
We model the extent to which age-targeted protective sequestration can be used to reduce ICU admissions caused by novel coronavirus COVID-19. Using demographic data from New Zealand, we demonstrate that lowering the age threshold to 50 years of age reduces ICU admissions drastically and show that for sufficiently strict isolation protocols, sequestering one-third of the countries population for a total of 8 months is sufficient to avoid overwhelming ICU capacity throughout the entire course of the epidemic. Similar results are expected to hold for other countries, though some minor adaption will be required based on local age demographics and hospital facilities.
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Affiliation(s)
- Alastair Jamieson-Lane
- Institut für Chemie und Biologie des Meeres, Carl von Ossietzky Universität Oldenburg, Wilhelmshaven, Germany
| | - Eric Cytrynbaum
- Department of Mathematics, University of British Columbia, Vancouver, Canada
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42
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Moses MJ, Bosco JA, Schwarzkopf R, Zuckerman JD, Long WJ. Ethical Implications of Resuming Elective Orthopedic Surgery During the COVID-19 Pandemic. Bull Hosp Jt Dis (2013) 2020; 78:221-226. [PMID: 33207142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The COVID-19 pandemic has had unprecedented impact on the United States health care system. One of the consider-ations was the decision to halt elective orthopedic surgery to preserve consumption of scarce resources. However, as the number of COVID-19 cases decrease, there will be discus-sions regarding the modality of resuming elective orthopedic surgery. Ethical considerations will come to the forefront in terms of determining the best course of action, patient selection, resource rationing, and financial implications. These factors will be examined through the lens of the four tenets of bioethics, beneficence, maleficence, autonomy, and justice, to elucidate the best approach in ethically manag-ing elective orthopedic surgery during a global pandemic.
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43
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Satre DD, Iturralde E, Ghadiali M, Young-Wolff KC, Campbell CI, Leibowitz AS, Sterling SA. Treatment for Anxiety and Substance Use Disorders During the COVID-19 Pandemic: Challenges and Strategies. J Addict Med 2020; 14:e293-e296. [PMID: 33156267 PMCID: PMC7892198 DOI: 10.1097/adm.0000000000000755] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: The COVID-19 pandemic is likely to exacerbate existing anxiety and substance use disorders (SUDs) and increase vulnerability among individuals previously free of these conditions. Numerous pandemic-related stressors-coronavirus infection fears, social distancing and isolation, activity restrictions, financial insecurity and unemployment, caregiving or childcare responsibilities-place a substantial burden both on the general population and on many health care providers. Anxiety symptoms such as worry, tension, irritability, difficulty concentrating, and sleep disruption are increasingly prevalent. For individuals in SUD treatment, anxiety can complicate efforts to achieve treatment goals. In this commentary, we outline the potential impact of anxiety on substance use problems during the COVID-19 crisis and describe key behavioral, pharmacological, and digital health treatment considerations. We highlight populations of special concern due to heightened vulnerability and challenges accessing services, strategies to support health care providers, and directions for future research.
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Affiliation(s)
- Derek D. Satre
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Esti Iturralde
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Murtuza Ghadiali
- Addiction Medicine and Recovery Services, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Kelly C. Young-Wolff
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Cynthia I. Campbell
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Amy S. Leibowitz
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Stacy A. Sterling
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
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Bhaskar A, Ng AKM, Patil NG, Fok M. Zooming past the coronavirus lockdown: online spirometry practical demonstration with student involvement in analysis by remote control. Adv Physiol Educ 2020; 44:516-519. [PMID: 32880483 PMCID: PMC7473887 DOI: 10.1152/advan.00097.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 05/25/2023]
Abstract
This paper describes the process involved in conducting an online spirometry practical through Zoom. The teacher demonstrated the practical from the medical school, and the students observed the procedure from the comfort of their own homes. Students were able to analyze the graphs captured in the teacher's laptop by remotely controlling the teacher's laptop. This method may be useful for places where face-to-face classes are suspended due to the COVID-19 pandemic.
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Affiliation(s)
- Anand Bhaskar
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
| | - Anna Kit Man Ng
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
| | | | - Manson Fok
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macau
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Carter CW, Herrero CP, Bloom DA, Karamitopoulos M, Castañeda PG. Early Experience with Virtual Pediatric Orthopedics in New York CityPearls for Incorporating Telemedicine into Your Practice. Bull Hosp Jt Dis (2013) 2020; 78:236-242. [PMID: 33207144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The purpose of this study was to identify and characterize challenges and benefits to the use of tele-medicine for the treatment of pediatric orthopedic patients during and after the COVID-19 pandemic. METHODS A novel survey was sent to all faculty members at an academic pediatric orthopedic practice in New York City regarding their use of telemedicine in response to the COVID-19 pandemic. RESULTS Faculty members performed 227 unique tele-health visits with pediatric orthopedic patients over a 7-week period in early 2020, and this formed the basis for responses to the survey. The results of the faculty survey suggest that telemedicine has substantial clinical benefits for pediatric orthopedic surgeons and our patients that extend beyond the COVID-19 pandemic. Providers recognize the limits of conducting physical exams over telemedicine and should always use clinical judgment when evaluating patients, par-ticularly trauma patients who may require prompt referral for additional care. CONCLUSIONS The ability to provide pediatric orthopedic care through telemedicine has allowed us to safely evaluate and treat pediatric patients with musculoskeletal problems in New York City and its environs despite the COVID-19 pandemic. The efficient evaluation of both new and exist-ing pediatric orthopedic patients via telehealth is viable. Physical examination is the most challenging aspect of the physician-patient encounter to replicate virtually. Targeted educational efforts for patients and their families before the visit about what to expect and how to prepare improves efficiency with virtual pediatric orthopedic visits. Efforts to limit disparities in access to telemedicine will be needed to allow all pediatric orthopedic patients to participate in telemedicine equitably.
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Abstract
Understanding and interpretation of acid-base disorders is an important clinical skill that is applicable to the majority of physicians. Although this topic is taught early in medical school, acid-base disturbances have been described as challenging by postgraduate trainees. We describe the use of Twitter, an online microblogging platform, to augment education in acid-base disturbances by using polls in which the user is shown laboratory values and then asked to select the most likely etiology of the disorder. The answer and a brief explanation are then shared in a subsequent tweet. Both polling questions and answers are shared from the account for the online, mobile-optimized, nephrology teaching tool NephSIM (https://www.nephsim.com/). An anonymous survey was administered to assess attitudes toward these polls. Using Twitter as an approach to enhance teaching of acid-base disturbances was both feasible and an engaging way to teach a challenging topic for trainees and physicians. Moreover, the coronavirus disease 2019 (COVID-19) pandemic has demonstrated the importance of incorporating virtual learning opportunities in all levels of medical education.
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Affiliation(s)
- Joshua L Rein
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, Duke University School of Medicine and Renal Section, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Rachel Hilburg
- Division of Hypertension-Electrolytes, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Samira S Farouk
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Tiwari R, Dhama K, Sharun K, Iqbal Yatoo M, Malik YS, Singh R, Michalak I, Sah R, Bonilla-Aldana DK, Rodriguez-Morales AJ. COVID-19: animals, veterinary and zoonotic links. Vet Q 2020; 40:169-182. [PMID: 32393111 PMCID: PMC7755411 DOI: 10.1080/01652176.2020.1766725] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), has spread over 210 countries and territories beyond China shortly. On February 29, 2020, the World Health Organization (WHO) denoted it in a high-risk category, and on March 11, 2020, this virus was designated pandemic, after its declaration being a Public Health International Emergency on January 30, 2020. World over high efforts are being made to counter and contain this virus. The COVID-19 outbreak once again proves the potential of the animal-human interface to act as the primary source of emerging zoonotic diseases. Even though the circumstantial evidence suggests the possibility of an initial zoonotic emergence, it is too early to confirm the role of intermediate hosts such as snakes, pangolins, turtles, and other wild animals in the origin of SARS-CoV-2, in addition to bats, the natural hosts of multiple coronaviruses such as SARS-CoV and MERS-CoV. The lessons learned from past episodes of MERS-CoV and SARS-CoV are being exploited to retort this virus. Best efforts are being taken up by worldwide nations to implement effective diagnosis, strict vigilance, heightened surveillance, and monitoring, along with adopting appropriate preventive and control strategies. Identifying the possible zoonotic emergence and the exact mechanism responsible for its initial transmission will help us to design and implement appropriate preventive barriers against the further transmission of SARS-CoV-2. This review discusses in brief about the COVID-19/SARS-CoV-2 with a particular focus on the role of animals, the veterinary and associated zoonotic links along with prevention and control strategies based on One-health approaches.
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Affiliation(s)
- Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Pt. Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Mohd. Iqbal Yatoo
- Sher-E, Kashmir University of Agricultural Sciences and Technology of Kashmir, Shalimar, Srinagar, Jammu and Kashmir, India
| | - Yashpal Singh Malik
- Division of Biological Standardization, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Rajendra Singh
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
| | - Izabela Michalak
- Faculty of Chemistry, Department of Advanced Material Technologies, Wrocław University of Science and Technology, Wrocław, Poland
| | - Ranjit Sah
- Department of Microbiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - D. Katterine Bonilla-Aldana
- Semillero de Zoonosis, Grupo de Investigación BIOECOS, Fundación Universitaria Autónoma de las Américas, Sede Pereira, Pereira, Risaralda, Colombia
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Colombia
| | - Alfonso J Rodriguez-Morales
- Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnologica de Pereira, Pereira, Colombia
- Grupo de Investigacion Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Risaralda, Colombia
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Buonanno G, Morawska L, Stabile L. Quantitative assessment of the risk of airborne transmission of SARS-CoV-2 infection: Prospective and retrospective applications. Environ Int 2020; 145:106112. [PMID: 32927282 PMCID: PMC7474922 DOI: 10.1016/j.envint.2020.106112] [Citation(s) in RCA: 180] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/28/2020] [Accepted: 08/31/2020] [Indexed: 05/17/2023]
Abstract
Airborne transmission is a recognized pathway of contagion; however, it is rarely quantitatively evaluated. The numerous outbreaks that have occurred during the SARS-CoV-2 pandemic are putting a demand on researchers to develop approaches capable of both predicting contagion in closed environments (predictive assessment) and analyzing previous infections (retrospective assessment). This study presents a novel approach for quantitative assessment of the individual infection risk of susceptible subjects exposed in indoor microenvironments in the presence of an asymptomatic infected SARS-CoV-2 subject. The application of a Monte Carlo method allowed the risk for an exposed healthy subject to be evaluated or, starting from an acceptable risk, the maximum exposure time. We applied the proposed approach to four distinct scenarios for a prospective assessment, highlighting that, in order to guarantee an acceptable risk of 10-3 for exposed subjects in naturally ventilated indoor environments, the exposure time could be well below one hour. Such maximum exposure time clearly depends on the viral load emission of the infected subject and on the exposure conditions; thus, longer exposure times were estimated for mechanically ventilated indoor environments and lower viral load emissions. The proposed approach was used for retrospective assessment of documented outbreaks in a restaurant in Guangzhou (China) and at a choir rehearsal in Mount Vernon (USA), showing that, in both cases, the high attack rate values can be justified only assuming the airborne transmission as the main route of contagion. Moreover, we show that such outbreaks are not caused by the rare presence of a superspreader, but can be likely explained by the co-existence of conditions, including emission and exposure parameters, leading to a highly probable event, which can be defined as a "superspreading event".
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Affiliation(s)
- G Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - L Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Qld, Australia
| | - L Stabile
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy.
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Li D, Sangion A, Li L. Evaluating consumer exposure to disinfecting chemicals against coronavirus disease 2019 (COVID-19) and associated health risks. Environ Int 2020; 145:106108. [PMID: 32927283 PMCID: PMC7470762 DOI: 10.1016/j.envint.2020.106108] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/03/2020] [Accepted: 08/31/2020] [Indexed: 05/19/2023]
Abstract
Disinfection of surfaces has been recommended as one of the most effective ways to combat the spread of novel coronavirus (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). However, overexposure to disinfecting chemicals may lead to unintended human health risks. Here, using an indoor fate and chemical exposure model, we estimate human exposure to 22 disinfecting chemicals on the lists recommended by various governmental agencies against COVID-19, resulting from contact with disinfected surfaces and handwashing. Three near-field exposure routes, i.e., mouthing-mediated oral ingestion, inhalation, and dermal absorption, are considered to calculate the whole-body uptake doses and blood concentrations caused by single use per day for three age groups (3, 14, and 24-year-old). We also assess the health risks by comparing the predicted whole-body uptake doses with in vivo toxicological data and the predicted blood concentrations with in vitro bioactivity data. Our results indicate that both the total exposure and relative contribution of each exposure route vary considerably among the disinfecting chemicals due to their diverse physicochemical properties. 3-year-old children have consistent higher exposure than other age groups, especially in the scenario of contact with disinfected surfaces, due to their more frequent hand contact and mouthing activities. Due to the short duration of handwashing, we do not expect any health risk from the use of disinfecting chemicals in handwashing. In contrast, exposure from contact with disinfected surfaces may result in health risks for certain age groups especially children, even the surfaces are disinfected once a day. Interestingly, risk assessments based on whole-body uptake doses and in vivo toxicological data tend to give higher risk estimates than do those based on blood concentrations and in vitro bioactivity data. Our results reveal the most important exposure routes for disinfecting chemicals used in the indoor environment; they also highlight the need for more accurate data for both chemical properties and toxicity to better understand the risks associated with the increased use of disinfecting chemicals in the pandemic.
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Affiliation(s)
- Dingsheng Li
- School of Community Health Sciences, University of Nevada Reno, Reno, NV 89557-274, United States
| | - Alessandro Sangion
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario M1C 1A4, Canada
| | - Li Li
- School of Community Health Sciences, University of Nevada Reno, Reno, NV 89557-274, United States.
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Hobday D, Welman T, O'Neill N, Pahal GS. A protocol for wide awake local anaesthetic no tourniquet (WALANT) hand surgery in the context of the coronavirus disease 2019 (COVID-19) pandemic. Surgeon 2020; 18:e67-e71. [PMID: 32631702 PMCID: PMC7324324 DOI: 10.1016/j.surge.2020.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022]
Abstract
There are new and unique challenges to emergency surgery service provision posed by the Coronavirus disease 2019 global pandemic. It is in the best interests of patients for care providers to streamline services where possible to maximise the number of cases that can be performed by limited surgical and anaesthetic teams, as well as minimising patient interactions and admission times to reduce potential spread of the virus. There is evidence that wide awake local anaesthetic no tourniquet (WALANT) hand and upper limb surgery can meet this need in a number of ways, including reduced pre-operative work up, the lack of a need for an anaesthetist or ventilator, shorter inpatient stays and improved cost efficiencies. Though updated national guidelines exist that advocate increased use of WALANT surgery in response to the pandemic there are not yet clear protocols to facilitate this. We outline a protocol being developed at one UK Major Trauma Centre tailored to the expansion of WALANT hand and upper limb emergency surgery with particular emphasis on facilitating timely surgical care while minimising healthcare encounters pre and post-operatively. This will serve to reduce potential transmission of the virus and create cost efficiencies to free funding for COVID-19 related care. Our protocol is easily replicable and may be of benefit to other centres dealing with emergency upper limb surgery in the new climate of COVID-19.
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Affiliation(s)
- Dorian Hobday
- Department of Plastic and Reconstructive Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, United Kingdom.
| | - Ted Welman
- Department of Plastic and Reconstructive Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, United Kingdom.
| | - Niamh O'Neill
- Department of Plastic and Reconstructive Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, United Kingdom.
| | - Gurjinderpal Singh Pahal
- Department of Plastic and Reconstructive Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, United Kingdom.
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