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COVID-19 vaccination rates of a large health system reflected their respective service areas but varied by work role. Nurse vaccination rates were higher (56.9%) while nursing support personnel were lower (38.6%) than their communities (51.7%; P<0.001). Physician vaccination rates were highest (71.6%) and not associated with community vaccination levels.
Describe cumulative seroprevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among employees of a large pediatric healthcare system.
Design, Setting, and Participants:
Prospective observational cohort study open to adult employees at Children’s Hospital of Philadelphia, conducted April 20 – December 17, 2020.
Employees were recruited starting with high-risk exposure groups, utilizing emails, flyers, and announcements at virtual town halls. At baseline, 1-month, 2-month, and 6-month timepoints, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity.
1740 employees were enrolled. At 6-months, cumulative seroprevalence was 5.3%, below estimated community point seroprevalence; seroprevalence was 5.8% and 3.4% among employees with and without direct patient care, respectively. Most participants seropositive at baseline remained positive at follow-up assessments. In post hoc analysis, direct patient care (HR: 1.95, 95% CI: 1.03 to 3.68), Black race (HR: 2.70, 95% CI: 1.24 to 5.87), and exposure to a confirmed case in a non-healthcare setting (HR: 4.32, 95% CI: 2.71 to 6.88) were associated with statistically significant increased risk for seropositivity.
Employee SARS-CoV-2 seroprevalence rates remained below the surrounding community’s point prevalence rates. Provision of direct patient care, Black race, and exposure to a confirmed case in non-healthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID waves or other epidemics.
The surface environment in COVID-19 patient’s rooms may be persistently contaminated despite disinfection. A continuously active disinfectant demonstrated excellent sustained antiviral activity following a 48-hour period of wear and abrasion exposures with reinoculations. Reductions of >4-log10 were achieved within a 1-minute contact time for SARS-CoV-2 and the human coronavirus, 229E.
Identifying the patients at higher risk for poor outcomes after radiotherapy (RT) during COVID-19 era is an unmet clinical need.
The Ovid MEDLINE, Ovid Embase, Clarivate Analytics Web of Science, PubMed, and Wiley-Blackwell Cochrane Library databases were searched. Eligible studies were required to address the outcomes of cancer patients who underwent RT during the COVID-19 era. The primary outcome was early mortality, while secondary outcomes included length of hospital stay, hospital admission, intensive care unit (ICU) admission, and use of mechanical ventilation. Pooled event rates were calculated and meta-regression and “leave-one-out” sensitivity analyses were performed.
Twelve eligible studies were included out of 928. The prevalence of early mortality after COVID-19 infection was 21.0%. The prevalence of hospital admission, ICU admission, and mechanical ventilation was 78.1%, 15.4%, and 20.0%, respectively. Meta-regression showed that older age was significantly and positively associated with early mortality (β=0.0765 ± 0.0349, p = 0.0284), while breast cancer was negatively associated with early mortality (β=-1.2754 ± 0.6373, p = 0.0454).
Older age adversely impacts the early mortality rate in cancer patients during COVID-19 era. The risks of interruption/delay of cancer treatment should be weighed against the risk of increased morbidity and mortality from the infection. A global registry is needed to establish international oncologic guidelines during the COVID-19 era.
To explore (a) the approaches to corporate social responsibility (CSR) implemented by e-commerce platforms in China during the early stage of COVID-19 (ESCOVID-19) and; (b) the factors associated with the platforms’ choice of these approaches.
We collected the CSR data from the Internet during ESCOVID-19. Conventional content analysis was used to develop the targeted approaches. Finally, based on the frequency analysis of each approach, rank-based nonparametric testing was conducted to answer objective (b).
Three main approaches (i.e., donative CSR actions, responsive CSR actions, and strategic CSR actions) and eight sub approaches were implemented. The strategic approach was the most frequently used approach. The platforms with higher market size implemented more donative and strategic CSR actions than the platforms with lower market size did. Donative CSR actions were significantly implemented in the earlier period, while strategic CSR actions were significantly implemented in the later period.
Our research highlights the importance of e-commerce platforms to help the public survive and identifies that market size and time were associated with the platforms’ CSR choice. The design of prevention and control policies should incorporate and support e-commerce platforms and evaluate the factors when confronting future public health crises.
The number of coronavirus disease 2019 (COVID-19) cases and deaths registered in Mexico during 2020 could be underestimated, due to the sentinel surveillance adopted in this country. Some consequences of following this type of epidemiological surveillance were the high case fatality rate and the high positivity rate for COVID-19 shown in Mexico in 2020. During this year, the Mexican Ministry of Health only considered cases from the public health system, which followed this sentinel surveillance, but did not consider those cases from the private health system. To better understand this pandemic, it is important to include all the results obtained by all the institutions capable of testing for COVID-19, thus the Mexican Government could make good decisions to protect the population from this disease.
Infectious disease outbreaks are the scale of the current COVID-19 pandemic are a new phenomenon in many parts of the world. Many isolation unit designs with corresponding workflow dynamics and personal protective equipment postures have been proposed for each emerging disease at the health facility level, depending on the mode of transmission. However, personnel and resource management at the isolation units for a resilient response will vary by human resource capacity, reporting requirements, and practice setting. This paper describes an approach to Isolation unit management at a rural Uganda Hospital and shares lessons from the Uganda experience for isolation unit managers in low- and middle-income settings.
Routine childhood vaccination and well-child visits are essential for pediatric patients’ preventative and public healthcare services. The COVID-19 pandemic had an immediate and significant decline in well-child visits and vaccine administration. A one-of-a-kind’ Drive Through Vaccine Clinic’ was established to improve the vaccination rate and alleviate parental anxiety about being exposed to COVID-19 infection.
Our initial focus was on children between 18 months – 4 years of age at the start of the pandemic, and then slowly extended this to the back-to-school vaccines and the Influenza vaccines.
The Drive-Through Immunization Station provided 745 vaccines to 415 patients between April and September 2020. The median wait time involved from patient arrival to completion of vaccine administration was five minutes at the Drive-Through location. Patient and parent feedback was positive. The addition of Drive Through Clinic helped significantly increase the total number of vaccines administered compared to the previous year.
In a global pandemic, innovative ideas to increase access to preventive healthcare should be a priority. In the future, this method of nontraditional vaccine administration will allow for improved outreach efforts to underserved populations in our communities and better disaster preparedness.
The unprecedented disruption brought about by the global coronavirus disease 2019 (COVID-19) pandemic had produced tremendous influence on the practice of pharmacy. Sufficient knowledge of pharmacists was needed to deal with the epidemic situation, however, outbreak also aggravated psychological distress among healthcare professionals. Therefore, this study aimed to determine knowledge about the pandemic and related factors, prevalence and factors associated with psychological distress among hospital pharmacists of Xinjiang Province, China.
An anonymous online questionnaire-based cross-sectional study was conducted via WeChat, a popular social media platform in China, during the COVID-19 outbreak from 23th to 27th February 2020. The survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge about COVID-19 and assessment of overall mental health through World Health Organization Self-Reporting Questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to classify the participant as in psychological distress. SRQ-20 score and related knowledge score were used as dependent variables, demographic characteristics (such as gender, age, monthly income, etc) were used as independent variables, and univariate binary logistic regression was used to screen out the variables with p<0.05. Then, the filtered variables were used as independent variables, multivariate logistic regression models were used to analyze associations with sufficient knowledge of COVID-19 and psychological distress.
A total of 365 pharmacists participated in the survey, fewer than half (35.1%, n=128) of pharmacists attained a score of 6 or greater (out of 10) in overall disease knowledge, and most were able to select effective disinfectants and isolation or discharge criteria. In multivariable model, age ages 31-40(OR=3.25, p<0.05), ages 41-50(OR=2.96, p<0.05) vs >50 (referent); primary place of practice in hospitals: drug supply (OR=4.00, p<0.01), inpatient pharmacy(OR=2.06, p<0.01), clinical pharmacy (OR=2.17, p<0.05) vs outpatient pharmacy (referent); monthly income Renminbi (RMB, China’s legal currency) 5000-10000 (OR=1.77, p<0.05) vs <5000 (referent); contact with COVID-2019 patients or suspected cases (OR=2.27, p<0.01); access to COVID-19 knowledge remote work+ on-site work(OR=6.07, p<0.05), single on-site work (OR=6.90, p<0.01) vs remote work (referent) were related to better knowledge of COVID-19. Research found that 18.4% of pharmacists surveyed met the SRQ-20 threshold for distress. Self-reported history of mental illness (OR=3.56, p<0.05) and working and living in hospital vs delay in work resumption (OR=2.87, p<0.01) were found to be risk factors of psychological distress.
Further training of COVID-19 knowledge was required for pharmacists. As specific pharmacist groups were prone to psychological distress, it was important for individual hospitals and government to consider and identify pharmacists’ needs and take steps to meet their needs with regard to pandemic and other work-related distress.
To assess the association between household food insecurity (FI) and major depressive episodes (MDE) amid Covid-19 pandemic in Brazil.
Cross-sectional study carried out with data from four consecutive population-based studies.
The study was conducted between May and June 2020, in Bagé, a Brazilian southern city. Household FI was measured using the short-form version of the Brazilian Food Insecurity Scale. Utilizing the Patient Health Questionnaire-9, we used two different approaches to define MDE: the cut-off point of ≥9 and the diagnostic criteria proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R). Association between FI and MDE was analysed using crude and adjusted Poisson regression models.
1550 adults (≥20 years old).
The prevalence of household FI was 29.4% (95%C.I 25.0; 34.4). MDE prevalence varied from 4.4% (95%C.I. 3.1 to 6.0), when we used the DSM-IV-R criteria to define this condition, to 9.6% (95%C.I 7.3; 12.5) of the sample, when we used the cut-off point of ≥9 as definition. Prevalence of MDE was more than two times higher in those individuals living with FI, independent of the criteria adopted to define the outcome. Adjustment for potential confounders did not change the association’s magnitude.
Household FI has been positively associated with MDE amid Covid-19 pandemic, independent of sociodemographic characteristics of participants. Actions are needed to warrant basic living conditions to avoid food insecurity and hunger and its consequences for the Brazilian population, especially those consequences linked to mental health disorders.
To understand the transmission dynamics of SARS-CoV-2 in a hospital outbreak to inform infection control actions.
Retrospective cohort study.
General medical and elderly inpatient wards in a hospital in England.
COVID-19 patients were classified as community or healthcare-associated by time from admission to onset/positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, non-respiratory or respiratory. Infectiousness was calculated from 2 days prior to 14 days post symptom onset or positive test.
Cases were defined as healthcare-associated COVID-19 patients where infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aOR) were calculated from univariable and multivariable logistic regression.
Of 153 patients: 65 were COVID-19 patients (45 healthcare-associated). Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR 3.81; 95%CI 1.6.3-8.87), non-respiratory exposure was only significant within 2.5m (aOR 5.21; 95%CI 1.15-23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95%CI 0.99-4.22) to 2.36 (95%CI 1.44-3.88)
Respiratory exposure anywhere within a 4-bedded bay was a risk whereas non-respiratory exposure required bed distance ≤2.5m. Standard Infection control measures required beds to be >2m apart; our study suggests this may be insufficient to stop SARS-CoV-2 spread. We recommend improving cohorting and further studies into bed distance and transmission factors.
There is evidence to suggest that patients delayed seeking urgent medical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A delay in health-seeking behavior could increase the disease severity of patients in the prehospital setting. The combination of COVID-19-related missions and augmented disease severity in the prehospital environment could result in an increase in the number and severity of physician-staffed prehospital interventions, potentially putting a strain on this highly specialized service.
The aim was to investigate if the COVID-19 pandemic influences the frequency of physician-staffed prehospital interventions, prehospital mortality, illness severity during prehospital interventions, and the distribution in the prehospital diagnoses.
A retrospective, multicenter cohort study was conducted on prehospital charts from March 14, 2020 through April 30, 2020, compared to the same period in 2019, in an urban area. Recorded data included demographics, prehospital diagnosis, physiological parameters, mortality, and COVID-status. A modified National Health Service (NHS) National Early Warning Score (NEWS) was calculated for each intervention to assess for disease severity. Data were analyzed with univariate and descriptive statistics.
There was a 31% decrease in physician-staffed prehospital interventions during the period under investigation in 2020 as compared to 2019 (2019: 644 missions and 2020: 446 missions), with an increase in prehospital mortality (OR = 0.646; 95% CI, 0.435 – 0.959). During the study period, there was a marked decrease in the low and medium NEWS groups, respectively, with an OR of 1.366 (95% CI, 1.036 – 1.802) and 1.376 (0.987 – 1.920). A small increase was seen in the high NEWS group, with an OR of 0.804 (95% CI, 0.566 – 1.140); 2019: 80 (13.67%) and 2020: 69 (16.46%). With an overall decrease in cases in all diagnostic categories, a significant increase was observed for respiratory illness (31%; P = .004) and cardiac arrest (54%; P < .001), combined with a significant decrease for intoxications (-58%; P = .007). Due to the national test strategy at that time, a COVID-19 polymerase chain reaction (PCR) result was available in only 125 (30%) patients, of which 20 (16%) were positive.
The frequency of physician-staffed prehospital interventions decreased significantly. There was a marked reduction in interventions for lower illness severity and an increase in higher illness severity and mortality. Further investigation is needed to fully understand the reasons for these changes.
Characterize and compare SARS-CoV-2–specific immune responses in plasma and gingival crevicular fluid (GCF) from nursing home residents during and after natural infection
SARS-CoV-2–infected nursing home residents
A convenience sample of 14 SARS-CoV-2–infected nursing home residents, enrolled 4–13 days after real-time reverse transcription polymerase chain reaction diagnosis, were followed for 42 days. Post diagnosis, plasma SARS-CoV-2–specific pan-Immunoglobulin (Ig), IgG, IgA, IgM, and neutralizing antibodies were measured at 5 timepoints and GCF SARS-CoV-2–specific IgG and IgA were measured at 4 timepoints.
All participants demonstrated immune responses to SARS-CoV-2 infection. Among 12 phlebotomized participants, plasma was positive for pan-Ig and IgG in all 12, neutralizing antibodies in 11, IgM in 10, and IgA in 9. Among 14 participants with GCF specimens, GCF was positive for IgG in 13 and IgA in 12. Immunoglobulin responses in plasma and GCF had similar kinetics; median times to peak antibody response was similar across specimen types (4 weeks for IgG; 3 weeks for IgA). Participants with pan-Ig, IgG, and IgA detected in plasma and GCF IgG remained positive through this evaluation’s end 46–55 days post-diagnosis. All participants were viral culture negative by the first detection of antibodies.
Nursing home residents had detectable SARS-CoV-2 antibodies in plasma and GCF after infection. Kinetics of antibodies detected in GCF mirrored those from plasma. Non-invasive GCF may be useful for detecting and monitoring immunologic responses in populations unable or unwilling to be phlebotomized.