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OBJECTIVES/GOALS: The COVID-19 pandemic has impacted nursing frontline professionals. The aims of this study were to explore experiences of nursing professionals in Puerto Rico during the pandemic, examine the impact on their health and provide research development opportunities enhance research capacity. METHODS/STUDY POPULATION: This interpretative phenomenological study recruited graduate nurses who participated in one in-depth semi-structured virtual interviews. Interviews were audio recorded and transcribed. The data analysis process was guided using the following steps: 1. Reading and re-reading, 2. Initial noting, 3. Developing emergent themes, 4. Searching for connections across emergent themes, 5. Moving to the next case, 6. Looking for patterns across cases, and 7. Writing up. In addition, Van Manen's thematic structure of four foundations was used as a complement to guide reflection and interpretation. Faculty and students participated throughout the process. RESULTS/ANTICIPATED RESULTS: Seven nursing professionals'lived experiences caring for Covid-19 patients were gathered. Their ages ranged from 31 to 45 and had worked between 2 and 14 years providing direct care. Themes that emerged from narrations include compassion fatigue, teamwork, working beyond clinical role, and gratification. Nurses expressed dealing with a very difficult situation, fear of being infected , or infecting my family , and working together to get through it and better help patients . Nurses also expressed feelings of anxiety and lack of institutional support. Additionally, the impact of working with patients, feeling good for being there, good or bad and support from families. DISCUSSION/SIGNIFICANCE: Nurses'narrations point to the complexities of their experiences working during the pandemic. They had to transcend usual demands even though they often lacked needed support. We must recognize the value of nursing and reflect upon changes in healthcare that are essential to move nursing forward.
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BACKGROUND: Saliva samples may be an easier, faster, safer, and cost-saving alternative to NPS samples, and can be self-collected by the patient. Whether SARS-CoV-2 RT-qPCR in saliva is more accurate than in nasopharyngeal swaps (NPS) is uncertain. We evaluated the accuracy of the RT-qPCR in both types of samples, assuming both approaches were imperfect. METHODS: We assessed the limit of detection (LoD) of RT-qPCR in each type of sample. We collected paired NPS and saliva samples and tested them using the Berlin Protocol to detect SARS-CoV-2 envelope protein (E). We used a Bayesian latent class analysis (BLCA) to estimate the sensitivity and specificity of each test, while accounting for their conditional dependence. RESULTS: The LoD were 10 copies/mL in saliva and 100 copies/mL in NPS. Paired samples of saliva and NPS were collected in 412 participants. Out of 68 infected cases, 14 were positive only in saliva. RT-qPCR sensitivity ranged from 82.7 % (95 % CrI: 54.8, 94.8) in NPS to 84.5 % (50.9, 96.5) in saliva. Corresponding specificities were 99.1 % (95 % CrI: 95.3, 99.8) and 98.4 %(95 % CrI: 92.8, 99.7). CONCLUSIONS: SARS-CoV-2 RT-qPCR test in saliva specimens has a similar or better accuracy than RT-qPCR test in NPS. Saliva specimens may be ideal for surveillance in general population, particularly in children, and in healthcare or other personnel in need of serial testing.
Subject(s)
COVID-19 , SARS-CoV-2 , Child , Humans , SARS-CoV-2/genetics , COVID-19 Testing , Saliva , Bayes Theorem , COVID-19/diagnosis , Clinical Laboratory Techniques/methods , Nasopharynx , Sensitivity and SpecificityABSTRACT
Background:Although the technology has been available and several pilot studies have shown success, use of telemedicine has previously been limited in the United States, especially among surgeons. This study aimed to investigate the benefits and obstacles for successful implementation of telemedicine visits in paediatric surgical subspecialties amid the COVID-19 pandemic.Methods:We analysed survey data from telemedicine visits with paediatric surgical subspecialists from May 1 through June 30, 2020 at our paediatric surgery subspecialty clinics. Univariate logistic regression was used to determine associations in survey responses and various demographic factors.Results:There were 164 respondents to the survey. The most frequently cited barrier to care was ability to get time off work (46.3%). Overall satisfaction with the telemedicine visit was 93.8%, and 55.6% responded that they would choose video telemedicine rather than an in-person or telephone visit. Those living at least 25 miles from the hospital had increased odds of indicating interest in using telemedicine for future visits (OR = 2.56, 95% CI = 1.12?5.86, p = 0.026). The average respondent saved between 30 minutes and 1 hour, and 45 minutes using telemedicine.Conclusions:The implementation of telemedicine at our institution in the paediatric surgical subspecialties has proven to be effective and well-received. Given the benefits of time and money saved for families, paired with high satisfaction rates and continued interest, paediatric surgical subspecialists should work to incorporate virtual visits into regular patient care, even well after the COVID-19 pandemic.Level of Evidence:Level IV
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Background: Information on the occupational distribution of COVID-19 mortality is limited. Objective: To characterize COVID-19 fatalities among working Californians. Design: Retrospective study of laboratory-confirmed COVID-19 fatalities with dates of death from January 1 to December 31, 2020. Setting: California. Participants: COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18-64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as confirmed working. The remainder were classified as likely working (n=4,121 [51.2%]) or not working (n=1,443 [17.9%]) using death certificate and case registry data. Measurements: We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators. Results: Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3-30.8). Workers in nine occupational groups had mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7-88.2); material moving (77.8; 95% CI, 70.2-85.9); construction (62.4; 95% CI, 57.7-67.4); production (60.2; 95% CI, 55.7-65.0); and transportation (57.2; 95% CI, 52.2-62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers. Limitations: The requirement that fatalities be laboratory-confirmed and the use of 2019 denominator data may underestimate the occupational burden of COVID-19 mortality. Conclusion: Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers.
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COVID-19ABSTRACT
COVID-19 is a terrible virus that has impacted human health and the economy on a global scale. The detection and control of the pandemic have become necessities that require appropriate monitoring strategies. One of these strategies involves measuring and quantifying the virus in water at different stages of the Urban Water Cycle (UWC). This article presents a comprehensive literature review of the analyses and quantifications of SARS-CoV-2 in multiple UWC components from 2020 to June 2021. More than 140 studies worldwide with a focus on industrialized nations were identified, mainly in the USA, Australia, and Asia and the European Union. Wastewater treatment plants were the focus of most of these studies, followed by city sewerage systems and hospital effluents. The fewest studies examined the presence of this virus in bodies of water. Most of the studies were conducted for epidemiological purposes. However, a few focused on viral load and its removal using various treatment strategies or modelling and developing strategies to control the disease. Others compared methodologies for determining if SARS-CoV-2 was present or included risk assessments. This is the first study to emphasize the importance of the various individual components of the UWC and their potential impacts on viral transmission from the source to the public.
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Background: Cruise travel contributed to SARS-CoV-2 transmission when there were relatively few cases in the United States. By March 14, 2020, the Centers for Disease Control and Prevention (CDC) issued a No Sail Order suspending U.S. cruise operations; the last U.S. passenger ship docked on April 16.Methods: We analysed SARS-CoV-2 outbreaks on cruises in U.S. waters or carrying U.S. citizens and used regression models to compare voyage characteristics. We used compartmental models to simulate the potential impact of four interventions (screening for COVID-19 symptoms; viral testing on two days and isolation of positive persons; reduction of passengers by 40%, crew by 20%, and port visits to one) for 7-day and 14-day voyages.Findings: During January 19–April 16, 2020, 89 voyages on 70 ships had known SARS-CoV-2 outbreaks; 16 ships had recurrent outbreaks. There were 1,669 RT-PCR-confirmed SARS-CoV-2 infections and 29 confirmed deaths. Longer voyages were associated with more cases (adjusted incidence rate ratio, 1·10, 95% CI: 1·03-1·17, p < 0.0001). Mathematical models estimated a 70-78% reduction in transmission for 7-day vs. 14-day voyages. On 7-day voyages, the most effective interventions were reducing the number of individuals onboard (43-49% reduction in total infections) and testing passengers and crew (42-43% reduction in total infections). Results were similar for 14-day voyages. All four interventions reduced transmission by 80%, but no single intervention or combination eliminated transmission.Interpretation: SARS-CoV-2 outbreaks on cruises were common during January-April 2020. Despite all interventions modelled, cruise travel still poses a significant SARS-CoV-2 transmission risk.Funding: CDC.Declaration of Interests: The authors have no interests to declare.Ethics Approval Statement: This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy (See e.g., 45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. §241(d); 5 U.S.C. §552a; 44 U.S.C. §3501 et seq.). Passenger-level data were deidentified and analysed at the voyage-level.
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COVID-19ABSTRACT
Background: Healthcare workers (HCWs) are at increased risk for SARS-CoV-2 infection, however not all face the same risk. We aimed to determine antibody prevalence and risk factors associated with seropositivity in the Chilean HCW community.Methods: This was a nationwide, cross-sectional study consisting of a questionnaire and COVID-19 antibody testing. All HCWs in the Chilean public health care system were invited to participate three to four months following the peak of the country's first wave.Findings: Overall SARS-Cov-2 blood antibody positivity by fingerstick or venipuncture in 85 529 HCWs was 7 · 2%, ranging from 1 · 6% to 12 · 4% between regions. SARS-Cov-2 positive PCR results were self-reported in 8 330 individuals (9 · 7%) of which 47% were seropositive. Overall 10 863 (12 · 7%) either reported prior PCR positive results and/or were seropositive. Several factors were independently associated with higher IRR for seropositivity, including working in hospital (IRR 1·484), medicine/surgery w ards (IRR 1·383), emergency room (IRR 1·266), and night shifts (IRR 1·616), as were history of contact with a confirmed case (IRR 1·462), and use of public transport (IRR 1·367). These variables remained significant when including self-reported PCR positive cases in the model.Interpretation: HCWs in the hospital were at highest risk for COVID-19, especially if working in medicine/surgery wards or emergency rooms, in night shifts, older age, exposed to confirmed cases and/or using public transport. Antibody results using lateral flow likely underestimated true infection rates by nearly 40-50%. Nevertheless, risk factors were sustained when adjusting for self-reported PCR positive cases.Funding: No funding institution.Conflict of Interest: Authors do not declare any conflict of interest.Ethical Approval: The study was designed in August 2020 by Health Ministry personnel in conjunction with an academicadvisory board; the study was approved by the Ethical Committee of the Servicio de Salud Araucanía Sur (Nº CEC-201, August 10, 2021).
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COVID-19ABSTRACT
Background: After eight months of the COVID-19 pandemic, Latin American countries have some of the highest rates in COVID-19 mortality. Despite being one of the most unequal regions of the world, there is a scarce report of the effect of socioeconomic conditions on COVID-19 mortality in their countries. We aimed to identify the effect of some socioeconomic inequality-related factors on COVID-19 mortality in Colombia. Methods: We conducted a survival analysis in a nation-wide retrospective cohort study of confirmed cases of COVID-19 in Colombia from March 2nd to October 26th, 2020. We calculated the time to death or recovery for each confirmed case in the cohort. We used an extended multivariable time-dependent Cox regression model to estimate the hazard risk ratio (HR) by age groups, sex, ethnicity, type of health insurance, area of residence, and socioeconomic strata. Results: There were 1 033 218 confirmed cases and 30 565 deaths for COVID-19 in Colombia between March 2nd and October 26th. The risk of dying for COVID-19 among confirmed cases was higher in males (HR=1.68 95% CI: 1.64-1.72), in people older than 60 years (HR=296.58 95% CI: 199.22-441.51), in indigenous people (HR=1.20 95% CI: 1.08-1.33), in people with subsidized health insurance regime (HR=1.89 95% CI: 1.83-1.96), and in people living in the very low socioeconomic strata (HR=1.44 95% CI: 1.24-1.68). Conclusion: Our study provides evidence of socioeconomic inequalities in COVID-19 mortality in terms of age groups, sex, ethnicity, type of health insurance regime, and socioeconomic status.
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COVID-19 , AnisocoriaABSTRACT
Sin embargo, COVID-19 puede ser una enfermedad severa en los menores, contribuyendo no solo al número de ingresos a unidades de cuidados intensivo sino al de casos fatales3. Esto indica que los niños infectados constituyen una fuente importante de contagio para sus pares, con evidencia de mayor transmisión en el nivel de secundaria comparado con el de primaria5, así como para los miembros del personal docente y administrativo de sus escuelas. La alternancia se ofrece en diferentes modalidades como la híbrida, en la que es posible que un grupo de estudiantes reciban de manera presencial la clase y el resto lo hagan de manera virtual en forma sincrónica, con opciones de participación en ambos espacios. Garantizar la ventilación adecuada y los recambios de aire, de los diferentes espacios de las instituciones educativas especialmente en las áreas cerradas, es un factor de especial importancia para disminuir la transmisión del virus. Revista Cuidarte. 2021;12(2):e.2244 http://dx.doi.org/10.15649/cuidarte.2244 Recibido: 4 de mayo de 2021 Aceptado: 6 de mayo de 2021 Publicado: 31 de mayo de 2021 H ·Correspondencia Myriam Oróstegui Arenas1 E-mail: ciepi_uis@hotmail.com Esto indica que los niños infectados constituyen una fuente importante de contagio para sus pares, con evidencia de mayor transmisión en el nivel de secundaria comparado con el de primaria5, así como para los miembros del personal docente y administrativo de sus escuelas El conocimiento cabal de la situación epidemiológica