Retrospective Observational Study of Complete Blood Count (CBC) Parameters and ICU Mortality of COVID-19 Disease in Delta Variant and Omicron Variant in a Community-Based Hospital in New York City.

BACKGROUND: Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is the official name of COVID-19, a respiratory infection that had the first case reported from the Hubei province of China on December 8, 2019. This virus is the main etiological agent behind the most dreaded pandemic of pneumonia that has spread to the entire world in a brief period and continues to pose a threat. The first wave corresponded with the period from February 2020 to June 2020, the Delta variant occurred around the middle of June 2021 and the Omicron wave was reported from December 2021 to February 2022. Objective: This study aims to compare the Delta and the Omicron variants of COVID-19 infection in a community-based hospital in New York City considering the comparison of ICU admissions in both variants. We aim to study the comparison of complete blood count (CBC) parameters and inflammatory markers of patients admitted to ICU stratified by two waves of COVID-19 infection. We aim to analyze the association of CBC parameters at admission and the discharge during ICU stay in both variants. We also aim to study the association of CBC parameters at admission and discharge with ICU mortality in both variants. METHODS: We conducted a retrospective observational study based on data from randomly selected hospitalized patients with COVID-19 in a community-based hospital in New York City during the Delta variant and the Omicron wave. A total of 211 patients COVID-19 positive from June to July 2021 (Delta variant) and 148 patients from December to February 2022 (Omicron wave) were included in the study. A comparison was done between the basic characteristics of patients with and without ICU admissions in both variants of COVID-19. We compared the relationship of different parameters of CBC (hemoglobin (Hgb), white blood count (WBC), lymphocytes, neutrophils, and platelets) on ICU admission and further analyzed any changes associated with ICU mortality. Logistic regression was performed to evaluate the relationship of different presenting CBCs on patients' disposition to ICU.  Result: A total of 211 patients (106 female) in the Delta wave (2021 variant) and 148 patients (80 female) in the Omicron wave (2022 variant) with an average ages of 60.9 ±18.10 (Delta variant) and 63.2 ± 19.10 (Omicron variant) were included in this study. There were 45 patients (21.3%) in the Delta wave and 42 patients (28.4%) in the Omicron wave were admitted to ICU. The average length of hospital stay was seven days in the Delta wave and nine days in the Omicron wave. No significant association was found between presenting cell count and ICU admission (p>0.05). Significant associations were found between different cell counts on admission and discharge and death in Delta waves except Hgb and platelets on admission. However, in the Omicron variant, a significant association was found only between WBC on admission and discharge, and Hgb and neutrophil on discharge with death in the univariate model. CONCLUSION:  Comparative study of different clinical parameters between the Delta and the Omicron variants of COVID-19 with the correlation of ICU stay and mortality can be used as a beneficial modality in assessing the outcome of the disease.

Seroprevalence of SARS-CoV-2 among Children Visiting a Tertiary Hospital in Himachal Pradesh, India

Introduction: Research on Coronavirus Disease-2019 (COVID-19) seroprevalence in children and adolescent population across the globe is quite limited. In India, there is a dearth of data on COVID-19 seropositivity, especially in unvaccinated paediatric population, particularly in the Himalayan region. Aim: To estimate the seroprevalence of COVID-19 in children presenting in a tertiary care health institution. Materials and Methods: A hospital-based cross-sectional serosurvey was conducted on 500 children, from October 2021 to March 2022 in paediatric age group, attending Indira Gandhi Medical College Shimla, Himachal Pradesh, India, for various health related concerns such as fever, cough, loose stools, vomiting and fast breathing using convenience sampling. Socio-demographic profile was recorded and blood sample was drawn for COVID-19 antibody titre estimation. Chi-squared and Fisher's-exact tests for proportions was used for testing statistical significance. Results: A total of 500 children, age ranged from 12 hours to 17 years 7 months were enrolled with maximum children belonging to 01-05 years age group and there was slight male preponderance. Seropositivity in males (27.3%) was significantly higher than females (8.3%). Highest (42.3%) seropositivity was seen in age group of 06 months to 01 year. About 10.8% of cases were positive for Immunoglobulin (Ig) G antibody, 4.4% were positive for IgM antibody, while about 6.6% cases were positive for both antibodies. Conclusion: The seroprevalence status of children and adolescents is quite low in this region, revealing the high susceptibility of children to SARS-CoV-2 in the study region. It further emphasises benefits of serological testing in children for SARS-CoV-2 as well as the need of safe and effective vaccination for the unimmunised, unprotected and vulnerable paediatric age group.

Public transport strategy and epidemic prevention framework in the Context of Covid-19.

As countries across the world modify their travel in the face of the Covid-19 pandemic, the first casualty becomes the public transport sector. Transport authorities across the world have reported about 95% reduction in users during peak COVID-19, decrease of fare box revenues and additional costs for disinfecting and implementing physical distancing measures. The public transport companies in India face a larger crisis as nearly 85% people travelling intercity use public road transport in normal times. In this paper we drawpassenger clusters based on their travel dynamics and develop two frameworks, namely, passenger driven transportation strategy framework and epidemic prevention strategy framework to deal with the COVID-19 induced travel changes. The frameworks use three tenets of mobility, namely, agility, integrated movement, and public based partnership. The strategies aim to enable the transport enterprises to open new windows of travel and efficiencies for the passengers rather than restricting access and choices. However, security remains fundamental to making these new and innovative service changes possible.

Depression, Anxiety and Stress among Nurses Providing Care to the COVID-19 Patients: A Descriptive Cross-sectional Study.

INTRODUCTION: Addressing adequately the mental health during and after COVID-19, as well as preparation for possible future outbreaks, requires an understanding of the nature and extent of mental health impacts, factors related to negative mental health outcomes and symptoms of mental illness. The aim of this study was to find the prevalence of depression, anxiety and stress among nurses providing care to the COVID-19 patients. METHODS: A descriptive cross-sectional study was conducted from 10th April 2021 to 30th June 2021 among 301 nurses from three COVID-19 dedicated hospitals using self-administered questionnaires. Whole sampling technique was used. Ethical approval was obtained from the Ethical Review Board of Nepal Health Research Council (Registration number: 106/2021P). The data was analyzed using the Statistical Package for the Social Sciences version 16. Descriptive statistics like frequency, percentage, mean and standard deviation were calculated. RESULTS: Out of 301 nurses, the prevalence of depression, anxiety and stress was 258 (85.72%), 189 (62.80%) and 151 (49.84%) respectively. CONCLUSIONS: The study has shown a higher prevalence of depression, anxiety and stress among nurses in comparison to other studies in the similar settings. A quick assessment of the mental health status and mental health requirements of nurses would be helpful in responding to and reducing psychological distress in the crisis situation. The mental health status of nurses should thus be closely monitored by the employing health institutions including managing their workload, providing emotional support and responding to their personal needs.

Psychosocial responses to COVID-19 among nurses in two hospitals: a mixed method study at Eastern Nepal.

BACKGROUND: Most documented studies have focused on mental health status of health care workers during the pandemic but there are very few studies, focusing on mitigation of mental health problems among nurses. AIM: To study psychosocial responses to COVID-19 and the effectiveness of intervention among nurses. MATERIALS AND METHODS: A mixed-method study was conducted, including 278 nurses from two COVID-19 hospitals of the province by purposive sampling. Depression, anxiety and stress and a composite measure of personal financial burden scales for quantitative; and interview guide for qualitative data were used. A psychosocial strengthening session was introduced and the effectiveness of the program was assessed after 4-5 weeks of intervention. RESULTS: Mild, moderate and severe depression was found among 13.7%, 9.4% and 1.1% of the participants correspondingly. Mild, moderate, severe and extremely severe anxiety was found among 21.2%, 8.6%, 3.2% and 2.2% of the participants respectively. Stress was mild among 9% and moderate in 1.4% of the participants. Lack of PPE and fear of transmitting infection were found as frequent causes of problems. Mean scores of depression, anxiety and stress were significantly decreased after the psychosocial strengthening program. CONCLUSION: Depression, anxiety and stress are common issues of nurses. Common causes of problems were lack of resources, fear of being infected and fear of transmitting to family members. The psychosocial strengthening program was effective in reducing the problems.

Public transport strategy and epidemic prevention framework in the Context of Covid-19

As countries across the world modify their travel in the face of the Covid-19 pandemic, the first casualty becomes the public transport sector. Transport authorities across the world have reported about 95% reduction in users during peak COVID-19, decrease of fare box revenues and additional costs for disinfecting and implementing physical distancing measures. The public transport companies in India face a larger crisis as nearly 85% people travelling intercity use public road transport in normal times. In this paper we drawpassenger clusters based on their travel dynamics and develop two frameworks, namely, passenger driven transportation strategy framework and epidemic prevention strategy framework to deal with the COVID-19 induced travel changes. The frameworks use three tenets of mobility, namely, agility, integrated movement, and public based partnership. The strategies aim to enable the transport enterprises to open new windows of travel and efficiencies for the passengers rather than restricting access and choices. However, security remains fundamental to making these new and innovative service changes possible.

Observational Study of Thrombotic Events in a Random Cohort of Hospitalized COVID-19 Patients at a Community-Based Hospital of New York City During the Beginning of the 2020 Pandemic.

Coronavirus disease 2019 (COVID-19) continues to pose an unprecedented challenge for the entire world and the healthcare system. Different theories have been proposed elucidating the pathophysiological mechanisms attributing to high mortality and morbidity in COVID-19 infection. Out of them, thrombosis and procoagulant state have managed to earn the maximum limelight. We conducted an observational study based on data from randomly selected 349 hospitalized patients with COVID-19 infection in a community-based hospital in New York City during the first wave of the COVID-19 viral surge in March 2020. The main objective of our study was to assess the risk and occurrence of thrombotic events (both venous and arterial) among the hospitalized patients including the intensive care unit (ICU) and non-ICU admissions with confirmed COVID-19 infection. The primary outcome in our study was defined as the thrombotic events that included myocardial infarction (MI), deep venous thrombosis (DVT), cerebrovascular accidents (CVA), and pulmonary embolism (PE). The study correlated the association of thrombotic events with the level of biomarkers of interest: D-dimer >1000 ng/ml, troponin-I >1 ng/ml, or both. The association of D-dimers and troponin-I with thrombotic events was measured using both univariate and multivariate Cox proportional hazard (PH) regression analysis. Out of a total of 349 patients, 78 patients (22.35%) were found to have elevated biomarkers (D-dimer >1000 ng/ml and/or troponin-I >1 ng/ml) and were categorized as a high-risk group. Eighty-nine patients developed thrombotic complications (evidence of more than one thrombotic event was found in several patients). Two-hundred seventy-one (77.65%) patients had no documentation of thrombosis. The incidence of thrombotic events included myocardial infarction (MI; N=45; 12.8%), cerebrovascular accidents (CVA; N=16; 4.5%), deep venous thrombosis (DVT; N=16; 4.5%), and pulmonary embolism (PE; N=9; 2.57%).

An Unusual Presentation of COVID-19: Hemorrhagic Pericardial Effusion With Tamponade Physiology.

A 44-year-old woman with a history of factor V Leiden deficiency and recurrent pulmonary emboli was diagnosed with coronavirus disease 2019 (COVID-19) three weeks prior presented to her local ED with severe chest pain. She was found to have a large hemorrhagic pericardial effusion by cardiac MRI with echocardiographic signs of tamponade. She underwent the creation of a pericardial window and was treated with colchicine with improvement in symptoms.

Psychosocial Responses and Preparedness During Initial Phase of COVID-19 Pandemic Among Nurses Working Different Hospitals of Eastern Nepal: A Pre-Experimental Mixed Method Approach (preprint)

Background: Most documented studies have focused on mental health status of Health care workers during the pandemic but there are very few studies, focusing on mitigation of mental health problems among nurses. There is an increasingly urgent need to understand mental health impact of COVID-19 and address these impacts through research. Objective: To study psychosocial responses and preparedness for covid-19 and to assess effectiveness of intervention among nurses working in COVID-19 hospitals of eastern Nepal. Methods: Prospective explanatory mixed-method study was conducted among 278 nurses by purposive sampling. Self administered questionnaire method was used for data collection. Psychosocial strengthening program was delivered and effectiveness was assessed after 4-5 weeks of intervention among 192 nurses. DASS-21, Composite measure of personal financial burden scales and in-depth interview guide were used to collect data. Chi-square and paired t test, and Pearson's correlation test were used at 95% confidence interval. Results: Mild depression was found among 13.7%, moderate and severe depression were found among 9.4% and 1.1% respectively. Similarly, mild, moderate, severe and extremely severe anxiety were found among 21.2%, 8.6%, 3.2%, 2.2% respectively. Stress was mild among 9%, moderate 1.4% and severe in 0.7% of the participants. Lack of PPE and fear of transmitting infection to family were found as frequent causes of problems during in-depth interview. Mean Scores of Depression, Anxiety and Stress were significantly decreased after receiving psychosocial strengthening program (p=<0.001 for each). Majority of the participants (92.8%) had made infection prevention preparation and 11.2% of the participants had high financial worry.Conclusion: Anxiety and depression were common problems though having adequate preparedness to deal with COVID-19. Psychosocial strengthening program was effective in reducing the problems. 

Assessment of dispersion of airborne particles of oral/nasal fluid by high flow nasal cannula therapy (preprint)

BackgroundNasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients. MethodsLiquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared. ResultsO_LIImaging: During quiet breathing, no particles were recorded with unsupported breathing or 30 LPM NHF (detection limit for single particles 33 m). Particles were detected in 2 of 6 participants at 60 LPM quiet breathing at approximately 10% of the rate caused by unsupported vigorous breathing. Unsupported vigorous breathing released the greatest numbers of particles. Vigorous breathing with NHF at 60 LPM, released half the number of particles compared to vigorous breathing without NHF. C_LIO_LIChemical marker tests: No oral/nasal fluid was detected in quiet breathing without NHF (detection limit 0.28 L/m3). In quiet breathing with NHF at 60 LPM, small quantities were detected in 4 out of 29 quiet breathing tests, not exceeding 17 L/m3. Vigorous breathing released 200-1000 times more fluid than the quiet breathing with NHF. The quantities detected in vigorous breathing were similar whether using NHF or not. C_LI ConclusionDuring quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of L per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing. During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compares to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used.