Preparing Long-term care facilities for future pandemics-A systematic review of non-pharmacological interventions

Background Due to climate change, the likelihood of an extreme infectious disease events-similar to the COVID-19 pandemic-is very likely to increase. Anticipating and preparing for such events Is therefore essential. A setting of high risk in such an event are long-term care facilities (LTCF), which accounted for 30-60 % of all COVID-19 related deaths in most high-income countries (HIC). To prevent, mitigate, and avoid potential adverse consequences of future outbreaks of viral respiratory pathogens with pandemic potential (e.g., SARSCoV-2, SARS, MERS, influenza) in LTCFs, a systematic review will analyze which non-pharmacological interventions (NPI) are effective in LTCFs. Methods We conducted literature searches in Medline, Embase, CINAHL, and two comprehensive specialized registries focused on COVID-19-related literature. We included experimental, quasi-experimental, and specific observational studies assessing the effect of NPIs implemented in LTCFs regarding the outcomes: infections, outbreaks, hospitalizations and deaths due to the viral pathogens of interest and adverse consequences. Screening for eligibility and risk-of-bias (RoB) assessment was done in duplicate. For RoB assessment, we used the RoB2 and ROBINS-I tool. We synthesized findings narratively, focusing on the direction of effect. The certainty of evidence was evaluated using GRADE. Results We included 16 observational studies, 14 of which focused on intervention effectiveness. All were conducted in HIC and most focused on SARSCoV-2 (n = 14). There were serious concerns regarding RoB in almost all studies. We found low/very low certainty of evidence for the effectiveness of entry regulation measures (n = 1), regular testing of residents/staff (n = 5), combined outbreak control measures (n = 2), and for combinations of multiple NPIs (n = 3) in preventing outbreaks or mitigating their consequences. The evidence on the effectiveness of hand and surface hygiene interventions showed mixed results (n = 4). We found mixed results regarding adverse mental health outcomes due to visiting restrictions. Conclusion This review indicates a number of measures which could be effective in protecting residents and staff in LTCFs in upcoming extreme infectious disease epidemics, which are expected to become more likely in the future. Furthermore, we can point out several gaps in the evidence which require further research and specific study designs to improve pandemic preparedness in LTCFs.

Home-Based Respiratory Physiotherapy and Telephone-Based Psychological Support for COVID-19 Survivors in Peru: Protocol for a Randomized Controlled Trial.

BACKGROUND: Both pulmonary and mental health are affected following hospitalization for COVID-19 pneumonia. Pulmonary rehabilitation therapy has demonstrated benefits in improving mental health, but no validated combined programs that include mental health have been proposed. OBJECTIVE: This article presents the design of a trial that aimed to assess whether the participation in a combined rehabilitation program that includes home-based respiratory physiotherapy and telephone-based psychological support is associated with a greater improvement of pulmonary and mental health outcomes 7-12 weeks after COVID-19 hospitalization discharge compared with posthospital usual care provided by a public Peruvian hospital. METHODS: WAYRA (the word for air in the Quechua language) was an open-label, unblinded, two-arm randomized controlled trial. We recruited 108 participants aged 18-75 years who were discharged from the hospital after COVID-19 pneumonia that required >6 liters/minute of supplemental oxygen during treatment. Participants were randomly assigned at a 1:1 ratio to receive the combined rehabilitation program or usual posthospital care provided by a public Peruvian hospital. The intervention consisted of 12 at-home respiratory rehabilitation sessions and 6 telephone-based psychological sessions. The primary outcome was the 6-minute walk distance. Secondary outcomes included lung function, mental health status (depression, anxiety, and trauma), and quality of life. Outcomes were assessed at baseline (before randomization) and at 7 and 12 weeks after hospital discharge to assess the difference between arms. RESULTS: This study was funded by the Peruvian National Council of Science Technology and Technology Innovation in July 2020. Ethics approval was obtained on September 2, 2020. Recruitment and data collection occurred between October 2020 and June 2021. Results are expected to be published by the end of 2022. CONCLUSIONS: WAYRA was the first randomized controlled trial evaluating combined pulmonary-mental health rehabilitation for hospitalized COVID-19 survivors in resource-limited settings, potentially providing a foundation for the cost-effective scale-up of similar multidisciplinary rehabilitation programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04649736; https://clinicaltrials.gov/ct2/show/NCT04649736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/36001.

Atlas for a Warp Speed Future: Enhancing Usual Operating Modes of the U.S. Government

Operation Warp Speed (OWS) delivered new and effective vac-cines to the general public in just 9 months, exploding previously held ideas about the government’s role in medical countermeasure (MCM) development as well as what is possible on the timescale of vaccine development. OWS has potential to become a map for action in future pandemic crises. This article examines federal modes of governance that emerged in response to the Covid-19 crisis, with special attention to how those modes differ from normal government operations. It is at the intersection of crisis modes of action and normal modes of operation that lessons emerge from OWS that may be worth applying in normal times – or not. In “Rules for Operating at Warp Speed,” I outlined how the leadership of OWS was able to accelerate operations under a suspension of the government’s usual modes of operation (Arnold, 20201). This included suspension of rules that normally govern transparent and robust federal contracting and relaxing standards for scientific consensus-building and expertise across government. This article draws from interviews completed in 2020 and 2021 with senior officials at the Department of Defense (DOD), Food and Drug Administration (FDA), and the White House in order to identify the key pandemic modes of action contributing to the success of OWS. It also discusses whether (and how) those modes of action might be adapted to enhance critical infrastructure preparedness in non-crisis times. © 2022, Policy Studies Organization. All rights reserved.

Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward.

BACKGROUND: COVID-19 has the potential to cause outbreaks in hospitals. Given the comorbid and elderly cohort of patients hospitalized, hospital-acquired COVID-19 infection is often fatal. Pathogen genome sequencing is becoming increasingly important in infection prevention and control (IPC). AIM: To inform the understanding of in-hospital SARS-CoV-2 transmission in order to improve IPC practices and to inform the future development of virological testing for IPC. METHODS: Patients detected COVID-19 positive by polymerase chain reaction on Ward A in April and May 2020 were included with contact tracing to identify other potential cases. Genome sequencing was undertaken for a subgroup of cases. Epidemiological, genomic, and cluster analyses were performed to describe the epidemiology and to identify factors contributing to the outbreak. FINDINGS: Fourteen cases were identified on Ward A. Contact tracing identified 16 further patient cases; in addition, eight healthcare workers (HCWs) were identified as being COVID-19 positive through a round of asymptomatic testing. Genome sequencing of 16 of these cases identified viral genomes differing by two single nucleotide polymorphisms or fewer, with further cluster analysis identifying two groups of infection (a five-person group and a six-person group). CONCLUSION: Despite the temporal relationship of cases, genome sequencing identified that not all cases shared transmission events. However, 11 samples were found to be closely related and these likely represented in-hospital transmission. This included three HCWs, thereby confirming transmission between patients and HCWs.

PPE during a pandemic: The experience of obtaining PPE and lessons learned from a department of obstetrics and gynecology in New York city.

The COVID-19 Pandemic is an ongoing crisis that has strained hospitals and health systems around the globe. The provision of personal protective equipment (PPE) for frontline healthcare workers is of utmost importance in sustaining an effective response to this crisis. New York City has experienced one of the most devastating outbreaks of the SARS-CoV-2 virus. In this article we report the experience of the Department of Obstetrics and Gynecology at Columbia University in New York City in managing the supply of PPE for providers and staff during the height of the outbreak. We describe the types of equipment used and aspects of PPE regulation and certification. We also describe our practices in extended use and reuse of PPE in light of the current understanding of the virus characteristics and modes of transmission.