ABSTRACT
BACKGROUND: Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM: To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS: An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS: Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION: This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
ABSTRACT
We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
ABSTRACT
Background. Minority groups have the lowest vaccination rates when compared to the overall population. We aim to study the attitudes and perceptions of COVID-19 vaccination, about six months after vaccine rollout in the South Bronx. Methods. Cross-sectional anonymized online survey evaluating knowledge, attitude and perception about COVID-19 vaccination using SurveyMonkey™ was conducted in South Bronx community from April - June 2021. Results. Of the 281 participants, 67% were Latinx and 16% were African American (AA);69% (195) were fully vaccinated (FV) and 31% (86) with vaccine hesitancy (VH). The common reasons for hesitancy were "concerns about side effects" (38%), "vaccine is not safe" (27%) and "vaccine was approved too fast" (26%) (p< .001). VH were more likely to rely online/mobile apps (30%) and friends and family (23%) as compared to FV. VH were more likely to be AA, younger age (< 35 yrs), high school or lower education, single, unemployed, without comorbidities, not current on other eligible vaccines, and did not believe "vaccine is necessary to end the pandemic." Majority of participants from both cohorts trusted their primary care providers. Mistrust with healthcare and pharmaceutical companies was higher in VH (p=0.009). Both groups preferred to continue wearing mask and practice social distancing despite vaccination status. Conclusion. Persisting vaccine hesitancy is concerning in minority communities. Identifying the target population and implementation of innovative methods to improve COVID-19 vaccination acceptance leveraging primary care providers would be a possible solution.
ABSTRACT
The purpose of this study is to empirically analyze the contagion effects of the COVID-19 pandemic on stock returns of the Pakistan Stock Exchange (PSX). In this context, the causal changes of three major macroeconomic indicators i.e. gold prices, prices of real estate, and the US exchange rate on the stock market returns were assessed. The daily indices of stock returns, house prices index, plot price index, daily prices of gold, and the daily US dollar exchange rate are analyzed. The data spanning six months, including three months of pre-COVID-19 and three months of post-COVID-19, was analyzed using Eviews software. The event study methodology is used, and the GARCH model is applied to test the relations. The findings highlight the impact of the COVID-19 pandemic on stock returns and reveal a significant change in the relationship between prices of gold and the stock market returns. Similarly, the change in the relations between stock market returns and real estate prices got significant support. However, the change in the relations between the US dollar exchange rate and stock market returns was found insignificant. The study contributes by providing evidence that explains the changes in dynamics of the capital market during the pandemic. The study also helps the investors to understand how macroeconomic variables behave during periods of stress. © 2021. All Rights Reserved.
ABSTRACT
Background: Rapid spread of the Novel Coronavirus Disease (COVID-19) resulted in a global pandemic. As front-line health care workers, this crisis significantly affected emergency medicine residents and their respective programs. We sought to explore the impact of COVID-19 on the education and training of emergency medicine residents across the United States and Puerto Rico. Methods: A survey was sent out to Accreditation Council for Graduate Medical Education (ACGME) accredited United States and Puerto Rico emergency medicine residency programs (264 programs at the time) via email correspondence to the Program Directors and the Program Coordinators. The survey stratified program type (practice setting, length of training, institution type, moonlighting allowed) and impact of COVID-19 on residents (off-service rotations, weekly conferences, effect on research, and resident wellness initiatives). Comparison was made by United States and Puerto Rico regions divided by Northeast, South, Midwest, and West, as these closely correlated with the differences in areas of COVID-19 spread and saturation. REDCap was used as the platform for data capture. Results: A total of 134 emergency medicine residency programs completed the survey. Northeast (44%), South (26%), Midwest (17%) and West (13%) programs by regions were reviewed. Overall, the majority of programs were in an urban setting (70%), and academic practice comprised 58%, followed by community at 40% (p=NS). The curriculum was a 3-year format for 71% of the programs (p=0.002). Overall half of the programs stated their institution was declared a site of pandemic emergency status by the ACGME, with 70% in Northeast and 39% of the Midwest, followed by the West and South regions (p=0.011). The impact of COVID-19 on off-service rotations for the emergency medicine residencies was not significant;Northeast had a high impact in 34% of the programs, moderate impact for Midwest (35%) and minimal impact in the South (34%) and West (29%) programs. Weekly lectures were switched to virtual format and smaller groups. Of note, clinical research for prospective studies was negatively impacted throughout all the regions (p=0.034), however retrospective studies were not affected. Additionally, 88% of programs reported changes since the start of COVID-19 to assure residents with new initiatives and activities such as improving wellness and reducing burnout and stress. Conclusions: The COVID-19 pandemic impacted the training of emergency medicine residents in various aspects. Northeast programs were more affected compared to the other regions. Weekly didactic sessions largely transitioned to a virtual format and/or small group sessions. Off-service rotations overall were not significantly affected. Retrospective clinical research continued while there was a substantial disruption in prospective research projects. Finally, a positive outcome was the increased awareness to changes in improving resident well-being overall.
ABSTRACT
BACKGROUND: Transmission in healthcare settings can result in significant infections in healthcare workers and patients. Understanding infection dynamics has important implications for methods employed in hospitals to prevent nosocomial transmission events. METHODS: In this case series report we describe a cluster of COVID-19 (Coronavirus disease 2019) in a tertiary care university hospital, in the early phases of the epidemic, after hospital visiting had been stopped and when the UK lockdown was in place. FINDINGS: A 48 year old patient developed COVID-19 31 days post-admission and four days after admission to a medical ward from ITU. Infection was likely acquired from an asymptomatic or minimally symptomatic healthcare worker (HCW). Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward.Nine of the 23 affected staff members provided care for and had direct exposure with the index case. Four staff reported caring for the index case without use of personal protective equipment. One was coughed on directly by the patient 24 hours prior to the onset of symptoms. CONCLUSION: SARS CoV2 infection can be introduced to a ward area by asymptomatic and minimally symptomatic healthcare workers. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events.Transmission of infection from pre-symptomatic, asymptomatic and minimally symptomatic individuals means that universal use of measures to prevent transmission is required for successful reduction of transmission events in the hospital setting.