Adaptive Immunity Dysregulation Is Associated to the Development of Long Covid

Background: The pathogenetic mechanisms behind the development of long- COVID (LC) are largely unknown. Because both plasma SARS-CoV-2 RNAemia and dysregulated immunity have been correlated with COVID-19 severity, we evaluated whether they are associated with LC. Method(s): We consecutively enrolled unvaccinated hospitalized COVID-19 patients during acute-COVID-19 (T0) in March-October 2020 who either developed LC at a follow-up visit 2-3 months from virologic clearance (T1) or did not. LC was defined as persistence >=2 months after recovery of >=1 symptom: anosmia, dysgeusia, fever, gastrointestinal symptoms, dyspnoea, fatigue, musculoskeletal pain, muscle weakness, brain fog. We measured: SARS-CoV-2 RNAemia (RT-qPCR, log10(copies/mL)), magnitude (ELISA, AUC) and functionality (pseudovirus neutralization, ID50;Fc-mediated functions, %ADCC) of SARS-CoV-2-specific antibodies, SARS-CoV-2-specific B and CD4-T-cells (Immunophenotype, AIM and ICS assays). Result(s): We enrolled 48 COVID-19 individuals, 38/48 (79.2%) developed LC (LC+) and 10 did not (LC-). LC+ and LC- had similar co-morbidities and symptoms in the acute phase (Fig.1A), and the majority showed a radiologically documented SARS-CoV-2 pneumonia. The SARS-CoV-2 RNAemia did not differ between groups at both time points. The levels of RBD-specific Abs, as well as their functionality, appeared to increase over time in the LC- group but not in the LC+ (Fig.1B-D). Similarly, a trend towards increased RBD-specific B-cells was observed over time in the LC- group but not in LC+ (Fig.1E). B-cell immunophenotyping showed a significant increase over time of classical memory B cells (MBCs) at the expenses of activated MBCs (Fig.1F-G) as well as an IgA class-switching in the LC- group compared to LC+ (Fig.1H-I). Furthermore, LC+ showed a faster decline of SARS-CoV-2-specific (CD69+CD137+) CD4- TEMRA and CD4-TEM (Fig.1L-M). Finally, IFN-gamma-producing TREG of LC- individuals increased over time (Fig.1N). Conclusion(s): Acutely ill, hospitalized COVID-19 patients developing LC feature a dysregulated SARS-CoV-2-specific humoral as well as B- and T-cell response, in both magnitude and functionality, suggesting a link between dysregulated SARS-CoV-2-specific adaptive immunity and LC development. The fine understanding of the factors contributing to such dysregulation in LC patients is strongly needed, that might further inform targeted therapeutic interventions. (Figure Presented).

Zooming in or zoning out: examining undergraduate learning experiences with zoom and the role of mind-wandering

The COVID-19 pandemic necessitated a systematic change in course modalities due to the nationwide suspension of in-person instruction, resulting in the transition to emergency remote distance learning via Zoom. This transition certainly facilitated affordances of flexibility and continuity, but with it brought issues of unfamiliarity, lack of confidence, anxiety, distractions, and validity from both the instructors and the student perspectives. This in situ study aimed to better understand the students' learning experiences with Zoom by assessing the social, cognitive, and behavioral factors influencing learner's mind-wandering and its effect on online engagement. Undergraduate students from 14 classes across two research institutions in California (N = 633) were recruited to participate in an online survey while distance learning through a pandemic. Structural equation modeling was used to conduct a path analysis to explain the factors impacting students' online engagement mediated by students' frequency to mind-wander. Study findings revealed that (1) self-efficacy and trait anxiety had significant direct effects on students' mind-wandering;(2) self-efficacy, trait anxiety, task-value beliefs, and mind-wandering had significant direct effects on students' online engagement;and finally (3) the frequency of students' mind-wandering partially mediated the relationship between self-efficacy and engagement and between trait anxiety and engagement. Identifying these structural relationships further confirmed our hypotheses on sources contributing to students' mind-wandering while learning remotely, provided insights into potential mechanisms underpinning students' online engagement, and suggests practical pedagogical learning experience design recommendations for instructors to immediately implement while teaching and learning with Zoom..

Telemonitoring for Cystic fibrosis patients of Bambino Gesù Children's Hospital during COVID-19.

Background: Cystic fibrosis (CF) is the most common autosomal recessive genetic pathology of the Caucasian race and it affects nearly 100,000 people worldwide (many have not been diagnosed) and, in Italy, there are about 6000 patients. In the last few years, telemedicine has proved to be an effective home care tool for patients suffering from chronic pathologies. The advent of the COVID-19 pandemic has caused an increase of communications through mobile devices. Aim: To evaluate the role of telemonitoring during the pandemic phase of Covid-19. Materials and methods: 34 (M 15, F 19) (M 44%, F 56%) Cystic Fi-brosis patients were evaluated; Median age ± SD 30.97±10.59 Median FEV1 2020 74.76; number of trasmission and hospital admissions. Results: It was evident that the absolute number of telemedicine visits increased from 1456 to 1605 in the pandemic year (10% more). Conclusions: Telemedicine became an important tool for home management of patients, in particular about chronic diseases. Telemonitoring, an integral part of telemedicine, underlined its effectiveness in all health emergency phase.

Global marine biosecurity and ship lay-ups: intensifying effects of trade disruptions.

Recent global trade disruptions, due to blockage of the Suez Canal and cascading effects of COVID-19, have altered the movement patterns of commercial ships and may increase worldwide invasions of marine non-indigenous species. Organisms settle on the hulls and underwater surfaces of vessels and can accumulate rapidly, especially when vessels remain stationary during lay-ups and delays. Once present, organisms can persist on vessels for long-periods (months to years), with the potential to release propagules and seed invasions as ships visit ports across the global transportation network. Shipborne propagules also may be released in increasing numbers during extended vessel residence times at port or anchor. Thus, the large scale of shipping disruptions, impacting thousands of vessels and geographic locations and still on-going for over two years, may elevate invasion rates in coastal ecosystems in the absence of policy and management efforts to prevent this outcome. Concerted international and national biosecurity actions, mobilizing existing frameworks and tools with due diligence, are urgently needed to address a critical gap and abate the associated invasion risks.

Accounts as acts of identity Justifying business closures on COVID-19 public signs in Athens and London

This paper investigates accounts justifying the closures of businesses found on public signs in Athens and London during the COVID-19 pandemic. The data for the study was drawn from a corpus of COVID-19-related public signage collected in the two cities during the first lockdown. The accounts used on these signs are analysed as acts of identity and, specifically, as discursive means deployed by the authors of the signs to project themselves and their businesses favourably. It is shown that the accounts used at the micro-level of discourse align to various degrees with the dominant discourses surrounding the pandemic at the macro-level and with the values these discourses draw upon. It is also shown that the accounts are used to reframe the public's understanding of the closures and to construct identities congruent with the interests of the business owners, ensuring post-pandemic continuity.

Measuring depression, stress, anxiety and resilience levels during the covid-19 pandemic using validated psychometric testing

Learning Objectives: To describe the prevalence of depression, anxiety, stress and resilience in EM residents during the Covid-19 pandemic Background: EM residents were already known to be high-risk for depression and burnout;in all likelihood the Covid-19 pandemic has added to this risk. In addition to the understandable work stressors, social isolation caused by the lockdowns likely has affected their support structure negatively. Objectives: Using validated psychometric testing, we sought to determine the levels of depression, anxiety, stress, and resilience in EM residents in a region severely impacted by the pandemic. Methods: Setting: An EM residency program in the state with the highest per-capita deaths from Covid-19. All EM residents were surveyed eight months into the pandemic using the Depression, Anxiety, Stress Scales (DASS) and Brief Resilience Scale (BRS). Both studies have been validated in the psychology literature across multiple settings. Surveys were anonymous to promote honesty in answers. Levels of depression, anxiety, stress, and resilience were determined. Demographic information was also collected. Results: 23 of 27 residents (85%) completed the survey. Using the DASS, 48% (95%CI 27-69) were found to have at least mild depression, with 17% (95%CI 2-33) found to have “severe” or “extremely severe” depression. 35% (95%CI 15-55) were found to have at least mild levels of anxiety, with 4% (95%CI-4 to 13) having “severe” or “extremely severe” anxiety. 52% (95%CI 31-73) were found to have at least mild stress, with 13% (95%CI-1 to 27) found to have “severe” or “extremely severe” stress. Using the BRS, 9% (95%CI-3 to 20) were found to have low levels of resilience. Conclusion: While we knew EM residents (physicians) are high-risk for depression and burnout, the levels of depression and stress measured by validated psychometric testing during the Covid-19 pandemic were concerning. Although the residency has increased its wellness activities significantly, it appears much more needs to be done to help residents get through this extremely difficult situation.

Social stressors and isolation have biggest effect on resident wellness during a pandemic

Learning Objectives: To identify what features of the Covid-19 pandemic have the biggest negative impact on the wellness of EM residents and what interventions help the most. Background: EM physicians are already known to be high-risk for depression and burnout. In all likelihood the Covid-19 pandemic has added to this risk. Objectives: We sought to identify the primary stressors for EM residents during this pandemic and determine which factors and interventions have helped most to improve their wellness. Methods: Setting: An EM residency program in the state with the highest per-capita deaths from Covid-19. All EM residents were surveyed eight months into the pandemic using Google Forms. Surveys were anonymous to promote honesty. Residents were asked about to identify the three factors that had the greatest negative impact on their wellness. They were also asked to identify the three features that did most to improve wellness. Demographic information was collected. Results: 23 of 27 residents (85%) completed the survey. 91% (95%CI 80-100) said the negative impact of the pandemic affects them more socially than professionally. The factors identified most commonly contributing negatively to a resident's wellness were “decreased socialization / isolation” (74%) and “concerns for family safety” (70%). “Changing hospital protocols” (35%), “Feeling under-appreciated at work” (30%), and “Public not doing enough to stop the spread” (30%) were also identified frequently as having a negative effect. “Concerns for my own safety” was only identified by 17% of residents as being a top-three issue. The features most commonly identified as helping wellness were “Ability to socialize in small groups” (65%), “team mentality” (57%) and “free food” (44%). Conclusion: Overwhelmingly, residents cite the social impact of the pandemic as having a more negative effect on their wellness than work did. Concerns for their own safety are not identified frequently as having a significant impact. Interventions that are social and decrease the sense of isolation appear to be especially important in improving wellness.

Social Stressors and Isolation Have Biggest Effect on Resident Wellness During a Pandemic

Background: Emergency physicians are already known to be high-risk for depression and burnout. In all likelihood the COVID-19 pandemic has added to this risk. Study Objectives: We sought to identify the primary stressors for EM residents during this pandemic and determine which factors and interventions have helped most to improve their wellness. Methods: The setting was an EM residency program in the state with the highest per-capita deaths from COVID-19. All EM residents were surveyed eight months into the pandemic using Google Forms. Surveys were anonymous to promote honesty. Residents were asked about to identify the three factors that had the greatest negative impact on their wellness. They were also asked to identify the three features that did most to improve wellness. Demographic information was collected. Results: 23 of 27 residents (85%) completed the survey. 91% (95% CI 80-100) said the negative impact of the pandemic affects them more socially than professionally. The factors identified most commonly contributing negatively to a resident’s wellness were “decreased socialization/isolation” (74%) and “concerns for family safety” (70%). “Changing hospital protocols” (35%), “feeling under-appreciated at work” (30%), and “public not doing enough to stop the spread” (30%) were also identified frequently as having a negative effect. “Concerns for my own safety” was only identified by 17% of residents as being a top-three issue. The features most commonly identified as helping wellness were “ability to socialize in small groups” (65%), “team mentality” (57%) and “free food” (44%). Conclusion: Overwhelmingly, residents cite the social impact of the pandemic as having a more negative effect on their wellness than work did. Concerns for their own safety are not identified frequently as having a significant impact. Interventions that are social and decrease the sense of isolation appear to be especially important in improving wellness.