Towards optimal quarantine: A scoping review of quarantine planning in the pandemic preparedness plans and pandemic exercises of Australia and New Zealand

Introduction: Since 2020, the New Zealand and Australian federal, state and territory governments have used quarantine as a strategic infection control measure to contain the SRS-CoV-2 (COVID-19) virus. However, the quarantine programs of both countries were rapidly operationalised without a clear blueprint for infection prevention. This paper identifies gaps in forecasting the need, and planning, for widespread quarantine within New Zealand's and Australia's Pandemic Preparedness Plans and pandemic exercise reports. Method(s): This paper adhered to the Joanna Briggs Institute (JBI) methodology for scoping reviews. Parliamentary websites and databases (Parlinfo, Pandora) were searched for plans and exercise reports, that were publicly available from 2009 to May 2022. Documents were examined using directive content analysis and assessed on their alignment with the core elements of people, resources, governance, systems, and processes, as addressed in the Australian Disaster Preparedness Framework 2018. Result(s): The degree to which the core elements outlined in the Australian Disaster Preparedness Framework were covered in the documents varies significantly across both New Zealand, and the Australian federal, states and territories. Of the 15 identified plans and 8 exercise reports most did not foresee the need for mandatory, large-scale quarantine of people arriving from interstate or overseas and contemplated voluntary quarantine occurring within people's private residences. Conclusion(s): This paper confirms the need to focus on widespread quarantine as an infection control measure to enhance future pandemic operational preparedness. Further development of quarantine capabilities is required in locations aside from private residences, including at Australia's new purpose-built quarantine facilities.Copyright © 2022

Child, parent, and family mental health and functioning in Australia during COVID-19: comparison to pre-pandemic data.

The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.

Key lessons from the COVID-19 public health response in Australia.

Australia avoided the worst effects of the COVID-19 pandemic, but still experienced many negative impacts. Reflecting on lessons from Australia's public health response, an Australian expert panel composed of relevant discipline experts identified the following key lessons: 1) movement restrictions were effective, but their implementation requires careful consideration of adverse impacts, 2) disease modelling was valuable, but its limitations should be acknowledged, 3) the absence of timely national data requires re-assessment of national surveillance structures, 4) the utility of advanced pathogen genomics and novel vaccine technology was clearly demonstrated, 5) decision-making that is evidence informed and consultative is essential to maintain trust, 6) major system weaknesses in the residential aged-care sector require fixing, 7) adequate infection prevention and control frameworks are critically important, 8) the interests and needs of young people should not be compromised, 9) epidemics should be recognised as a 'standing threat', 10) regional and global solidarity is important. It should be acknowledged that we were unable to capture all relevant nuances and context specific differences. However, the intent of this review of Australia's public health response is to critically reflect on key lessons learnt and to encourage constructive national discussion in countries across the Western Pacific Region.

Assessment of COVID-19 outbreaks in long-term care facilities.

BACKGROUND: The B.1.167.2 (Delta) variant quickly became the predominant circulating SARS-CoV-2 strain in the USA during summer 2021. Missouri identified a high number of outbreaks in long-term care facilities (LTCFs) across the state with low vaccination rates among LTCF staff members and poor adherence to mitigation measures within local communities. AIM: To describe COVID-19 outbreaks that occurred in Missouri LTCFs impacting staff and residents during the surge of the Delta variant. METHODS: Outbreaks of COVID-19 in 178 LTCFs were identified by the Missouri Department of Health and Senior Services. Case data from LTCFs with the highest burden of disease were analysed to assess disease transmission, vaccination status, and outcomes among residents and staff. Additional investigational measures included onsite visits to facilities with recent COVID-19 outbreaks in communities with substantial transmission to assess mitigation measures. FINDINGS: During April 22nd to July 29th, 2021, 159 COVID-19 cases among 72 staff members and 87 residents were identified in 10 LTCFs. More than 74.7% of resident cases were vaccinated compared to 23.6% of staff cases. Vaccinated residents had a lower proportion of hospitalizations and deaths reported compared to unvaccinated residents. Data analysis and contact-tracing efforts from a sample of the facilities suggest that staff members were likely a major factor in introducing SARS-CoV-2 virus into the facilities. Adherence to COVID-19 mitigation measures varied at the visited facilities. CONCLUSION: Data showed that vaccination rates varied between staff cases and resident cases in facilities with high-burden outbreaks. Differences were identified in mitigation practices in at least two facilities.

Exosomes/EVs: QUANTIFICATION OF CD81+ AND CD133+ EXTRACELLULAR VESICLE POPULATIONS DERIVED FROM AMNIOTIC FLUID

Background & Aim: Amniotic fluid (AF)-derived extracellular vesicles (EVs) are currently being studied within clinical trials as a novel therapeutic drug for acute and chronic diseases such as COVID-19, osteoarthritis, and chronic obstructive pulmonary disease (COPD). Recently, AF has been characterized to contain harvestable EVs that reduce cytokine expression and protect from high oxygen tissue injury. However, the reproducibility of EV populations derived from AF samples has yet to be fully explored. Here within, we present results of a fluorescent nanoparticle tracking analysis that characterizes the reproducibility of CD81+ and CD133+ populations of EVs. Methods, Results & Conclusion: AF was collected from consenting adults during planned, full term cesarean sections and then processed via filtration and ultracentrifugation to precipitate the nanoparticle population. Prior to fluorescent analysis, a MACSPlex exosome kit (Miltenyi Biotec) was used to identify potential exosome surface markers. Nine independent samples of AF-derived nanoparticles were used for Zetaview analysis. Each pellet was resuspended in saline and stained with CD133-AF488 and CD81-DyLight55 antibodies. Fluorescent nanoparticle tracking analysis was completed using the Zetaview Quatt (Particle Metrix). Subsequent videos of stained and total particles were recorded to determine the percentage of positive stained nanoparticles. Exosome surface marker analysis revealed 10 out of the 37 tested surface markers to be present with the most intense surface markers being CD81 and CD133. Furthermore, detection of CD81+ and CD133+ nanoparticles via Zetaview was found in all samples (n=9). The AF- derived nanoparticles were CD81+ and CD133+ at 73.51 ± 18.35 % and 30.41 ± 14.06 % (Mean ± SD), respectively. A high percentage of the nanoparticles were CD81+ with a smaller yet apparent display of CD133+ nanoparticles throughout the samples. Fluorescent characterization of the AF-derived samples demonstrated the reproducibility of both CD81+ and CD133+ nanoparticles. Studying the nature of these nanoparticle populations helps researchers to characterize samples consistently and could lead to understanding their therapeutic potential as a novel biologic.

Cambodia 2018-2021: From demoCraCy to autoCraCy

The years between 2018 and 2021 continued a pattern for Cambodia of a rolling back of democracy, human rights, and civil liberties, and saw the completion of the transition from a multi-party illiberal democracy to a one-party, authoritarian state. As attacks against political opposition increased, and political space was progressively closed, most commentators agreed that Cambodia had transitioned from competitive to authoritarian hegemony. The global COVID-19 pandemic saw a marked contraction of the economy, and its ability to recover remains to be seen. Foreign relations with the US and EU, already seriously deteriorated by 2018, continued to decline, and dependence on China increased, bringing unease to nations in the region and further afield. Recognising growing dissatisfaction among the population, the ruling party took measures to secure future control through varying means, including some efforts to address corruption, widening patronage networks, and co-opting youth groups to the party. A cabinet reshuffle brought younger blood into key political positions, and health diplomacy due to the pandemic offered means for Cambodia to smooth over tense international relations. However, at the end of 2021, the Cambodian Prime Minister remained defiant of international opinion and pressure, and looks set to continue his authoritarian, politically violent, rule. © Viella s.r.l. & Associazione Asia Maior.

Four-Fold Increased Mortality from Sars-Cov-2 Infection in Patients with Hematologic Versus Non-Hematologic Malignancies Treated at the Largest Tertiary COVID-19 Center in Chicago/Rush University Medical Center (March 1, 2020-December 31,2020)

[Formula presented] N.K.Y., P.C., & P.R.Y. contributed equally to this study Introduction: Many studies have concluded that active cancer patients infected with SARS-CoV-2 have a more complicated infection course and worse outcomes compared to the general patient population hospitalized with COVID-19. However, little evidence exists whether having a history of cancer plays a significant role in these observations. Patients with hematologic malignancy (HM) might have worse prognosis among all cancer patients but the reason remains unclear. Our objective is to evaluate outcomes and severity of COVID-19 in patients with Hematological Malignancy (HM) versus Solid-tumors (ST) in different clinical settings and also compare these outcomes within the group of patients with hematological malignancies. Methods: This retrospective study examines risk factors and outcomes of COVID-19 in patients with a history of cancer and laboratory-confirmed COVID-19 diagnosis between March 1 st, 2020, and December 31 st, 2020, at Rush University Medical Center, one of the largest COVID-19 tertiary care hospitals in Chicago. Baseline characteristics, malignancy type and types of cancer treatment within the last 30 days were recorded. Measures of COVID-19 severity included hospital admission versus outpatient care, use of oxygen, intensive care unit (ICU) admission, and mechanical ventilation. The primary outcome was death. Statistical analysis was conducted using optimal discriminant analysis, a non-parametric exact machine-learning algorithm which identifies the relationship between independent and dependent variables that maximizes model predictive accuracy adjusted to remove the effect of chance. Analysis was performed separately for each attribute using the entire sample (“training” analysis), then one-sample jackknife analysis was conducted to estimate cross-generalizability of findings using the model to classify an independent random sample. Results: 378 total patients with a history of cancer tested positive for COVID-19 within the time frame of the study. Of these, 294 (78%) patients had ST malignancy and 84 (22%) patients had HM. Characteristics and outcomes are summarized in Table 1. ST patients were marginally older than HM patients (p<0.025). A significantly greater proportion of HM patients were male (p<0.0023). HM and ST patients did not differ with respect to percentage receiving active cancer treatment (p<0.81). Compared to ST patients, more HM patients had received corticosteroids in the 30 days prior to COVID-19 diagnosis (p<0.017), had higher rates of hospitalization (p<0.0013) and ICU requirement (p<0.0001) with a significantly longer length of ICU stay (p<0.0036). Compared to ST patients, HM patients also required oxygen (p<0.002) and mechanical ventilation (p<0.0005) more often and had a 3.88-fold statistically higher death rate (OR 3.88 [95% CI 1.62-9.29] p<0.003). Patients with HM are categorized by disease subtype and summarized in Table 2. The case fatality rate from COVID-19 was 33.3% for patients with myeloproliferative neoplasms/myelodysplastic syndromes (MPN/MDS), 21.4% for patients with chronic lymphocytic leukemia (CLL), 13.6% for patients with non-Hodgkin lymphoma, 10.5% for patients with plasma cell neoplasms, and 4.5% for patients with acute leukemia. When looking at outcomes, CLL had the highest percentage of patients requiring hospital admission, oxygen, and ICU admission, and MPN/MDS had the highest percentage of patients requiring mechanical ventilation. Conclusions: Patients with hematologic malignancies had more severe COVID-19 illness and hospitalization rates and a 3.88-fold higher rate of death than patients with solid tumors. The comparable proportion of patients on anti-cancer therapy despite differences in survival suggests that being on anti-cancer therapy is less important than the underlying diagnosis of HM versus ST as a determinant of poor outcomes. Clinicians should closely monitor and initiate early COVID-19 treatments for all patients with HM and COVID-19. Because HM are highly he erogenous group of cancers, it is important to look at subtypes in greater detail. Numerous patient-level, disease-specific, and therapy-related factors may impact outcomes of COVID-19 among patients with HM, and we are currently analyzing additional data to better understand the factors which make this disease group more susceptible to severe infection. [Formula presented] Disclosures: Kuzel: Sanofi-Genzyme Genomic Health Tempus laboratories Bristol Meyers Squibb: Honoraria;Genomic Health: Membership on an entity's Board of Directors or advisory committees;Exelixis: Membership on an entity's Board of Directors or advisory committees;Cardinal Health: Membership on an entity's Board of Directors or advisory committees;Abbvie: Other;Curio Science: Membership on an entity's Board of Directors or advisory committees;AmerisourceBergen Corp: Membership on an entity's Board of Directors or advisory committees;CVS: Membership on an entity's Board of Directors or advisory committees;Tempus Laboratories: Membership on an entity's Board of Directors or advisory committees;Bristol Meyers Squibb: Membership on an entity's Board of Directors or advisory committees;Merck: Other: Data Monitoring Committee Membership;Amgen: Other: Data Monitoring Committee Membership;SeaGen: Other: Data Monitoring Committee Membership;Medpace: Other: Data Monitoring Committee Membership.

Interdependent Variables: Remotely Designing Tactile Graphics for an Accessible Workflow

In this experience report, we offer a case study of blind and sighted colleagues creating an accessible workflow to collaborate on a data visualization-focused project. We outline our process for making the project's shared data representations accessible through incorporating both handmade and machine-embossed tactile graphics. We also share lessons and strategies for considering team needs and addressing contextual constraints like remote collaboration during the COVID-19 pandemic. More broadly, this report contributes to ongoing research into the ways accessibility is interdependent by arguing that access work must be a collective responsibility and properly supported with recognition, resources, and infrastructure. © 2021 Owner/Author.

Lemierre's syndrome with cavernous sinus thrombosis: A therapeutic dilemma

Introduction: Internal jugular vein septic thrombophlebitis, known as Lemierre's syndrome, is an uncommon complication of deep-space head and neck infections. Cavernous sinus thrombosis is another potential complication of head and neck infections. A clinical picture of these in combination is exceedingly rare. Here is a case of Lemierre's syndrome with complicating cavernous sinus thrombosis caused by a deep-space neck infection. Method: A 21-year-old, previously healthy man presented to the emergency department for right facial swelling and bilateral pleuritic chest pain. A SARS-CoV-2 polymerase chain reaction nasopharyngeal swab, taken in the setting of upper respiratory infection symptoms, was negative 5 days prior. He was admitted to the intensive care unit (ICU) for medical management of facial cellulitis complicated by internal jugular vein thrombosis, mediastinitis, septic pulmonary emboli, and cavernous sinus thrombosis. Results: Therapeutic anticoagulation and culture-directed therapy to Fusobacterium necrophorum were started. He developed pleural effusions attributed to pulmonary septic emboli requiring chest tubes and he developed a large subcapsular hepatic hematoma necessitating embolization. Throughout his course, he did not develop cranial nerve palsies consistent with cavernous sinus thrombosis syndrome, despite progressive imaging findings. After 2 weeks in the ICU, he was stabilized and then managed with long-term therapy. Conclusion: This case demonstrates the challenges of treating 2 rare complications of deep-space neck infections in a patient with no identifiable site for surgical source control. The role of anticoagulation in Lemierre's syndrome and cavernous sinus thrombosis is controversial and not without great risk. The complications that can arise from both the disease process and treatment must be weighed in each case.

Managing precarity: Food bank use by low-income women workers in a changing welfare regime

Employment had risen to historically high levels in Britain before the coronavirus crisis;however, whereas work is traditionally conceptualized as a route out of poverty, this is no longer necessarily the case. Participation in non-standard or low-income work such as zero-hour contracts, involuntary part-time work and self-employment is increasingly a feature of the labour market and in-work benefits which top-up low incomes have been pared back. This case study undertaken in the period before the coronavirus crisis takes a multi-disciplinary approach in relation to three key questions: are working women resorting to food bank use in times of financial hardship?;to what extent is this a function of non-standard working practices?;and is welfare reform a contributing factor? A three-strand approach is taken: a synthesis of literature, an analysis of national data and in-depth interviews with stakeholders involved with referrals to or delivery of emergency food provision within northern Britain. The findings highlight a growth in precarious employment models since the 2008/2009 recession and how this intersects with increasing conditionality in welfare policy. We contribute to the debate by arguing that ideological driven policy fails to acknowledge structural deficiencies in labour market demand and misattributes responsibility for managing precarious working patterns onto individuals who are already struggling to get by. © 2021 The Authors. Social Policy & Administration published by John Wiley & Sons Ltd.

Disability and the COVID-19 Pandemic: Using Twitter to Understand Accessibility during Rapid Societal Transition

The COVID-19 pandemic has forced institutions to rapidly alter their behavior, which typically has disproportionate negative effects on people with disabilities as accessibility is overlooked. To investigate these issues, we analyzed Twitter data to examine accessibility problems surfaced by the crisis. We identified three key domains at the intersection of accessibility and technology: (i) the allocation of product delivery services, (ii) the transition to remote education, and (iii) the dissemination of public health information. We found that essential retailers expanded their high-risk customer shopping hours and pick-up and delivery services, but individuals with disabilities still lacked necessary access to goods and services. Long-experienced access barriers to online education were exacerbated by the abrupt transition of in-person to remote instruction. Finally, public health messaging has been inconsistent and inaccessible, which is unacceptable during a rapidly-evolving crisis. We argue that organizations should create flexible, accessible technology and policies in calm times to be adaptable in times of crisis to serve individuals with diverse needs. © 2020 Owner/Author.