Contribution of Testing Strategies and Contact Tracing towards COVID-19 Outbreaks Control: A Mathematical Modeling Study.

This modeling study considers different screening strategies, contact tracing, and the severity of novel epidemic outbreaks for various population sizes, providing insight into multinational containment effectiveness of emerging infectious diseases, prior to vaccines development. During the period of the ancestral SARS-Cov-2 virus, contact tracing alone is insufficient to achieve outbreak control. Although universal testing is proposed in multiple nations, its effectiveness accompanied by other measures is rarely examined. Our research investigates the necessity of universal testing when contact tracing and symptomatic screening measures are implemented. We used a stochastic transmission model to simulate COVID-19 transmission, evaluating containment strategies via contact tracing, one-time high risk symptomatic testing, and universal testing. Despite universal testing having the potential to identify subclinical cases, which is crucial for non-pharmaceutical interventions, our model suggests that universal testing only reduces the total number of cases by 0.0009% for countries with low COVID-19 prevalence and 0.025% for countries with high COVID-19 prevalence when rigorous contact tracing and symptomatic screening are also implemented. These findings highlight the effectiveness of testing strategies and contact tracing in reducing COVID-19 cases by identifying subclinical cases.

A comprehensive evaluation of COVID-19 policies and outcomes in 50 countries and territories.

The COVID-19 pandemic struck the world unguarded, some places outperformed others in COVID-19 containment. This longitudinal study considered a comparative evaluation of COVID-19 containment across 50 distinctly governed regions between March 2020 and November 2021. Our analysis distinguishes between a pre-vaccine phase (March-November 2020) and a vaccinating phase (December 2020-November 2021). In the first phase, we develop an indicator, termed lockdown efficiency (LE), to estimate the efficacy of measures against monthly case numbers. Nine other indicators were considered, including vaccine-related indicators in the second phase. Linear mixed models are used to explore the relationship between each government policy & hygiene education (GP&HE) indicator and each vital health & socioeconomic (VH&SE) measure. Our ranking shows that surveyed countries in Oceania and Asian outperformed countries in other regions for pandemic containment prior to vaccine development. Their success appears to be associated with non-pharmaceutical interventions, acting early, and adjusting policies as needed. After vaccines have been distributed, maintaining non-pharmacological intervention is the best way to achieve protection from variant viral strains, breakthrough infections, waning vaccine efficacy, and vaccine hesitancy limiting of herd immunity. The findings of the study provide insights into the effectiveness of emerging infectious disease containment policies worldwide.

Public-Private Partnerships for Environmental, Social, and Governance Projects: How Private Funding for Infrastructure Can Produce Mutual Benefits for Companies and the Public

The current concern for climate change and social equity in the US, highlighted by the global COVID-19 pandemic, has increased public attention on environmental, social, and governance (ESG) issues. One of the primary challenges the country faces is the issue of infrastructure, which has a profound impact on environmental and social conditions. Private entities have an opportunity to address ESG factors and improve climate resiliency, environmental justice, and economic opportunity through public-private partnerships (PPPs) that are focused on America's aging infrastructure. It is also an opportune time to initiate infrastructure projects as they align with the Biden Administration's aggressive climate change and economic stimulus plans. This study utilized publicly available information, including sustainability reports, news sources, and research papers, to explore examples of PPPs and current ESG trends, with a focus on environmental criteria, and demonstrated how private investment in infrastructure can produce mutually beneficial results for the private entity and society.

Small Towns, Big Cities: Rural and Urban Disparities among Hospitalized Patients with COVID-19

Background. More than half of all hospitals in the U.S. are rural hospitals. Frequently understaffed and resource limited, community hospitals serve a population that tends to be older and have less access to care with increased poverty and medical co-morbidities. There is a lack of data surrounding the impact of COVID-19 among rural minority communities. This study seeks to determine rural and urban disparities among hospitalized individuals with COVID-19. Methods. This is a descriptive, retrospective analysis of the first 155 adult patients admitted to a tertiary hospital with a positive COVID-19 nasopharyngeal PCR test. Augusta University Medical Center serves the surrounding rural and urban counties of the Central Savannah River Area. Rural and urban categories were determined using patient address and county census data. Demographics, comorbidities, admission data and 30-day outcomes were evaluated. Results. Of the patients studied, 62 (40%) were from a rural county and 93 (60%) were from an urban county. No difference was found when comparing the number of comorbidities of rural vs urban individuals;however, African Americans had significantly more comorbidities compared to other races (p-value 0.02). In a three-way comparison, race was not found to be significantly different among admission levels of care. Rural patients were more likely to require an escalation in the level of care within 24 hours of admission (p-value 0.02). Of the patients that were discharged or expired at day 30, there were no differences in total hospital length of stay or ICU length of stay between the rural and urban populations. Conclusion. This study suggests that patients in rural communities may be more critically ill or are at a higher risk of early decompensation at time of hospitalization compared to patients from urban communities. Nevertheless, both populations had similar lengths of stay and outcomes. Considering this data is from an academic medical center with a large referral area and standardized inpatient COVID-19 management, these findings may prompt further investigations into other disparate outcomes.

Catastrophic covid-19 in a pregnant woman

Case Report We report here a case of a 26-year-old woman at week 29 of a pregnancy who was transferred to our hospital for OBGYN care after on the same day she presented to an outside facility for one day of vaginal bleeding. At the transferring facility she was noted to be hypertensive with concerns for pre-eclampsia, acute kidney injury and non-reactive nonstress test. She had not had any pre-natal care or screenings done. Upon arrival she was normotensive but became obtunded and emergently taken to the OR. She was found to have a 50% placental abruption with uterine atony, hemorrhaging, and unfortunately fetal demise. She tested positive for SARS-CoV-2 on screening though she had no initial respiratory symptoms. Following extubation, she was noted to have very labored breathing, continued disorientation, and repeatedly stated that she was blind. She was subsequently re-intubated both to protect her airway and due to her work of breathing. Chest imaging showed bilateral patchy opacifications of her lungs and she was initiated on treatments for COVID19 pneumonia. She was lymphopenic at this time with an absolute lymphocyte count of 800 cells/mm. She had not been vaccinated against SARS-CoV-2. Over her hospitalization, she underwent extensive workup. For her complaints of vision loss she underwent ophthalmologic exam which did not find uveitis or other changes consistent with syphilis but rather for ischemic central retinal vein occlusions. She had persistent hypoxic respiratory failure and ultimately necessitated tracheostomy due to prolonged dependence of mechanical ventilation support. Approximately 1 month after her hospitalization, she developed a new left lower lung opacification as well as scattered tree-in-bud nodular findings on chest CT imaging. On bacterial and culture workup she grew methicillin-susceptible Staphylococcus aureus as well as Aspergillus species (identification still pending). She was treated with a short course of cefazolin for bacterial pneumonia and was started on a 3-month course of isavuconazonium sulfate for probable COVID-19-associated pulmonary aspergillosis (CAPA). After a two-month long hospitalization, she had gradual clinical improvement and was transferred to a skilled nursing facility for long-term care. In this case, the devastating impact of COVID-19 disease in a young, unvaccinated, and pregnant woman is clearly seen, as are multiple sequelae. She unfortunately lost her pregnancy and developed severe visual impairments and several opportunistic respiratory infections. Her placental abruption, ischemic retinal vein occlusions and pulmonary aspergillosis were all felt to be directly attributable to her COVID19 disease. The case presented here serves as a cautionary tale that even the young are at risk for severe COVID-19 disease. Healthcare professionals should continue to advocate for screening and vaccination for these high-risk individuals.

Cryptococcal meningitis complicated by covid-19

Case Report A 45-year-old man with a history of end-stage renal disease s/p kidney transplant 14 months prior presented with severe headaches, neck pain, nausea, and vomiting for the past week. He takes tacrolimus, mycophenolate mofetil, and prednisone. Exam was notable for fever of 38.1°C, photophobia, and neck pain induced with forward flexion. Noncontrasted CT head found no intracranial processes. Lumbar puncture demonstrated an opening pressure of 45 cm H20 with CSF showing 108 WBCs with 67% neutrophils, normal glucose, and protein elevated to 112 mg/dL. Due to our high suspicion for cryptococcal meningitis, he was started on induction therapy with amphotericin B and flucytosine. CSF and serum cryptococcal antigens later returned positive at 1:320 and 1:2560, respectively. CSF culture also grew Cryptococcus neoformans/gattii complex. He underwent serial lumbar punctures and completed 14 days of induction therapy. He was transitioned to fluconazole consolidation after CSF cultures cleared and opening pressures on lumbar puncture had normalized. After induction, he acutely developed a severe leukopenia to 100 cells/mm3 along with profuse diarrhea. Over the next 1-2 days, he had progressive cough and dyspnea followed by hypotension, tachycardia, and hypoxemia, at which point he was diagnosed with SARS-CoV-2. He had completed his SARS-CoV-2 vaccinations 4 months prior to hospitalization. He was started on broad spectrum antibiotics and dexamethasone, placed on high-flow oxygen, and transferred to the intensive care unit. He was diagnosed with Klebsiella pneumoniae bacteremia. He developed progressive multi-organ failure and suffered a cardiac arrest. After discussion with family, the patient was transitioned to comfort care and passed away. Patients on immunosuppressive therapy are high risk for severe outcomes from both opportunistic infections and common infections that may affect the immunocompetent. It was critical to maintain a broad differential on this patient's presentation, as while cryptococcal meningitis is classically a disease of advanced HIV/AIDS, it may also occur in patients with alternative causes of immunosuppression. These patients often have other features that complicate therapy, such as an inability to reduce immunosuppression to control the disease, or drug interactions between antifungals and their immunosuppressive medications. This patient also suffered other complications from his chronic immunosuppression;a poor response to his initial SARS-CoV-2 vaccination and predisposition to more severe COVID-19 disease. Both leukopenia and diarrhea are common findings in COVID-19, which provoked the Klebsiella pneumoniae bacteremia. This unfortunate case demonstrates the need to always remain vigilant for both opportunistic and routine infections in an immunocompromised patient, especially in the setting of an ongoing viral pandemic.

Telemedicine services are acceptable to neurologists for the delivery of outpatient specialty neurology care during the covid-19 pandemic, but require improvement

Introduction: The COVID-19 pandemic accelerated the adoption of telemedicine services for the delivery of outpatient neurological care. To date, teleneurology has been primarily used in the hospital setting related to both billing restrictions and the need for hands-on maneuvers to complete the neurological assessment. We sought to understand perceptions of neurology specialists during rapid proliferation of telemedicine services into their outpatient practices and the acceptance of this technology. Hypothesis: Neurologists may report profound challenges acclimating to the telemedicine platform, completing visits, and making clinical decisions via telemedicine. We also expected that neurology sub-specialties would differ in their attitudes. Methods: Adapted from the Telehealth Usability Questionnaire (TUQ), our 29 item questionnaire evaluated the teleneurology system in three domains: quality of the telemedicine platform, ability to conduct a sufficient neurological examination, and areas for improvement. The survey was distributed to 88 clinical Neurology faculty in the Johns Hopkins Health System. Seven-point Likert scale responses were collapsed into “Favorable”, “Neutral”, and “Unfavorable.” Within each domain, responses to individual questions were analyzed by neurology sub-specialty using descriptive statistics. Results: We received completed surveys from 46/88 (52%) neurology faculty. Of those, most reported comfort with the current platform (98%) and favorably regarded the system's ease of use (73%) and quality (80%). However, responses indicated only average ability to troubleshoot telemedicine platform issues when they occurred (55%) and to complete a neurological exam (52%). Sub-specialty comparisons revealed differences in diagnostic confidence;only 30% of neuromuscular faculty indicated they could make accurate neurological diagnoses through a teleexam as opposed to 84% or greater for other specialties. Conclusions: Teleneurology appears to be feasible and acceptable to a majority of academic neurologists, though diagnostic confidence may differ by sub-specialty. Improvements in technological infrastructure and care models are needed to advance telemedicine neurological care delivery.

Household Food Dynamics and Food System Resilience Amid the COVID-19 Pandemic: A Cross-National Comparison of China and the United States

The COVID-19 pandemic is a “perfect storm” that is testing the resilience and functional stability of the food system, as it ultimately affects household food dynamics and consumer food experiences. This cross-national survey-based study examined in real time how the COVID-19 pandemic impacted food-centric matters in 1,732 Chinese and 1,547 U.S. households during the stay-at-home directives. Both cohorts reported increased efficiency in the use of food, families spending more time cooking and eating together, and more prudent use of food with less waste. Food purchasing patterns shifted from frequent trips to the store to dramatic increases in online ordering. A small proportion (2% U.S. and 11% Chinese respondents) reported clinically significant weight gains of >4.5 kg. Household food security weakened, with large increases in people worrying about or experiencing food shortage. Collective grocery-shopping experiences by survey respondents indicated that the functional stability of food supply systems remained steady;all food types were somewhat available, except for noticeably higher prices widely reported by the Chinese cohort. This study offers insights into food system resilience when facing the pandemic and sheds light on future food patterns as well as long-term questions for additional research about how people make decisions and food behavioral changes at times of crisis. © Copyright © 2021 Dou, Stefanovski, Galligan, Lindem, Rozin, Chen and Chao.

Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020.

In Taiwan, lower nonpolio enterovirus activity during the coronavirus disease pandemic in 2020 compared with 2014-2019 might be attributable to adherence to nonpharmaceutical interventions. The preventable fraction among unexposed persons indicated that 90% of nonpolio enterovirus activity might have been prevented during 2014-2019 by adopting the same measures enforced in 2020.

The effect of preventing subclinical transmission on the containment of COVID-19: Mathematical modeling and experience in Taiwan.

The control strategies preventing subclinical transmission differed among countries. A stochastic transmission model was used to assess the potential effectiveness of control strategies at controlling the COVID-19 outbreak. Three strategies included lack of prevention of subclinical transmission (Strategy A), partial prevention using testing with different accuracy (Strategy B) and complete prevention by isolating all at-risk people (Strategy C, Taiwan policy). The high probability of containing COVID-19 in Strategy C is observed in different scenario, had varied in the number of initial cases (5, 20, and 40), the reproduction number (1.5, 2, 2.5, and 3.5), the proportion of at-risk people being investigated (40%, 60%, 80%, to 90%), the delay from symptom onset to isolation (long and short), and the proportion of transmission that occurred before symptom onset (<1%, 15%, and 30%). Strategy C achieved probability of 80% under advantageous scenario, such as low number of initial cases and high coverage of epidemiological investigation but Strategy B and C rarely achieved that of 60%. Considering the unsatisfactory accuracy of current testing and insufficient resources, isolation of all at-risk people, as adopted in Taiwan, could be an effective alternative.

Collateral Benefit of COVID-19 Control Measures on Influenza Activity, Taiwan.

Taiwan has strictly followed infection control measures to prevent spread of coronavirus disease. Meanwhile, nationwide surveillance data revealed drastic decreases in influenza diagnoses in outpatient departments, positivity rates of clinical specimens, and confirmed severe cases during the first 12 weeks of 2020 compared with the same period of 2019.