Promoting COVID-19 Health Equity through Partnership with Community-Based Organizations and Home Vaccination Services

Background. The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups. The Fulton County Board of Health (FCBOH) sought to promote COVID-19 health equity by partnering with Community Organized Relief Effort (CORE) and Community-Based Organizations (CBOs) to address access barriers and increase vaccine acceptance in Black and Latinx residents. These priority populations were identified using data from the Social Vulnerability Index, the COVID-19 Community Vulnerability Index, and local data regarding COVID-19 positivity and death rates. Methods. With support from the Centers for Disease Control, FCBOH partnered with CORE to deploy mobile units that provided free at-home vaccination services to Fulton County residents. CORE promoted their services in zip codes identified as having higher proportions of Black and Latinx residents. Additionally, CORE partnered with three CBOs that represented and had pre-existing relationships with our target populations. These CBOs promoted CORE's at-home services to their constituents. CORE also provided vaccination and health education services at community outreach events hosted by the CBOs as well as at clinics operated by the CBOs. Results. Between the months of September 2021 and March 2022, our programs were able to provide a total of 897 vaccinations - 510 (57%) at community events, 330 (37%) through at-home services, and 54 (6%) in community-based clinics. Among the 714 vaccinations for which race and ethnicity information were available, 348 (49%) were delivered to Black individuals and 326 (46%) vaccines were administered to Latinx individuals. Uptake of vaccines for Black and Latinx individuals was highest at community events (54% and 88%, respectively), followed by at-home services (35% and 12%, respectively). Conclusion. At-home vaccination services and partnerships with local CBOs can support a higher proportion of COVID-19 vaccinations administered to populations most at-risk. Notably, community events were the most effective settings for administering vaccines to these populations. Utilizing these methods can help overcome barriers to accessing healthcare and ultimately reduce COVID-19 health disparities in underserved minority communities.

Randomised trial of synthetic osmotic cervical dilator versus dinoprostone for labour induction

Background: Induction of labor is a commonly performed obstetric intervention. Vaginal prostaglandin E2 (dinoprostone) is the recommended first choice agent in the UK. Mechanical methods of induction are slower to achieve cervical ripening but have a lower risk of adverse effects. Objective: To compare the efficacy, maternal and neonatal safety, and maternal satisfaction of a synthetic osmotic cervical dilator (Dilapan-S) with vaginal prostaglandin E2 (dinoprostone) in cervical ripening for induction of labour. Design: Open-label, multicentre, superiority, randomised controlled trial in four UK National Health Service maternity units. Participants: Eligible participants were women ≥ 16 years of age undergoing induction of labour for a singleton pregnancy, ≥ 37 weeks' gestation with vertex presentation and intact membranes. The trial did not reach its planned sample size of 860 due to restrictions on research during the Covid-19 pandemic. Interventions: Women were randomly assigned to receive Dilapan-S or dinoprostone using a telephone randomisation system minimised by hospital, parity, BMI and maternal age. The induction agent was replaced as required until the cervix was assessed as favourable for labour. Main outcome measures: The primary outcome was failure to achieve vaginal delivery (i.e. caesarean delivery). Secondary outcome measures included maternal and neonatal adverse events. Analysis was by intention-to- treat, adjusting for design variables where possible. Results: Between 19 December 2017 and 26 January 2021, 674 women were enrolled: 337 were randomly assigned to Dilapan-S and 337 to dinoprostone (n = 337). The primary outcome was missing for two women in the dinoprostone group. Failure to achieve vaginal delivery (caesarean section) occurred in 126 women (37.4%) allocated to Dilapan-S, and 115 (34.3%) women allocated to dinoprostone (adjusted risk difference 0.02, 95% confidence interval -0.05 to 0.10). There were similar maternal and neonatal adverse events between the groups. Conclusions: Women undergoing induction of labour with Dilapan-S have similar rates of caesarean section and maternal and neonatal adverse events compared to dinoprostone.

Is Zoom viable for sociophonetic research? A comparison of in-person and online recordings for vocalic analysis

In this study, we explore whether Zoom is a viable method for collecting data for sociophonetic research, focusing on vocalic analysis. We investigate whether recordings collected through Zoom yield different acoustic measurements than recordings collected through in-person recording equipment, for the exact same speech. We analyze vowel formant data from 18 speakers who recorded Zoom conversations at the same time as they recorded themselves with portable recording equipment. We find that, overall, Zoom recordings yield lower raw F1 values and higher F2 values than recording equipment. We also tested whether normalization affects discrepancies between recording methods and found that while discrepancies still appear after normalizing with the Watt and Fabricius modified method, Lobanov normalization largely minimizes discrepancies between recording methods. Discrepancies are also mitigated with a Zoom recording setup that involves the speaker wearing headphones and recording with an external microphone.

The role of telephone triage in head and neck cancer care in a teaching hospital

Introduction: NHS England sets standards to ensure prompt specialist review, diagnosis, and treatment of cancer. Patients with suspected cancer should receive specialist review within 14 days of referral, diagnosis by day 28 and first treatment by day 62. To reduce transmission during the SARS-CoV-2 pandemic, the NHS recommended telephone triage as the first specialist appointment. The effect of telephone triage on head and neck cancer timeframes in an NHS teaching hospital was assessed. Method: Four head and neck cancer telephone triage clinics during July 2020 were selected at random. Clinical correspondence and the electronic patient records were reviewed for each patient and cancer pathway timeframes were analysed. Results: 31 patients were referred for telephone triage and 100% received specialist review within 14 days. Subsequently 17 (55%) patients were investigated, 12 (71%) of which received a diagnosis within 28 days. 4 patients received a cancer diagnosis, but none received first treatment within 62 days. 24 (77%) patients were seen in a face-to-face clinic after telephone triage on average 7 days after telephone triage. Conclusions: In this sample, telephone triage allowed safe initial specialist review by meeting the 14-day standard. However, the 28-day diagnosis and 62-day treatment standards were not adhered to. Telephone triage does not largely reduce overall patient contact, with 77% of patients subsequently reviewed in a patient-facing setting. The addition of telephone triage delayed first clinical examination by a specialist by an average of 7 days, which may be a contributing factor to the delays seen in diagnosis and treatment.

The role of blautia in SARS-COV-2

Introduction: Blautia, a genus of commensal anaerobes, has been shown in recent years to play a critical anti-inflammatory role in the human body, from colorectal cancer to Graft-versus-Host Disease. One species of Blautia reduces infection with Vibrio cholerae by degrading a key bile salt, taurocholate, which prevents activation of virulence genes. Inflammation also plays a critical role in COVID-19. When this inflammation spirals out of control, it causes a “cytokine storm” which can be even more lethal than the virus itself. Methods: Microbiome profiles of 40 ambulatory individuals with PCR-confirmed COVID-19 (C19) were compared to those of 11 high-risk healthy control (HRHC) subjects. To obtain these microbiome profiles, DNA was extracted from the fecal samples. DNA was then quantitated and normalized for downstream library fabrication utilizing shotgun methodology. Prepared and indexed libraries were subsequently pooled and sequenced on the Illumina NextSeq 550 System. Sample FASTQ files were analyzed with a computational tool profiling the microbial communities from metagenomic sequencing data with species level resolution. Finally, individual microbiome profiles were analyzed for relative abundance. The C19 subjects were further stratified by disease severity based on NIH criteria. Each severity level was compared to the HRHC, as well as the C19 group as a whole. The study was approved by Advarra IRB and is listed as NCT04359836. Results: The relative abundance of Blautia in subjects with COVID-19 was found to be elevated in subjects with COVID-19 when compared to HRHC (p< 0.05). Conclusion: Higher levels of genus Blautia in subjects who subsequently underwent allogenic blood or bone marrow transplantation were associated with lower rates of Graft-versus-Host disease, a potential indication of the critical role of Blautia in the inflammatory process, and cytokine storm formation. Finding this genus elevated in subjects with COVID-19 is not surprising. This elevation may be protective or harmful. There is also very little known about this genus. Further study is needed utilizing both hospitalized and ambulatory subjects to assess this hypothesis, but these early results indicate that high relative abundance of Blautia has the potential to serve as a biomarker for COVID-19 susceptibility.

The role of roseburia in COVID-19 pathogenesis

Introduction: Short-chain fatty acid (SCFA) production from dietary fiber by the gut microbiome is a crucial component in the prevention and reduction of inflammation. One anaerobic producer of SCFA butyrate is the genus Roseburia, which has been found to be dysbiotically reduced in individuals with IBS, metabolic syndrome and obesity. Another condition in which inflammation plays a major role is COVID-19. In our study, we sought to understand whether dysbiosis was present in individuals with COVID-19, and whether Roseburia was a part of that dysbiosis. Methods: Microbiome profiles of 40 individuals with PCR-confirmed COVID-19 (C19) were compared to those of 11 high-risk healthy control (HRHC) subjects. To obtain these microbiome profiles, DNA was extracted from the fecal samples. DNA was then quantitated and normalized for downstream library fabrication utilizing shotgun methodology. Prepared and indexed libraries were subsequently pooled and sequenced on the Illumina NextSeq 550 System. Sample FASTQ files were analyzed with a computational tool profiling the microbial communities from metagenomic sequencing data with species level resolution. Finally, individual microbiome profiles were analyzed for relative abundance. The C19 subjects were further stratified by disease severity based on NIH criteria. Each severity level was compared to the HRHC, as well as the C19 group as a whole. The study was approved by Advarra IRB and is listed as NCT04359836. Results: When the HRHC relative abundance of Roseburia was compared to C19 it was found that C19 had significantly reduced levels (P< 0.05). Figure 1 illustrates these results with the C19 subjects in shades of blue. Darker represents more severe illness, as described by NIH guidelines. Conclusion: It is impossible to know whether the C19 subjects had lower levels of Roseburia prior to infection or as a result of it. However, these findings pose important questions. If the subjects had a lower level of Roseburia prior to becoming infected with SARS-CoV-2, this dysbiosis could have predisposed these individuals to becoming infected. If the subjects were not dysbiotic prior to infection, the severity of illness could be an indicator of the severity of the resulting dysbiosis. Although much is still unknown about Roseburia, these results indicate it could serve as a biomarker of COVID-19 susceptibility. (Table Presented).

Managing an adult CF population in the COVID-19 pandemic-1 year on.

BACKGROUND: The advent of the COVID-19 pandemic in 2020 required an alteration in the routine care of people with CF (pwCF), deemed to be extremely vulnerable. AIM: We wished to report the alterations in clinical practice, including the introduction of remote video-assisted clinics, made to manage the adult pwCF attending our large centre. METHODS: We studied clinical records over a period of 2 years (March 2019 to February 2021) by comparing 19th March to 20th February (Y1) with 20th March to 21st February (Y2). RESULTS: We have shown out of hospital Multi Disciplinary Team (MDT) support increased and a greater proportion of IV therapy was administered at home. The VAC model of care increased clinical activity while reducing clinic non-attendance rates, suggesting more individuals engage with their carers. CONCLUSIONS: This new model of care has allowed greater engagement with pwCF.

Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic.

Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.