ABSTRACT
This study examines risk perceptions and evacuation planning for those residents affected by Hurricane Laura}the first major hurricane evacuation during the COVID-19 pandemic}and Hurricane Sally, prior to the wide-spread availability of vaccines. Research on hurricane evacuation behavior and risk perceptions during a pandemic is critical for quantifying the intersect of these compounding threats. Analyses captured how people perceive public shelters and whether evacuation choices changed in light of the pandemic. Many study participants considered themselves vulnerable to COVID-19 (39.4%), and two-thirds believed it would be “very serious” if they or their loved ones contracted COVID-19, but this had no impact on their actual evacuation decision-making. Approximately 75% of the sample stayed at home during Hurricanes Laura or Sally, and, of these, just over 80% indicated that COVID-19 was a somewhat important deciding factor. This reflects the partial role that COVID-19 played in balancing individual and household protective action decision-making during complex disasters, whereas 15.5% wanted to evacuate but waited until it was too late. For those who evacuated to a hotel, many found that staff and guests wore masks and socially distanced in common spaces. Of particular interest is that individuals have a continued negative perception of public shelters’ ability to safeguard against COVID-19 that was coupled with a significant decrease in the number of respondents that would potentially use shelters in 2020 as compared with before the COVID-19 pandemic. These results have informed and will inform future hazard mitigation planning during the current pandemic or future pandemics or infectious disease outbreaks. © 2022 American Meteorological Society.
ABSTRACT
Although research relating to hurricane evacuation behavior and perceptions of risk has grown throughout the years, there is very little understanding of how these risks compound during a pandemic. Utilizing the U.S. territories of Puerto Rico and the U.S. Virgin Islands (PRVI) as a study region, this work examines risk perceptions and evacuation planning during the first hurricane season following the coronavirus disease 2019 (COVID-19) pandemic before vaccines were widely available. Analyses of how people view public shelters and whether evacuation choices will change in light of COVID-19 concerns were conducted, and results reflect major changes in anticipated evacuation behavior during the 2020 hurricane season. Key findings include that over one-half of the sample considered themselves vulnerable to COVID-19. When asked about their intended actions for the 2020 hurricane season, a significant number of individuals who would have previously evacuated to a shelter said that they would choose not to during the pandemic, reflecting that public shelter usage has the potential to decrease when the decision is coupled with COVID-19 threats. In addition, individuals were shown to have a negative perception of public shelter options. Approximately one-half of the respondents had little faith in shelters’ ability to protect them, and three-quarters of respondents found the risks of enduring a hurricane to be less than those posed by public shelters. These results will inform future hazard mitigation planning during a disease outbreak or pandemic. © 2022 American Meteorological Society.
ABSTRACT
The prolonged coronavirus-2019 (COVID-19) pandemic and co-occurring disasters during 2020 took a toll on everyone, taxing public health and disaster management personnel particularly. This initial study evaluated levels of exhaustion, cynicism, and professional efficacy among a broad array of the disaster workforce responding to these events through an online survey. Responses were compared to normative standards from an international dataset using a one-sample t-test and described using k-means cluster analysis. Results from 111 emergency management and disaster services, public health, healthcare, first responders, and other professionals and volunteers indicated high levels of emotional exhaustion and cynicism, along with high levels of personal efficacy compared to normative samples. Perceptions of the heightened risk of contracting COVID-19 were significantly associated with increased emotional exhaustion and cynicism. Cluster analysis results indicated three different patterns of burnout: half of the respondents were overextended (high levels of emotional exhaustion, cynicism, and efficacy) or burned out (high emotional exhaustion and cynicism, low efficacy), while 50 percent were engaged (low emotional exhaustion, low cynicism, and high personal efficacy). This suggests that despite the COVID-19 pandemic, a substantial proportion of the disaster response workforce is still thriving. However, a large proportion is burned out or at high risk (overextended). Limitations of this study include a lack of diversity in the sample, which, although similar to the demographic characteristics of the emergency manager population, may limit the generalizability of the study results. System-level planners can use this information to develop comprehensive workforce approaches, policies, and procedures to prevent burnout for these essential personnel working behind the scenes. © 2021 Weston Medical Publishing. All rights reserved.
ABSTRACT
BACKGROUND Cellular therapies (allogeneic hematopoietic cell transplantation, allo-HCT, autologous hematopoietic cell transplantation, auto-HCT, and chimeric antigen receptor T cell therapy, CAR T) render patients severely immunocompromised for extended periods post-therapy. Emerging data suggest reduced immune responses to COVID-19 vaccines among patients with hematologic malignancies, but data for cellular therapy recipients are sparse. We therefore assessed immune responses to mRNA COVID-19 vaccines among patients who underwent cellular therapies at our center to identify predictors of response. PATIENT AND METHODS In this observational prospective study, anti-SARS-CoV-2 spike IgG antibody titers and circulating neutralizing antibodies were measured at 1 and 3 months after the 1 st dose of vaccination. CD4, CD19, mitogen, and IgG levels from patient samples collected prior to initiation of vaccination in a subset of patients were used to assess immune recovery and association with response. A concurrent healthy donor (HD) cohort provided control response rates. RESULTS Allo-HCT (N=149), auto HCT (N=61), and CAR T (N=7) patients vaccinated between 12/22/2020- 2/28/2021 with mRNA vaccines and 69 HD participated in this study. At 3 months, 188 pts (87%) had a positive anti-SARS-CoV-2 spike IgG levels (median 5,379 AU/mL, IQR 451-15,750), and 139 (77%) had a positive neutralization Ab assay (median 93%, IQR 36-96%). All HD (100%) had a positive anti-SARS-CoV-2 spike IgG and a positive neutralization Ab assay with median levels of 8,011 AU/mL (IQR 4573-11,159) and 96% (IQR 78- 96%), respectively. Time from vaccination to cellular therapy was associated with response;67% of patients vaccinated in the first 12 months post-cellular therapy (N=42) mounted a serologic response, compared with patients vaccinated between 12-24 (89%) (N=45), 24-36 (91%) (N=32) and >36 (93%) (N=98) months post-treatment, p= 0.001 (figure 1). Patients with immune parameters below the recommended threshold for vaccinations post-cellular therapies were also less likely to mount a response (figure 2): CD4+ T-cell count < 200 vs >200 cells/μL, 66% vs 87% (p=0.012);CD19+ B-cell count <50 vs >50 cells/μL;33% vs 95% (p<0.001), phytohemagglutinin mitogen response <40% vs >40%, 42% vs 89% (p<0.001), and IgG <500 vs >500 mg/dl, 71% vs 91% (p=0.003). Patient age, gender, prior COVID-19 infection, treatment with IVIG, and type of mRNA COVID-19 vaccine were not associated with the likelihood of serologic response. CONCLUSION This largest cohort to date, demonstrates that COVID-19 vaccine responses of cellular therapy recipients are reduced compared to healthy control and response varies based on time interval from cellular therapy and immune function at the time of vaccination, underscoring the importance of monitoring immune status parameters, as well as qualitative measures (neutralizing Ab) of vaccine response, in informing clinical decisions, including the indication for booster vaccines. [Formula presented] Disclosures: Politikos: Merck: Research Funding;ExcellThera, Inc: Other: Member of DSMB - Uncompensated. Vardhana: Immunai: Membership on an entity's Board of Directors or advisory committees. Perales: Equilium: Honoraria;Cidara: Honoraria;Sellas Life Sciences: Honoraria;Miltenyi Biotec: Honoraria, Other;Celgene: Honoraria;MorphoSys: Honoraria;Takeda: Honoraria;Incyte: Honoraria, Other;Karyopharm: Honoraria;Kite/Gilead: Honoraria, Other;Merck: Honoraria;NexImmune: Honoraria;Novartis: Honoraria, Other;Medigene: Honoraria;Omeros: Honoraria;Servier: Honoraria;Bristol-Myers Squibb: Honoraria;Nektar Therapeutics: Honoraria, Other. Shah: Amgen: Research Funding;Janssen Pharmaceutica: Research Funding.
ABSTRACT
Since the first confirmed case in Wuhan, China on December 31, 2019, the novel coronavirus (SARS-CoV-2) has spread quickly, infecting 165 million people as of May 2021. Since this first detection, research has indicated that people contracting the virus may suffer neurological and mental disorders and deficits, in addition to the respiratory and other organ challenges caused by COVID-19. Specifically, early evidence suggests that COVID-19 has both mild (e.g., loss of smell (anosmia), loss of taste (ageusia), latent blinks (hete-rophila), headaches, dizziness, confusion) and more severe outcomes (e.g., cognitive impairments, seizures, delirium, psychosis, strokes). Longer-term neurological challenges or damage may also occur. This knowledge should inform clinical guidelines, assessment, and public health planning while more systematic research using biological, clinical, and longitudinal methods provides further insights.
ABSTRACT
Study Objective To pilot a remote learning Fundamentals of Laparoscopic Surgery (FLS) elective to pre-clinical medical students. Design Due to COVID-19 restrictions, pre-clinical medical students were required to strictly quarantine for two weeks upon arrival to their clinical rotation sites, during which they would engage in an elective of their choice. Medical students enrolled in the Remote Learning FLS Elective received a laparoscopic training box (Task It) with supplies prior to traveling around the continental United States for clinical rotations. Students also received instructions to access publicly available FLS modules and videos to introduce instruments and tasks. Each learner engaged in self-guided practice with coaching available via a live-streaming platform to assist with refining their skills during the course. Setting While quarantined in three different locations (Bethesda MD, San Antonio TX, and San Diego CA) learners utilized space in their living quarters to set up the Task II trainer and computer. Patients or Participants Three pre-clinical medical students enrolled in a 2-week distance learning FLS elective. Interventions Learners participated in a 2-week distance learning elective that utilized self-directed learning and practice, use of available FLS modules and videos, and individual coaching sessions with instructor. Measurements and Main Results All learners were true novices with no prior FLS or laparoscopic experience, and minimal to no experience with surgical skills. Learners practiced individually and timed themselves practicing each skill. Each was able to attain facility with object transfer, depth perception. Conclusion All learners improved from their baseline skills level. Remote coaching of FLS with true novices is a viable alternative to traditional face to face learning with motivated learners.
ABSTRACT
The coronavirus-2019 (COVID-19) pandemic corresponded with a record-breaking year for billion-dollar disasters. While the pandemic swept across the United States, the country also experienced a record-setting hurricane season on the East Coast and an unprecedented wildfire season on the West Coast. These co-occurring threats have placed unprecedented strain on our disaster response workforce with potential long-term implications for turnover and disaster response efficacy. In this paper, we draw from the Job Demands-Resources model to address the influence of workers’ role stressors and community infection rates during the COVID-19 pandemic and job burnout and turnover in the disaster response workforce. © 2021 Weston Medical Publishing. All rights reserved.
ABSTRACT
Since the first confirmed case in Wuhan, China on December 31, 2019, the novel coronavirus (SARS-CoV-2) has spread quickly, infecting 165 million people as of May 2021. Since this first detection, research has indicated that people contracting the virus may suffer neurological and mental disorders and deficits, in addition to the respiratory and other organ challenges caused by COVID-19. Specifically, early evidence suggests that COVID-19 has both mild (e.g., loss of smell (anosmia), loss of taste (ageusia), latent blinks (heterophila), headaches, dizziness, confusion) and more severe outcomes (e.g., cognitive impairments, seizures, delirium, psychosis, strokes). Longer-term neurological challenges or damage may also occur. This knowledge should inform clinical guidelines, assessment, and public health planning while more systematic research using biological, clinical, and longitudinal methods provides further insights.
ABSTRACT
Objective New evidence is emerging regarding the effects of Coronavirus (COVID-19) in pregnancy. We report this case to highlight COVID-19 complications and challenges in the 3rd trimester of pregnancy. Case report A 35 years old, Para 1, had an uneventful pregnancy up to 36 weeks' gestation, when she was admitted with reduced fetal movements, feeling unwell, fever, and cough with a positive COVID-19 PCR. She was febrile, tachycardiac, and normotensive with no proteinuria. Symptomatic treatment was commenced with infection control measures. Cardiotocograph (CTG) was reassuring initially. Her platelet count was 66 9 109/L and her liver function tests (LFT) were mildly deranged. Peripheral blood film showed no signs of Microangiopathic hemolytic anemia. The hematologist suggested that thrombocytopenia was most likely related to COVID-19 & her isolated mildly prolonged APTT was corrected by Vitamin K. She was induced in view of intermittent decelerations on CTG and progressive thrombocytopenia. However, CTG became abnormal and she had a lower segment cesarean section under General Anastasia (because of thrombocytopenia). She delivered a 2.8 kg baby boy (APGAR score of 6 and 9 at 5 and 10 mins respectively, normal cord pH). Delivery was complicated by a Postpartum hemorrhage of 2 L, for which she was transfused one unit of platelets, and two units of red cells, along with oxytocics and antibiotics. Neonate was COVID-19 positive and had hyperbilirubinemia, which settled subsequently. The subsequent recovery of the mother was uneventful, with improvement in her platelet count and LFT. She was discharged home with her baby on the 4th postoperative day after the debriefing. She was prescribed thromboprophylaxis for 6 weeks and followed up as an outpatient. Discussion The management of COVID-19 in pregnancy should include a multidisciplinary approach, foeto-maternal surveillance, infection control measures, delivery planning, and psychological support. Rasmussen SA advocates the use of empiric antibiotics for secondary bacterial infection risk & mechanical support in case of respiratory compromise. Thrombocytopenia is a known complication of COVID-19 in pregnancy. Thromboprophylaxis is challenging in such patients and depends on risks and benefits, clotting profile, and the timing of delivery. Moreover, the differential diagnosis for epigastric pain in pregnancy with COVID-19 infection varies from gastritis and preeclampsia to hepatic and myocardial injury. Vertical transmission is a known risk of maternal COVID-19 infection. Conclusion As obstetric teams face COVID-19 pandemic associated foeto-maternal challenges, there is a need for holistic interventions for caveats arising from COVID-19 complications.