Optimal strategies to protect a sub-population at risk due to an established epidemic.

Epidemics can particularly threaten certain sub-populations. For example, for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the elderly are often preferentially protected. For diseases of plants and animals, certain sub-populations can drive mitigation because they are intrinsically more valuable for ecological, economic, socio-cultural or political reasons. Here, we use optimal control theory to identify strategies to optimally protect a 'high-value' sub-population when there is a limited budget and epidemiological uncertainty. We use protection of the Redwood National Park in California in the face of the large ongoing state-wide epidemic of sudden oak death (caused by Phytophthora ramorum) as a case study. We concentrate on whether control should be focused entirely within the National Park itself, or whether treatment of the growing epidemic in the surrounding 'buffer region' can instead be more profitable. We find that, depending on rates of infection and the size of the ongoing epidemic, focusing control on the high-value region is often optimal. However, priority should sometimes switch from the buffer region to the high-value region only as the local outbreak grows. We characterize how the timing of any switch depends on epidemiological and logistic parameters, and test robustness to systematic misspecification of these factors due to imperfect prior knowledge.

Building Resilience and Attachment in Vulnerable Adolescents (BRAVA): Piloting a Virtual Adaptation of a Brief Group Intervention for Adolescents With Mild-to-Moderate Suicidal Ideation and Their Caregivers

Objectives: Suicidal ideation (SI) is common in adolescents and increases the risk of completed suicide. Due to the COVID-19 pandemic, healthcare providers rapidly shifted to providing telehealth and virtual options for clients. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a group intervention designed for adolescents and their caregivers to reduce adolescent SI. The objective of this study was to adapt BRAVA for virtual delivery and evaluate the feasibility of this adaptation. Methods: We conducted an 8-week open trial between October and December 2020. Twelve participants (6 adolescents and 6 primary caregivers) were recruited from a pediatric hospital in Eastern Ontario. Through Zoom, adolescents and caregivers completed an intake assessment together, 6 weekly BRAVA group sessions separately, and an exit assessment together 1-week post-BRAVA. The primary adolescent outcome variable was the Suicidal Ideation Questionnaire Junior (SIQ-JR). Data were analyzed in IBM SPSS v.27. Pre-post comparisons on the SIQ-JR were done with a 2-tailed t test for matched pairs. Results: The study uptake rate was 42.9% of the eligible participants. There were no study dropouts. Adolescent (Mean [M] age = 15.3 years;SD age = 1.0;66.7% female) and caregiver attendance rates for BRAVA group sessions were high (median = 6). Overall group satisfaction scores were high for adolescents (M = 4.2;SD = 0.8) and their caregivers (M = 4.2;SD = 0.7). Most youth (83.4%) and caregivers (66.7%) reported that the virtual process worked well. Whereas all caregivers (100%) agreed they would participate in a virtual group session again, youth responses were more variable (50% agree, 33.3% neutral, 16.7% disagree). Adolescent SI decreased after completing the intervention (M pretreatment [tx] = 50.7, SD pretreatment [tx] = 16.7;M post-tx = 29.7, SD post-tx = 20.4;t = 5.7;95% CI, 11.52-30.5;p = 0.002). Conclusions: Study results indicate that the virtual delivery of BRAVA is feasible. Study uptake was good, retention was complete, and satisfaction was high for adolescents and their caregivers. Importantly, initial results suggest that this adaptation of BRAVA may help reduce SI in adolescents. Feedback from participants will inform further changes to improve the adaptation of BRAVA for use in a planned RCT. S, ADOL, FT

Survey results of patients with neuroendocrine cancer to find an overall high satisfaction with telemedicine and identify weaknesses of telemedicine unique to patients with rare cancers

Background: The COVID-19 pandemic has presented significant challenges to healthcare providers;especially in the treatment of patients with cancer. Many centers have delayed in-person visits by expanding the use of telemedicine (TM). The New Orleans Louisiana Neuroendocrine Tumor Specialists (NOLANETS) is a specialty referral center for patients with neuroendocrine tumors (NET), a rare cancer. This study sought to analyze the experience of TM in patients with a rare cancer and compare their experience with general oncology (Gen Onc) patients. Methods: NET patients completed an online survey conducted by the Neuroendocrine Cancer Awareness Network (NCAN), or an identical mailed paper survey conducted by NOLANETS. Data from these patients were pooled. Gen Onc patients completed the identical online survey using REDCap. Multi-disciplinary oncology physicians completed a unique online survey using REDCap. Results: NET patients (n = 247) rated their overall experience of TM as excellent (47%;n = 116) or good (41%;n = 102), and Gen Onc patients (n = 508) rated their experience as excellent, (54.6%;n = 305) and good (35.2%;n = 197);with no statistical difference between the cohorts. However, NET patients were less likely to agree that all their questions were answered than Gen Onc patients (p < 0.001). Factors associated with suboptimal experience for both cohorts included: telephone format and connection issues. Patients who experienced connection issues were less likely to agree that their questions were answered (NET p = 0.004;Gen Onc p < 0.0001) or that they wanted additional virtual visits (NET p = 0.004;Gen Onc p < 0.0001). NET patients reported a significant difference in the travel required to receive inperson care than Gen Onc patients (p < 0.0001) and significant cost savings associated with TM (p = 0.012). Physicians (n = 51) reported that they were able to effectively care for their patients using TM (88%), however there were significant differences when providers were asked if they were able to provide adequate care for follow-up (FU) visits vs new patient visits vs end-of-life visits (FU vs new, p = 0.000;FU vs End of Life, p < 0.0001;New vs End of Life, p = 0.009). Conclusions: While most NET and Gen Onc patients had a positive experience with TM, connection issues, and audio-only platform significantly decreased the overall experience. Importantly, while NET patients reported a significant cost savings, they were less likely to agree that all their questions were answered when compared to Gen Onc patients. And while most physicians agreed that they were able to effectively care for their patients, additional considerations should be made when new patients or end-of-life patients participate in TM. These results suggest that TM may offer new opportunities for rare-cancer patients but also poses unique challenges.

Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review.

OBJECTIVES: To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. DESIGN: Systematic review. METHODS: Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. OUTCOME MEASURES: Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. RESULTS: A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). CONCLUSIONS: COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.

Infection and mortality of healthcare workers worldwide from COVID-19: a scoping review (preprint)

Objectives To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective. Design Scoping review. Methods Two parallel searches of academic bibliographic databases and grey literature were undertaken. Governments were also contacted for further information where possible. Due to the time-sensitive nature of the review and the need to report the most up-to-date information for an ever-evolving situation, there were no restrictions on language, information sources utilised, publication status, and types of sources of evidence. The AACODS checklist was used to appraise each source of evidence. Outcome measures Publication characteristics, country-specific data points, COVID-19 specific data, demographics of affected HCWs, and public health measures employed Results A total of 152,888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%) and nurses (38.6%), but deaths were mainly in men (70.8%) and doctors (51.4%). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.17 deaths reported per 100 infections for healthcare workers aged over 70. Europe had the highest absolute numbers of reported infections (119628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). Conclusions HCW COVID-19 infections and deaths follow that of the general world population. The reasons for gender and speciality differences require further exploration, as do the low rates reported from Africa and India. Although physicians working in certain specialities may be considered high-risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine, or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.