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Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients;(b) autoimmune diseases and (c) solid organ transplant recipients (SOTR);(2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients;(b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients;(c) SOTR;(d) lupus. Method(s): For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy;SOTR;autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and diseasespecific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts. Result(s): Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions. Conclusion(s): Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.
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This paper examines the rapid introduction of AI and automation technologies within essential industries amid the COVID-19 pandemic. Drawing on participant observation and interviews within two sites of waste labor in the United States, we consider the substantial effort performed by frontline workers who smooth the relationship between robotics and their social and material environment. Over the course of the research, we found workers engaged in continuous acts of calibration, troubleshooting, and repair required to support AI technologies over time. In interrogating these sites, we develop the concept of "patchwork": human labor that occurs in the space between what AI purports to do and what it actually accomplishes. We argue that it is necessary to consider the often-undervalued frontline work that makes up for AI's shortcomings during implementation, particularly as CSCW increasingly turns to discussions of Human-AI collaboration. © 2023 Owner/Author.
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Rationale: Asthma remains a significant comorbidity among children with food allergy (FA). Longitudinal data on the course of asthma in this population, particularly during the COVID-19 pandemic, is lacking. This study aims to describe asthma management and control among children with FA during the COVID-19 pandemic. Methods: Children with FA (≤12 years old at enrollment) were enrolled into FORWARD, a prospective, observational cohort study. Data from participants with FA and asthma who completed a 12-month and 24-month post-enrollment asthma therapy assessment were included (n=125). Surveys were administered between January 2019 - July 2022, which includes the onset and duration of COVID-19. Responses to the same questions at the two time points were analyzed using tests of exact symmetry. Results: Compared to the 12-month survey, caregivers at the 24-month survey more frequently reported that their children were not using their inhaler for quick relief (1.6% vs. 9.4%, p = 0.008) and were using their medication incorrectly (3.2% vs. 8.7%, p = 0.003). They less frequently reported that they were unsure whether their medications were useful (3.2% vs. 0.0%, p = 0.016). A similar distribution was observed when non-Hispanic Black and non-Hispanic White participants were compared. No significant differences were evident when comparing symptoms. Conclusions: The symptom burden of asthma remained stable even during the pandemic. However, during this time, children with asthma were less likely to need a rescue inhaler and to be adherent to their maintenance regimen. Further longitudinal research on asthma management is necessary to better understand the potential impact of COVID-19.
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Three-dimensional virtual histology images of multiple organ tissues from patients deceased due to COVID-19 were acquired using dual-view inverted selective plane microscopy (diSPIM). Compared to conventional two-dimensional histology slides, these images can provide unique insights into the pathophysiology of COVID-19. © 2022 The Author(s).
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Background: Concerns about safety and treatment interference are known barriers to COVID-19 vaccination in cancer patients. Data on safety and tolerability in this population remain scarce. One of the objectives of this study is to describe COVID-19 vaccination safety in cancer patients. Methods: Patients diagnosed with a malignancy requiring systemic treatment in the last 12 months and undergoing COVID-19 vaccination were prospectively enrolled in this single-center study. Validated questionnaires to assess vaccine-related adverse events (VRAEs) were collected;chart review identified baseline characteristics and treatments received. Descriptive statistics and logistic regressions were performed. Results: 253 questionnaires were collected from 171 patients, enrolled between May and September 2021. 130 patients were survey-eligible after the 1st dose (D1) and 185 after 2nd dose (D2). 91 questionnaires were collected after D1 (Questionnaire 1: Q1) and 162 after D2 (Questionnaire 2: Q2). Surveys couldn't be collected due to interval > 1 month between D1 / enrollment, patients' unavailability, withdrawal of study or death. Median age was 55 (24-87) and 62.8% were female. 58.5% had solid tumors, treated with chemotherapy (49%) or checkpoint inhibitors only (9.5%);19.4% malignancies were treated with targeted therapies and 22.1% had hematological malignancies. Most frequent solid tumors were breast (31.3%), lung (15.9%) and gastro-intestinal (GI) (14.3%). Patients received 45.6% Pfizer/BioNTech, 52.8% Moderna and 1.6% Oxford/AstraZeneca. A combination of 2 different vaccines was administered to 11.9%. Interval between D1 and D2 was ≤30 days in 53.1%, 31-90 days in 42.6%, and 91-180 days in 4.3%. Among all patients, 84.1% developed VRAEs after a median of 2 days post-vaccine for a median of 4 days. 74.5% had local symptoms (Sx) (pain, sensitivity and/or redness at injection site and/or arm) and 65.8% had systemic Sx. Most frequent systemic Sx were fatigue, chills or myalgia (39.4%), GI (6.3%) and fever (2.9%). Most patients (90.7%) described their Sx as having no / minimal impact (Gr 1), 7.8% reported seeking medical consultation (Gr 2), and 1.5% lead to hospitalization (Gr 3) (1 cardiovascular event, 1 infection;causality with concurrent systemic treatment not excluded and 1 due to malignancy). Gr 2, but not Gr 3, VRAEs were more common after D2 (11.4% vs 2.5%, p = 0.03). 41.7% considered their Sx as a new health problem. On multivariate analysis, younger age and female sex were significantly associated with the development of any Sx (OR 1.08, p = 0.01;OR 2.92, p = 0.02, respectively) and local Sx (OR 1.04, p = 0.04;OR 2.19, p = 0.04), but not systemic Sx or new health problem. Conclusions: Patients experienced mostly minor and transient symptoms post-vaccination;few perceived these as a new health problem. COVID-19 vaccination is overall safe and well-tolerated among cancer patients.
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The reality is that transport and mobility matters to us all, it literally sustains our lives being an enabler of our economic and social life. 'We' take it for granted and perhaps none more so than the motorcar. Yet road transport also comes at a price-it takes lives. From a United Nations perspective, it is identified that road crashes risk jeopardizing the whole sustainable development agenda. This research commences by reflecting on the history and strategic direction being advocated at an international level. It considers the global divide, before attention and emphasis is turned to the EU's approach to saving lives on the road. This is also compared with the US. The method applied is from a legal/policy measures approach-which puts the driver at the heart of intervention strategies. Focus in particular is accorded to the success of the EU driver/education law and policy. Comparisons are also drawn within, between the pandemic of Covid-19 and this global epidemic (in terms of lives lost). It concludes by declaring road deaths as a global emergency, one that needs to be approached in the same way and with the same vigour and haste, in order to stop numbers rising. © 2022 Koninklijke Brill NV incorporates the imprints Brill, Brill Nijhoff, Brill Hotei, Brill Schöningh, Brill Fink, Brill mentis, Vandenhoeck Ruprecht, Böhlau Verlag and VR Unipress.
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This paper aims to elevate essential worker accounts of the introduction of AI technology amid the COVID-19 pandemic. Drawing from a mix of ethnographic observations, interviews, and participatory design encounters with frontline staff, we examine the experiences of workers in a waste management facility in the United States newly tasked with overseeing autonomous floor cleaning robots. To complement and extend managerial and engineering descriptions emphasizing the functionality and performance of these devices, we used recuperative approaches to re-center the socio-material realities of workers on-the-ground. For example, workers reported concerns on the safety of the devices in congested areas and a need for more comprehensive training across all levels of the organization. This research seeks to expand the discourse on ethical AI by situating essential workers as a key source in developing best practices for deploying new technologies and evaluating pilot projects. © 2022 Owner/Author.
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Background: The highly contagious Delta variant of COVID-19 accounts for more than 80% of SARS-CoV-2 cases in the fall of 2021. Our aim was to determine whether molecular methods for variant and lineage detection could be utilized at autopsy to examine pathologic findings of Delta variant as compared to non-Delta variant cases. Design: We evaluated the lungs from 20 decedents with death due to SARS-CoV-2 confirmed by antemortem nasopharyngeal RTPCR in July and August 2021 (Delta wave), as well as from 40 autopsy cases prior to February 2021 with death due to SARS-CoV- 2. The patient population included males and females, with an age range of 37-67 years in the Delta group, and 44-79 In the non- Delta group. The population demographic was considered at risk for death due to COVID-19, and only one decedent, with immunosuppression, was known to be vaccinated. Lung specimens were examined on H&E and with SARS-CoV-2 nucleocapsid immunostain (IHC). Results: The time from initial symptoms to death averaged 9 days within the Delta wave and 16 days in non-Delta cases. Steroids, anticoagulation, antibiotics, and monoclonal antibody infusion were frequently part of the clinical treatment of Delta wave cases. Notably, SARS-CoV-2 PCR of lung swabs at autopsy were positive in all but one case examined in the Delta variant group, and viral genome RNA sequencing from lung at autopsy confirmed Delta variant lineage. In both groups, gross features of the lungs included edema, while grossly identifiable thrombi were more commonly seen in non-Delta variant cases. Histologic examination revealed diffuse alveolar damage (DAD) in all cases, most commonly early stage DAD in Delta variant cases. SARS-CoV-2 IHC demonstrated patchy to strong positivity in the alveoli of the majority of Delta variant cases - a finding not frequently seen in non-Delta cases. Figure 1 - 15 Conclusions: Our study is the first to incorporate PCR and viral genome sequencing from the lung at autopsy to correlate the Delta variant wave with histopathologic findings - a technique that may be useful in identifying important pathologic features of future variants. While the finding of DAD remains the same across viral variants, the majority of Delta cases showed a significant presence of SARS-CoV-2 in the lung by IHC, with minimal inflammatory infiltrate and reduced thrombotic complication. Whether these findings are the result of a shorter time interval between disease onset and death, therapeutic intervention, or increased viral load remains to be determined.
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Background: Initial evidence has shown the occasional presence of SARS-CoV-2 in enterocytes in the intestines of patients with COVID-19. Our aim is to further assess the clinical and pathologic changes in the gastrointestinal tract caused by the highly contagious Delta (B.1.617.2) variant as compared to viral variants originating earlier in the pandemic. Design: Intestinal samples from 32 patients with death due to COVID-19 were obtained at autopsy. Decedents were males and females, with an age range of 32-73 years. Twenty-one of the decedents self-identified as Black/African American, eight as Caucasian, and three as Hispanic. Two groups were differentiated by viral genome RNA sequencing from autopsy tissue: those with Delta variant (n=16), and those with non-Delta variant (n=16). SARS-CoV-2 expression in the intestine was evaluated by immunohistochemical (IHC) detection of the SARS-CoV-2 nucleocapsid protein (N-protein). Results: Clinically, the Delta group reported diarrhea more frequently (25%) as compared to the non-Delta group (6%). Patients in the Delta group had a shorter time interval between the onset of gastrointestinal symptoms and death (mean = 19 days), as compared to the non-Delta group (mean = 25 days). Histologic examination revealed mostly normal to mild, non-specific chronic inflammation within the epithelium and lamina propria in both groups. Macrophages with positivity for N-protein IHC were present beneath the epithelium, most notably within the Delta group. N-protein positivity occurred most frequently in small submucosal and mesenteric blood vessels. Patchy positivity for N-protein in enterocytes was seen frequently in cases of Delta variant in which the time from initial symptoms to death was short (<14 days). Figure 1 - 11 Conclusions: As in prior studies, intestinal microscopic changes in COVID-19 were minimal, though our findings indicate that SARS-CoV-2 may be detected within enterocytes more frequently in the Delta group. Patients with the Delta variant experienced both a higher rate of diarrhea and a shorter interval between gastrointestinal symptom onset and death. Whether increased Nprotein in enterocytes is a result of the Delta variant itself, or earlier intestinal sampling relative to symptoms in this group, remains to be determined. Autopsy studies can add to our understanding of the effects of COVID-19 on the digestive system, by allowing a greater volume of tissue sampling, as well as temporal sampling relative to disease onset that is not always possible at endoscopy.
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Background: Across the globe, cases of post-acute sequelae of COVID-19 (PASC) are characterized by the delayed effects of SARS-CoV-2 infection in multiple organ systems. Patients may have appeared to recover from the initial infection, but experience sequelae of the disease weeks to months later. Autopsy studies of PASC have only initially begun. Our research aims to compare the pathology of cases in which patients experienced a prolonged, progressive decline, to the cases of patients who recovered from the initial infection of SARS-CoV-2, but experienced sequelae of the condition numerous weeks to months later. Design: Autopsies were performed on 17 male and female decedents with an age range of 31-79 years with cause of death related to COVID-19 infection confirmed by SARS-CoV-2 PCR, and time between the onset of symptoms and death ranging from 30 to 112 days. Cases in which the time between the onset of symptoms and death exceeded 30 days, with evidence of initial recovery, were considered potentially PASC-related. The cases were separated into two groups based upon the timeline of first positive PCR to time of death: those who succumbed to the initial COVID-19 infection after an extended hospital course, and those with potential PASC-related disease. Clinical, gross and microscopic findings from both groups were compared, as well as PCR and IHC for SARS-CoV-2 at autopsy. Results: The most common clinical comorbidity seen in both groups was hypertension (85.7%), followed by obesity and diabetes. Common microscopic findings in the lungs included proliferative to organizing diffuse alveolar damage (DAD). Findings in PASC-related cases included extensive alveolar fibrosis, fibrosing organizing pneumonia, and thrombi within medium-sized blood vessels. Two patients in their 30s presented with vasculitis/endotheliitis involving small blood vessels of the lungs and heart, consistent with Multisystem Inflammatory Syndrome. Additionally, late thrombotic events, and cardiac inflammation including macrophage infiltration appeared to be present in cases of PASC. Immunostaining for SARS-CoV-2 nucleocapsid and PCR at the time of autopsy did not reveal a persistence of virus in cases attributed to PASC. Figure 1 - 7 Conclusions: Our findings suggest that there may be pathologic differences between a prolonged course of acute COVID-19, and PASC-related disease. Characteristics of PASC included evidence of new or continued small vessel inflammation, macrophage infiltration, and/or fibrotic disease of affected organs.
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Introduction: COVID-19 has a significant effect upon the cardiovascular system including small amounts of myocyte death in some patients resulting in elevated troponin levels. While a number of different cardiovascular histopathologies have been described at post-mortem examination, the incidence of typical viral myocarditis in COVID-19 positive patients appears very low. Hypothesis: We hypothesized that COVID-19 causes a different type of inflammatory cell response that although different, may still cause significant negative effects on the cardiovascular system. Methods: Using immunoperoxidase staining, we characterized and quantified the number of CD3 , CD4 , CD8 , CD68 staining cells in 10 COVID-19 hearts, 10 hearts matched for age and underlying comorbidities, and 5 hearts with autopsy proven typical inflammatory myocarditis. Results: The results demonstrate a skewed distribution of the number of CD68+ cells in COVID-19 hearts, with upper quantiles showing a significant increase as compared to both matched control hearts, and those with myocarditis. In contrast, hearts from typical inflammatory myocarditis contained increased numbers of CD4+, and CD8+ cells compared to both COVID-19 and control cohorts. .
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The impact of Coronavirus disease 2019 (COVID-19) on outcomes in patients with cancer remains unclear. Acute Myeloid Leukemia (AML)/high-risk myelodysplasia (MDS) are common hematological malignancies resulting in profound immunosuppression, which is exacerbated by intensive and less-intensive chemotherapy. Importantly, venetoclax based regimens have been increasingly used during the pandemic as a strategy to reduce patient hospitalization however, there is little information concerning the impact of such regimens on COVID-19 infection rates. We therefore opened a prospective clinical study (PACE), at the start of the current pandemic in April 2020 to characterize the risk of COVID-19 infection in patients with AML/MDS-EB2 receiving intensive or non-intensive treatment, including patients treated with venetoclax-based regimens. The primary aim was to determine the incidence of COVID-19 in patients with AML /MDS-EB2 including both, prior to study entry and during treatment until 4 weeks after the last cycle of treatment. Secondary aims were to: characterize the presentation of COVID-19;define the severity and type of both non-COVID-19 and COVID-19 infections;and undertake an exploratory analysis to quantify the incidence of COVID-19 infection in patients receiving (less-intensive) venetoclax based regimens. All analysis conducted to date has been descriptive. 211/230 recruited patients had full treatment histories available, of whom 116 patients received intensive chemotherapy and 95 low intensity regimens. 48 patients received a venetoclax-based regimen. The median age of the non-intensive treatment arm was 72 years;(range 19.1-86.5) and of the intensive arm was 59 years (range 16.1-76.1). There were more cases of secondary AML and relapsed disease in the non-intensive arm as compared to the intensive arm. 25/226 evaluable patients tested positive for COVID-19 as defined by positive SARS-CoV2 PCR test, 10 with a prior diagnosis at study entry and 15 tested positive during the study. The incidence of COVID-19 infection for patients with AML/MDS-EB2 was 11.1% (90%CI: 7.8%-15.1%) (Table). A lower proportion of patients (n=6/91 6.6%) undergoing non-intensive treatment suffered COVID-19 as compared to those undergoing more intensive chemotherapy regimens (n=19/116, 16.4%). Specifically, only 3/48 (6.3%) patients undergoing a venetoclax regimen were infected with SARS-CoV2. The most common presenting symptoms of COVID-19 in this study, regardless of the intensity of chemotherapy, was fever and cough with 6/25 patients asymptomatic. The risk of death at 30 days following study entry in patients who had prior COVID-19 infection or who contracted COVID-19 during this period was 13.6%, compared to 3.9% in the overall cohort without COVID-19 infection. There was a lower incidence of non-COVID-19 related infections in patients receiving venetoclax-based regimens, n=43 infections in 24 (50.0%) of patients;with 313 infections in 94 (81%) of intensively treated patients. The overall occurrence of non-COVID-19 infection in the non-intensive arm was 87 infections in 50 (54.9%) patients. Our multi-center study provides real-world estimates for the incidence and presentation of COVID-19 infection in a cohort of patients with AML/MDS-EB2, and indicates a higher risk of death at 30 days in patients with prior COVID-19 infection prior to, or during treatment. Venetoclax based, and other non-intensive, regimens, increasingly implemented during the pandemic, to minimize patient exposure and reduce usage of hospital beds, appeared to be associated with a low incidence of COVID-19. Further follow-up will be required to understand the long-term impact of this strategy. Analysis of immune responses to COVID-19 infection and vaccination is on-going. Acknowledgments: This study was funded by Cure Leukaemia under the Trials Acceleration Program (TAP), and grants from BMS and Blood Cancer UK. [Formula presented] Disclosures: Loke: Novartis: Other: Travel;Janssen: Honoraria;Amgen: Honoraria;Pfizer: Honoraria;Daichi Sankyo: Other: Travel. K apper: Pfizer: Consultancy, Speakers Bureau;Astellas: Ended employment in the past 24 months, Speakers Bureau;Jazz: Consultancy, Speakers Bureau;Novartis: Consultancy, Research Funding, Speakers Bureau. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Dillon: Amgen: Other: Research support (paid to institution);Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Jazz: Other: Education events;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events;Shattuck Labs: Membership on an entity's Board of Directors or advisory committees. Culligan: AbbVie Ltd: Honoraria, Speakers Bureau;Celgene Ltd: Honoraria, Speakers Bureau;Gilead: Honoraria, Speakers Bureau;Jazz Pharma: Honoraria, Speakers Bureau;Takeda UK Ltd: Honoraria, Speakers Bureau. McMullin: Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Other: clinical trial support, Research Funding;Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AbbVie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;AOP Orphan: Research Funding, Speakers Bureau. Murthy: Abbvie: Other: support to attend educational conferences. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding.
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his year, 2021, marks the 20th anniversary since 9/11, recorded as the ‘day that changed the world.’ Security remains an area where governments and airlines are continuously struggling to stay ahead, but since 9/11 there have been other challenges to the air transport industry – not least Covid-19. This research primarily critically reviews the actions taken in the aftermath of 9/11 from the US and EU perspective, before consideration is given to the current/present situation, the new, and emerging challenges being faced. The research is undertaken through a legal/policy perspective. The findings are that internationally and regionally, society is not prepared for another attack and that there remain a number of challenges that stand to impact aviation;ultimately, more collective action is needed to mitigate for such risks going forward. © 2021. Journal of Strategic Security. All Rights Reserved
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Introduction: Establishment of a COVID19 Biospecimen Processing Facility (BPF) was undertaken, leveraging an existing Northwell Health Biospecimen Repository (NHBR). The purpose was to support COVID19 clinical trials and create a resource of biospecimens with clinical metadata. This institutional resource is envisioned to have impact on scientific inquiry, including innovation in clinical care and investigation of disease mechanisms. We present our experience, challenges, and scientific opportunities. Materials/Methods: NHBR pivoted from a cancer focus to COVID19, by establishing a dedicated BPF, redeploying existing personnel, recruiting additional volunteer health care workers, and building the IT infrastructure to support clinical trials and establish a COVID19 repository. Results: COVID19 biospecimens were obtained from three tertiary care facilities within Northwell Health;with inpatient COVID19 admission peak of 550, 711 & 304. NHBR staff of 6 Research Coordinators and 4 Pathologists' Assistants was supplemented by 22 volunteers. The Regeneron-Sanofi clinical trial to evaluate the efficacy of IL-6 inhibition with Sarilumab laid the framework for biospecimen processing. Additional COVID19 clinical trials continue to be supported by the BPF/NHBR. For biospecimen accrual, system data warehouse records were mined to identify biospecimens from COVID19 inpatients. A committee consisting of clinicians and clinical researchers provided guidance in developing the COVID19 BPF. The NHBRs preexisting global IRB-approved collection protocol obviated the need for an additional COVID19 biospecimen IRB protocol, which allowed for rapid activation of sample procurement. Accrual of 40,400 aliquots (serum, plasma, and whole blood) from 3,815 unique patients, including 366 COVID19 decedents. Viral Transport Medium (VTM) remnant specimens from more than 40,000 positive patients were retained. Conclusions: A database of remnant/discarded VTMs was established secondary to the patient care. Having a robust institutional research infrastructure is critical for preparedness and rapid response to the large-scale public health threat. Our call to action, rapid deployment and repurposing of existing assets enabled our health system to establish valuable resource that may enable us to further advance COVID19 related research. Limitations in our effort were: suspension of COVID19 biospecimen operations due to a shortage of human capital and a 4- month delay in procuring funding.
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The year 2020 has seen the COVID-19 virus lead to one of the worst global pandemics in history. As a result, governments around the world are faced with the challenge of protecting public health, while keeping the economy running to the greatest extent possible. Epidemiological models provide insight into the spread of these types of diseases and predict the effects of possible intervention policies. However, to date, the even the most data-driven intervention policies rely on heuristics. In this paper, we study how reinforcement learning (RL) can be used to optimize mitigation policies that minimize the economic impact without overwhelming the hospital capacity. Our main contributions are (1) a novel agent-based pandemic simulator which, unlike traditional models, is able to model fine-grained interactions among people at specific locations in a community;and (2) an RL-based methodology for optimizing fine-grained mitigation policies within this simulator. Our results validate both the overall simulator behavior and the learned policies under realistic conditions. Copyright © 2020 for this paper by its authors.
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The novel coronavirus (SARS-CoV-2) emerged in late 2019 and spread globally in early 2020. Initial reports suggested the associated disease, COVID-19, produced rapid epidemic growth and caused high mortality. As the virus sparked local epidemics in new communities, health systems and policy makers were forced to make decisions with limited information about the spread of the disease. We developed a compartmental model to project COVID-19 healthcare demands that combined information regarding SARS-CoV-2 transmission dynamics from international reports with local COVID-19 hospital census data to support response efforts in three Metropolitan Statistical Areas (MSAs) in Texas, USA: Austin-Round Rock, Houston-The Woodlands-Sugar Land, and Beaumont-Port Arthur. Our model projects that strict stay-home orders and other social distancing measures could suppress the spread of the pandemic. Our capacity to provide rapid decision-support in response to emerging threats depends on access to data, validated modeling approaches, careful uncertainty quantification, and adequate computational resources.