Using Population Mobility Patterns to Adapt COVID-19 Response Strategies in 3 East Africa Countries.

The COVID-19 pandemic spread between neighboring countries through land, water, and air travel. Since May 2020, ministries of health for the Democratic Republic of the Congo, Tanzania, and Uganda have sought to clarify population movement patterns to improve their disease surveillance and pandemic response efforts. Ministry of Health-led teams completed focus group discussions with participatory mapping using country-adapted Population Connectivity Across Borders toolkits. They analyzed the qualitative and spatial data to prioritize locations for enhanced COVID-19 surveillance, community outreach, and cross-border collaboration. Each country employed varying toolkit strategies, but all countries applied the results to adapt their national and binational communicable disease response strategies during the pandemic, although the Democratic Republic of the Congo used only the raw data rather than generating datasets and digitized products. This 3-country comparison highlights how governments create preparedness and response strategies adapted to their unique sociocultural and cross-border dynamics to strengthen global health security.

Uncontaining Mobility: Lessons from COVID-19 2nd AMMODI (African Migration, Mobility and Displacement) Annual Keynote Lecture, 30 June 2022

This keynote lecture argues that both the perpetrators of policed mobility and its victims can learn tremendous lessons from COVID-19? nimble-footedness, which humbles racialised technologies of containment and politics of redlining or something akin to it. The talk asserts that using technological gadgets that are very good at making it possible for us to be present in absence and absent in presence, strangers at various borders could borrow a leaf from COVID-19 on how to compress time and space in ways that enable even unwanted wayfarers to see, hear, smell, feel and touch virtually, thereby regaining freedom of movement by crossing borders undetected. The world as a whole could learn from resilient philosophies of kinship and solidarity in Africa to approach mobility in a more humane manner. Priority would be less on containment and more on accommodation of the stranger and freedom of movement.

ABDOMINAL COMPRESSION IN END-STAGE FIBROTIC INTERSTITIAL LUNG DISEASE (ILD) IMPROVES RESPIRATORY COMPLIANCE

SESSION TITLE: Critical Thinking SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 09:15 am - 10:15 am INTRODUCTION: Compressive therapies to improve respiratory mechanics, such as abdominal compression, have been described in literature in patients with COVID-19 induced acute respiratory distress syndrome (COVID-19 ARDS) 1–3. These compressive therapies minimize the risk of barotrauma by equal distribution of pressure across the alveoli. Hence, they help with lung protective ventilation. This phenomenon of paradoxical improvement in respiratory compliance with increase in intraabdominal pressure (IAP) has not been described in ILD population. We describe a case of end-stage fibrotic ILD, secondary to hypersensitivity pneumonitis (HP), exhibiting a paradoxical improvement in respiratory compliance with sustained abdominal compression. CASE PRESENTATION: 56-year-old female with history of NASH-related cirrhosis was transferred to our hospital for expedited work-up of lung transplant due to rapid progression of biopsy-proven steroid-unresponsive fibrotic HP. Due to worsening hypoxic respiratory failure, she was intubated on arrival to our hospital. Following intubation, she was sedated and paralyzed and was found to have high peak and plateau pressures in supine and reverse Trendelenburg positions. However, on application of abdominal pressure, her peak and plateau pressure showed a dramatic reduction in absolute values. This reduction was sustained during the entire duration of the maneuver. Overall, it reduced driving pressures and improved the static compliance of the respiratory system. We subsequently applied abdominal binder (table 1) and found a similar decrease in pressures (see images). Unfortunately, due to functional disability, patient was not deemed a candidate for lung and liver transplant and was transitioned to comfort measures. DISCUSSION: Paradoxical improvement in respiratory compliance has been demonstrated in late-stage COVID ARDS1,2. The mechanism behind this is unclear. In theory, increase in IAP increases intrapleural pressures, reduces end-expiratory volume and overdistention of aerated lung1,2. We hypothesize that patients with end-stage ILD behave similarly to patients with COVID-ARDS. However, this is purely exploratory as our observations are limited by lack of intrapleural measurements. Use of abdominal compression is a simple maneuver, which can be performed at the bedside to assess for the paradoxical phenomenon. Even though we postulate that long-term abdominal compression is well tolerated, we do not know the effects of sustained long-term abdominal compression on gas-exchange and chest wall dynamics. CONCLUSIONS: Patients with end-stage fibrotic lung disease, exhibiting high-driving pressures on mechanical ventilator in supine and reverse Trendelenburg positions, can be screened for reduction in peak and plateau pressures with abdominal compression. Use of this maneuver may help in lung-protective ventilation and minimize ventilator-induced lung injury. Reference #1: Elmufdi FS, Marini JJ. Dorsal Push and Abdominal Binding Improve Respiratory Compliance and Driving Pressure in Proned Coronavirus Disease 2019 Acute Respiratory Distress Syndrome. Crit Care Explor. 2021;3(11):e0593. doi:10.1097/cce.0000000000000593 Reference #2: Julia Cristina Coronado. Paradoxically Improved Respiratory Compliance With Abdominal Compression in COVID-19 ARDS. Is COVID-19 a risk factor Sev preeclampsia? Hosp Exp a Dev. 2020;(January):2020-2022. Reference #3: Stavi D, Goffi A, Shalabi M Al, et al. The Pressure Paradox: Abdominal Compression to Detect Lung Hyperinflation in COVID-19 Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2022;205(2):245-247. doi:10.1164/rccm.202104-1062IM DISCLOSURES: No relevant relationships by Abhishek Bhardwaj No relevant relationships by Brandon Francis no disclosure on file for Marina Freiberg;No relevant relationships by Simon Mucha No relevant relationships by Arsal Tharwani

Mesenchymal Stem Cell-Derived Extracellular Vesicles in the Management of COVID19-Associated Lung Injury: A Review on Publications, Clinical Trials and Patent Landscape.

The unprecedented COVID-19 pandemic situation forced the scientific community to explore all the possibilities from various fields, and so far we have seen a lot of surprises, eureka moments and disappointments. One of the approaches from the cellular therapists was exploiting the immunomodulatory and regenerative potential of mesenchymal stromal cells (MSCs), more so of MSC-derived extracellular vesicles (EVs)-particularly exosomes, in order to alleviate the cytokine storm and regenerate the damaged lung tissues. Unlike MSCs, the EVs are easier to store, deliver, and are previously shown to be as effective as MSCs, yet less immunogenic. These features attracted the attention of many and thus led to a tremendous increase in publications, clinical trials and patent applications. This review presents the current landscape of the field and highlights some interesting findings on MSC-derived EVs in the context of COVID-19, including in silico, in vitro, in vivo and case reports. The data strongly suggests the potential of MSC-derived EVs as a therapeutic regime for the management of acute lung injury and associated complications in COVID-19 and beyond.

ASSOCIATION OF GASTROINTESTINAL SYMPTOMS WITH OUTCOMES IN COVID-19 HOSPITALIZATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is a global health crisiswhich has caused a significant healthcare burden. Fever, cough and dyspnea are the classicsymptoms of COVID-19 but emerging literature has reported diarrhea, vomiting, loss ofappetite and other gastrointestinal symptoms (GI) as well. In this meta-analysis, we evaluatedthe association of diarrhea, vomiting and anorexia with outcomes in COVID-19 hospitalizedpatients.Methods: Data from observational studies describing GI symptoms and outcomes of COVID-19 hospitalized patients from December 1, 2019 till June 30, 2020 was extracted followingMOOSE guidelines with a consensus of four independent reviewers. Adverse outcomes weredefined as admission to the intensive care unit (ICU), oxygen saturation <90%, invasivemechanical ventilation (IMV), severe disease and in-hospital mortality. Data was analyzedusing Review Manager 5.4. The odds ratio (OR) and 95% confidence interval (95%CI) wereobtained and forest plots were created using random-effects models.Results: Out of 24 studies with 13,741 confirmed COVID-19 patients, 17 studies (4087patients), 5 studies (897 patients) and 5 studies (1751 patients) provided data on COVID-19 hospital outcomes and GI symptoms of diarrhea, anorexia and vomiting respectively. In patients with poor outcomes, the prevalence of diarrhea was 13.3%(187/1398), anorexia37%(172/464) and vomiting 7.6%(67/883). In meta-analysis, patients with anorexia(OR:4.27;95%CI:2.73–6.67;p<0.00001) and vomiting (OR:1.85;95%CI:1.13–3.05;p=0.02)had higher odds of poor outcomes compared to better outcomes with 0% heterogeneity (p=0.68 and p=0.91) respectively. Patients with diarrhea had no significant association withpoor outcomes (OR:1.04 (95%CI:0.75–1.44;p=0.81) with 23% heterogeneity (p=0.19).Conclusion: Our meta-analysis suggests that COVID-19 patients with anorexia and vomitinghad higher risk of poor outcomes and disease severity. Future studies should focus onwhether identification of GI invasion along with fecal PCR testing will help in early triageof high risk patients and improve outcomes.(Figure Presented)Figure 1: Forest Plot of Anorexia with Outcome in COVID-19 hospitalizations(Figure Presented)Figure 2: Forest Plot of Vomiting with Outcome in COVID-19 hospitalizations(Figure Presented)Figure 3: Forest Plot of Diarrhea with Outcome in COVID-19 hospitalizations

COVID-19-Associated Orphanhood and Caregiver Death in the United States (preprint)

Background: Most COVID-19 deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. Methods: We quantified COVID-19-associated caregiver loss and orphanhood in the US and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and co-residing grandparents, overall and by race/ethnicity. We further examined variations in COVID-19-associated orphanhood by race/ethnicity for each state. Results: We found that from April 1, 2020 through June 30, 2021, over 140,000 children in the US experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minorities, compared to Non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, Southeastern states for Black children, and in states with tribal areas for American Indian/Alaska Native populations. Conclusions: We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality childcare and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk, in the states most affected.

Response by the author

A non-linear future is much indebted to the rear-view mirror. [...]in answer to Morreira's question on the impact of the Covid-19 pandemic, one could argue that, due to structural inequalities inherited from the apartheid era and compounded by corruption and lip service to transformation under the ruling African National Congress (ANC) government, in South Africa, despite timely national state of disaster and prolonged lockdown measures taken to mitigate the explosive proliferation of Covid-19, the country has still emerged as having the most cases and the most deaths in Africa so far. [...]far from radically disrupting established hierarchies of inequalities in livelihoods, Covid-19 has mostly preyed upon and in some instances exacerbated existing victimhood and vulnerabilities. There is concern as well that the loan approved by the International Monetary Fund (IMF) to mitigate the negative economic effects of Covid-19 has only compounded the precarious situation of the South African poor, for a range of reasons, among which the IMF's notoriety as a cure that is often more dangerous than the disease. Taking cognizance of how what matters intersects in a given context is useful in bringing out the complexities and nuances in the situations and relationships that we are interested in exploring and explaining. Since publication of the book, I have become increasingly interested in how we could develop a framework of incompleteness as a replacement for the current dominant framework of completeness and the pursuit of superiority through zero-sum games of conquest and absolutes, violence and violations.

Infant delivery and maternal stress during the COVID-19 pandemic: a comparison of the well-baby versus neonatal intensive care environments.

OBJECTIVE: To describe impact of COVID-19 pandemic on stress and mood of new mothers, in particular in neonatal intensive care unit (NICU); a secondary objective was to assess whether customary social gender distancing practiced by ultra-religious Jews and Muslims offers built-in anti-stress protection. METHODS: Cross-sectional, observational survey of mothers of 52 normal newborn nursery (NNB) and 52 NICU infants. In all, 86 filled all the 6 questionnaires (Demographics, COVID-19 virus experience, Mental Health Inventory, Neonatal Satisfaction Survey, Parental Stressor Scale, and Questionnaire of Coping Strategies). RESULTS: Most mothers stated that COVID-19 pandemic had hurt social and family relationships, maternal role, and expressed stress and loneliness. Mothers of NICU infants had higher degree of helplessness. Religious social distancing was not protective. Background tendency to coping poorly with stress and depression most highly predicted stress. CONCLUSION: COVID-19 pandemic harms psychosocial well-being of most mothers. Detection of high-risk individuals is necessary to provide appropriate support.

Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations - United States, April 1-December 22, 2020.

Long-standing systemic social, economic, and environmental inequities in the United States have put many communities of color (racial and ethnic minority groups) at increased risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, as well as more severe COVID-19-related outcomes (1-3). Because race and ethnicity are missing for a proportion of reported COVID-19 cases, counties with substantial missing information often are excluded from analyses of disparities (4). Thus, as a complement to these case-based analyses, population-based studies can help direct public health interventions. Using data from the 50 states and the District of Columbia (DC), CDC identified counties where five racial and ethnic minority groups (Hispanic or Latino [Hispanic], non-Hispanic Black or African American [Black], non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], and non-Hispanic Native Hawaiian or other Pacific Islander [NH/PI]) might have experienced high COVID-19 impact during April 1-December 22, 2020. These counties had high 2-week COVID-19 incidences (>100 new cases per 100,000 persons in the total population) and percentages of persons in five racial and ethnic groups that were larger than the national percentages (denoted as "large"). During April 1-14, a total of 359 (11.4%) of 3,142 U.S. counties reported high COVID-19 incidence, including 28.7% of counties with large percentages of Asian persons and 27.9% of counties with large percentages of Black persons. During August 5-18, high COVID-19 incidence was reported by 2,034 (64.7%) counties, including 92.4% of counties with large percentages of Black persons and 74.5% of counties with large percentages of Hispanic persons. During December 9-22, high COVID-19 incidence was reported by 3,114 (99.1%) counties, including >95% of those with large percentages of persons in each of the five racial and ethnic minority groups. The findings of this population-based analysis complement those of case-based analyses. In jurisdictions with substantial missing race and ethnicity information, this method could be applied to smaller geographic areas, to identify communities of color that might be experiencing high potential COVID-19 impact. As areas with high rates of new infection change over time, public health efforts can be tailored to the needs of communities of color as the pandemic evolves and integrated with longer-term plans to improve health equity.

Liver disease and poor outcomes of COVID-19 hospitalizations-a meta-analysis

Background: COVID-19 pandemic has been a challenge with globally 12,567,457 coronavirus cases reported and 561,879 deaths as of July 11, 2020 Isolated small studies have reported the prevalence of comorbid chronic liver disease (CM-CLD) and COVID-19 associated acute liver injury (COVID-19-ALI) in hospitalized patients In this metaanalysis, we assessed the association of comorbid liver disease and acute liver injury and outcomes in COVID-19 hospitalized patients Methods: Observational studies describing the CM-CLD and COVID-19-ALI and outcomes of COVID-19 hospitalized patients from December 1, 2019, to June 30, 2020, were identified. Data was extracted following MOOSE guidelines with a consensus of four independent reviewers. Adverse outcomes were defined as admission to intensive care unit (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in-hospital mortality Data was analysed using Review Manager 5 4 The odds ratio (OR) and 95% confidence interval (95%CI) were obtained and forest plots were created using randomeffects models The p value <0 05 was considered statistically significant. Results: 12 studies with 7564 confirmed COVID-19 patients were included Out of these, 12 studies (7564 patients) and 3 studies (146 patients) provided data on CM-CLD and COVID-19-ALI, respectively The pooled prevalence of CM-CLD was 2 67% [(202/7564)∗d COVID-19-ALI was 22 6% [(33/146)∗ patients with poor outcomes, the prevalence of CM-CLD was 2 4%(54/2233) and COVID-19-ALI was 32% (18/56) In meta-analysis, CM-CLD had no significant association with poor outcomes (OR:0 89;95%CI:0 65-1 22;p=0 47) with no heterogeneity in the data (p=0 93;I2=0%) COVID-19-ALI had higher odds of poor outcomes with OR of 2 49 (95%CI:1 09-5 69;p=0 03) and without any significant heterogeneity between studies (p=0 67;I2=0%) Conclusion: Our meta-analysis suggests that acute liver injury was significantly associated with COVID-19 severity and poor outcomes Future studies should evaluate changing levels of biomarkers amongst liver disease patients to predict poor outcomes of COVID-19.

Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 - United States, May-August 2020.

During February 12-October 15, 2020, the coronavirus disease 2019 (COVID-19) pandemic resulted in approximately 7,900,000 aggregated reported cases and approximately 216,000 deaths in the United States.* Among COVID-19-associated deaths reported to national case surveillance during February 12-May 18, persons aged ≥65 years and members of racial and ethnic minority groups were disproportionately represented (1). This report describes demographic and geographic trends in COVID-19-associated deaths reported to the National Vital Statistics System† (NVSS) during May 1-August 31, 2020, by 50 states and the District of Columbia. During this period, 114,411 COVID-19-associated deaths were reported. Overall, 78.2% of decedents were aged ≥65 years, and 53.3% were male; 51.3% were non-Hispanic White (White), 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black (Black). The number of COVID-19-associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. From May to August, the percentage distribution of COVID-19-associated deaths by U.S. Census region increased from 23.4% to 62.7% in the South and from 10.6% to 21.4% in the West. Over the same period, the percentage distribution of decedents who were Hispanic increased from 16.3% to 26.4%. COVID-19 remains a major public health threat regardless of age or race and ethnicity. Deaths continued to occur disproportionately among older persons and certain racial and ethnic minorities, particularly among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups.