Implementation of solar powered oxygen delivery in a conflict zone: preliminary findings from Somalia on feasibility and usefulness.

Access to therapeutic oxygen in low-resource settings remains a significant global problem. Solar powered oxygen (SPO2) delivery is a reliable and cost-effective solution. We followed implementation research methodology to gather data on engineering parameters (remote monitoring), nurse training (before and after knowledge questionnaire), patients treated with SPO2 (descriptive case series), and qualitative user feedback (focus group discussions). In January 2021, SPO2 was installed at Hanano General Hospital in Dusamareb, Galmudug State, Somalia, in a conflict-affected region. Daily photovoltaic cell output (median 8.0 kWh, interquartile range (IQR) 2.6-14) exceeded the electrical load from up to three oxygen concentrators (median 5.0 kWh, IQR 0.90-12). Over the first six months after implementation, 114 patients (age 1 day to 89 years, 54% female) were treated for hypoxaemic illnesses, including COVID-19, pneumonia, neonatal asphyxia, asthma, and trauma. Qualitative end user feedback highlighted SPO2 acceptability. Violent conflict was identified as a contextual factor affecting local oxygen needs. We provide the preliminary findings of this implementation research study and describe the feasibility, fidelity, rapid adoption, usefulness, and acceptability of SPO2 in a low-resource setting characterized by violent conflict during the COVID-19 pandemic. Our findings demonstrated the lifesaving feasibility of SPO2 in volatile settings.

Vaccinating Children against COVID-19: Commentary and Mathematical Modeling.

With the recent licensure of mRNA vaccines against COVID-19 in the 5- to 11-year-old age group, the public health impact of a childhood immunization campaign is of interest. Using a mathematical epidemiological model, we project that childhood vaccination carries minimal risk and yields modest public health benefits. These include large relative reductions in child morbidity and mortality, although the absolute reduction is small because these events are rare. Furthermore, the model predicts "altruistic" absolute reductions in adult cases, hospitalizations, and mortality. However, vaccinating children to benefit adults should be considered from an ethical as well as a public health perspective. From a global health perspective, an additional ethical consideration is the justice of giving priority to children in high-income settings at low risk of severe disease while vaccines have not been made available to vulnerable adults in low-income settings. IMPORTANCE Countries have recently begun implementation of childhood vaccination against SARS-CoV-2 with the Pfizer/BioNTech mRNA vaccine in children 5 to 11 years of age. Because SARS-CoV-2 disease severity is remarkably age dependent, vaccinating children may have modest public health benefits, relative to the unequivocal benefit of vaccinating vulnerable older adults. Furthermore, vaccinating children to "altruistically" increase herd immunity should be considered from an ethical as well as a public health perspective. An additional question is related to global social justice: should priority be given to vaccinating children in high-income settings while older adult populations in low-resource settings have limited access to vaccine? To address the risks and benefits of childhood vaccination, we provide a balanced commentary, supported by a mathematical epidemiological model, using Australia and Alberta, Canada, as case studies. We give highlights of the modeling findings in the commentary and include details in the supplemental materials for interested readers.

Seasonality of Respiratory Viruses at Northern Latitudes.

Importance: Every year, respiratory viruses exact a heavy burden on Canadian hospitals during winter months. Generalizable seasonal patterns of respiratory virus transmission may estimate the evolution of SARS-CoV-2 or other emerging pathogens. Objective: To describe the annual and biennial variation in respiratory virus seasonality in a northern climate. Design, Setting, and Participants: This cohort study is an epidemiological assessment using population-based surveillance of patients with medically attended respiratory tract infection from 2005 through 2017 in Alberta, Canada. Incident cases of respiratory virus infection and infant respiratory syncytial virus (RSV) hospitalizations in Alberta were extracted from the Data Integration for Alberta Laboratories platform and Alberta Health Services Discharge Abstract Database, respectively. A deterministic susceptible-infected-recovered-susceptible mathematical model with seasonal forcing function was fitted to the data for each virus. The possible future seasonal course of SARS-CoV-2 in northern latitudes was modeled on the basis of these observations. The analysis was conducted between December 15, 2020, and February 10, 2021. Exposures: Seasonal respiratory pathogens. Main Outcomes and Measures: Incidence (temporal pattern) of respiratory virus infections and RSV hospitalizations. Results: A total of 37 719 incident infections with RSV, human metapneumovirus, or human coronaviruses 229E, NL63, OC43, or HKU1 among 35 375 patients (18 069 [51.1%] male; median [interquartile range], 1.29 [0.42-12.2] years) were documented. A susceptible-infected-recovered-susceptible model mirrored the epidemiological data, including a striking biennial variation with alternating severe and mild winter peaks. Qualitative description of the model and numerical simulations showed that strong seasonal contact rate and temporary immunity lasting 6 to 12 months were sufficient to explain biennial seasonality in these various respiratory viruses. The seasonality of 10 212 hospitalizations among children younger than 5 years with RSV was also explored. The median (interquartile range) rate of hospitalizations per 1000 live births was 18.6 (17.6-19.9) and 11.0 (10.4-11.7) in alternating even (severe) and odd (less-severe) seasons, respectively (P = .001). The hazard of admission was higher for children born in severe (even) seasons compared with those born in less-severe (odd) seasons (hazard ratio, 1.68; 95% CI, 1.61-1.75; P < .001). Conclusions and Relevance: In this modeling study of respiratory viruses in Alberta, Canada, the seasonality followed a pattern estimated by simple mathematical models, which may be informative for anticipating future waves of pandemic SARS-CoV-2.

Neuroinvasive potential of human coronavirus OC43: case report of fatal encephalitis in an immunocompromised host.

Neurologic manifestations of COVID-19 include anosmia, ageusia, encephalopathy, agitation, confusion, ischemic strokes, Guillain-Barré syndrome, seizures, and hemorrhagic encephalitis. Although mechanisms of central nervous system (CNS) injury are likely diverse, direct viral invasion of the CNS has been demonstrated in case reports. Neurotropism of human coronaviruses (HCoVs) is therefore of great interest in the context of the COVID-19 pandemic. Here we present an autopsy-proven case of fatal human coronavirus (HCoV)-OC43 encephalitis in an infant with aplastic thymus and chronic T-cell lymphopenia. Clinicians should remain alert to the possibility of direct CNS invasion by human coronaviruses, including the novel pandemic SARS-CoV-2.

Prevention of COVID-19 in Internally Displaced Persons Camps in War-Torn North Kivu, Democratic Republic of the Congo: A Mixed-Methods Study.

BACKGROUND: The coronavirus disease (COVID-19) pandemic poses a grave threat to refugees and internally displaced persons (IDPs). We examined knowledge, attitudes, and practices with respect to COVID-19 prevention among IDPs in war-torn Eastern Democratic Republic of the Congo (DRC). METHODS: Mixed-methods study with qualitative (focus group discussions, [FGDs]) and quantitative (52-item survey questionnaire) data collection and synthesis. RESULTS: FGDs (N=23) and survey questionnaires (N=164 IDPs; N=143 comparison group) were conducted in May 2020. FGD participants provided narratives of violence that they had fled. IDPs were statistically more likely to have larger household size, experience more extreme poverty, have lower educational attainment, and have less access to information through media and internet versus the comparison group (P<.05 for the comparison group). IDPs had a high level of awareness (99%) and fear (98%) of COVID-19, but lower specific knowledge (15% sufficient knowledge versus 30% among the comparison group, P<.0001), a difference which remained significant in a multivariable model adjusting for confounding. IDPs faced major barriers to implementing COVID-19 prevention measures. Physical distancing was impossible for IDPs in crowded shelters, and 70% reported coming in close contact with someone other than a family member within the past 24 hours (versus 56% of the comparison group, P=.014). Frequent movements in and out of the camp for subsistence left IDPs vulnerable to the introduction of COVID-19: 61% left the camp on a daily basis and 65% had received a visitor in the past month. Despite acceptance of hand hygiene for prevention, 92% lacked soap (versus 65% of the comparison group, P<.0001). IDPs' desire for peace and to return to their native homes, where COVID-19 precautions could be feasibly implemented, overshadowed their perceived benefits of measures such as a COVID-19 vaccine. CONCLUSIONS: These findings provide empiric evidence supporting the vulnerability of IDPs to COVID-19 and call for action to protect neglected displaced populations.

The Interaction of Natural and Vaccine-Induced Immunity with Social Distancing Predicts the Evolution of the COVID-19 Pandemic.

The existence and nature of immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are currently unknown; however, neutralizing antibodies are thought to play the major role and data from studying other coronaviruses suggest that partial clinical immunity lasting up to 1 year will occur postinfection. We show how immunity, depending on its durability, may work with current social practices to limit the spread of the virus. We further show that a vaccine that is 50% effective and taken by 50% of the population will prevent further loss of life, providing that social distancing is still practiced and that immunity does not wane quickly.IMPORTANCE The ability of our society to function effectively moving forward will depend on how the spread of the SARS-CoV-2 virus is contained. Immunity to the virus will be critical to this equation.

Review of Ebola virus disease in children - how far have we come?

Ebola virus (EBOV) causes an extremely contagious viral haemorrhagic fever associated with high mortality. While, historically, children have represented a small number of total cases of Ebolavirus disease (EVD), in recent outbreaks up to a quarter of cases have been in children. They pose unique challenges in clinical management and infection prevention and control. In this review of paediatric EVD, the epidemiology of past EVD outbreaks with specific focus on children is discussed, the clinical manifestations and laboratory findings are described and key developments in clinical management including specific topics such as viral persistence and breastfeeding while considering unique psychosocial and anthropological considerations for paediatric care including of survivors and orphans and the stigma they face are discussed. In addition to summarising the literature, perspectives based on the authors' experience of EVD outbreaks in the Democratic Republic of the Congo (DRC) are described.Abbreviations: ARDS: acute respiratory distress syndrome; aOR: adjusted odds ratio; ALT: alanine transferase; ALIMA: Alliance for International Medical Action; AST: aspartate transaminase; BUN: blood urea nitrogen; CNS: central nervous system; CUBE: chambre d'urgence biosécurisée pour épidémie; COVID-19: coronavirus disease 2019; Ct: cycle threshold; DRC: Democratic Republic of Congo; ETC: ebola treatment centre; ETU: ebola treatment unit; EBOV: ebola virus; EVD: ebolavirus disease; FEAST: fluid expansion as supportive therapy; GP: glycoprotein; IV: intravenous; MEURI: monitored emergency use of unregistered interventions; NETEC: National Ebola Training and Education Centre; NP: nucleoprotein; ORS: oral rehydration solution; PALM: Pamoja Tulinde Maisha; PREVAIL: Partnership for Research on Ebola Virus in Liberia; PPE: personal protective equipment; PCR: polymerase chain reaction; PEP: post-exposure prophylaxis; RDTs: rapid diagnostic tests; RT: reverse transcriptase; RNA: ribonucleic acid; UNICEF: United Nations International Children's Emergency Fund; USA: United States of America; WHO: World Health Organization.