Swimming during COVID-19: Operational recommendations and considerations for South African swimming venues.

Swimming is one of the most popular recreational activities in South Africa. Since the emergence of the Coronavirus disease 2019 (COVID-19), South Africa imposed one of the strictest lockdown measures to contain and control the spread of the virus. These measures included the closure of gyms, fitness centres and swimming pools across the country. However, as the restrictions begin to ease, it is important to consider how swimming facilities can reopen whilst simultaneously ensuring appropriate measures are in place to reduce COVID-19 infections. Outlined are recommendations and considerations for swimming facilities in South Africa. Currently there is no evidence to suggest that COVID-19 transmission to humans is possible through water, making swimming one of the safer options for physical activity indoors. However, participation is still not without risk and compliance with government mandates and public health officials take precedent over the recommendations outlined in this article.

Family Diabetes Camp Amidst COVID-19: A Community of Practice Model

Studies have found that youth are experiencing higher anxiety levels than prior to COVID-19, and youth with type 1 diabetes are at higher risk. Medical specialty camps are a type of camp that provide opportunities for youth with chronic illnesses to share common goals, increase socialization, improve camper well-being, and increase knowledge of diabetes management. The program evaluation sought to determine the impact of a campers' outcomes of independence and perceived competence and familial impact during COVID-19. Over half the participants were at their first diabetes camp and 71% of the campers felt their perceived competence "increased a little bit" because of camp. Over 95% of parents felt that their participation in camp had increased their diabetes knowledge. Qualitative data from parents revealed 2 themes, camp as a meeting place and learning from others. The findings from this study demonstrate that medical specialty camps influence campers' perceptions of independence and competence and that families play an important role in creating a community of practice.

Impact of Washington State's Increasing STI Burden on Case Investigation Patterns among Priority Groups

BACKGROUND: In recent years, Washington State has seen an increasing burden of STIs. Insufficient staffing capacity, exacerbated by the COVID-19 pandemic, presents challenges for initiating case investigations, important for connecting affected individuals to appropriate treatment and stemming further transmission. This study examines impacts of the rising gonorrhea and syphilis burden on case investigation patterns among high-risk priority groups. METHOD(S): Records from Washington's statewide STI surveillance data system (PHIMSSTD) were included for all reported gonorrhea and syphilis cases diagnosed in 2016-2020. Cases were considered 'uninvestigated' if zero contact attempts and no interview were on record;they were 'initiated' if at least one contact attempt or interview (complete or partial) was indicated. Data was stratified by priority group and jurisdiction-level morbidity and staffing indicators. Chi-square tests were performed to assess changes in the number of initiated cases from aggregate 2016-2019 data to 2020 data for each priority group and in 2020 across jurisdiction-level indicators. RESULT(S): Comparing aggregate 2016-2019 data to 2020 data, there were significant increases in the number of uninvestigated gonorrhea and syphilis cases (p-value<0.0005). For gonorrhea, this was seen among MSM, pregnant persons, females of reproductive age, and cases randomly sampled for interview based on the STD Surveillance Network (SSuN) protocol (all pvalues <0.0005). For syphilis, an increase was seen among MSM (p-value <0.0005) but not among female cases. In 2020, gonorrhea had a greater proportion of uninvestigated cases (58%) than syphilis (27%). A lower proportion of uninvestigated gonorrhea cases were in counties with designated staff for STI case investigation work compared to counties without such capacity (p-value<0.0005), but there was no such difference for syphilis cases. CONCLUSION(S): Results suggest that Washington's increasing burden of gonorrhea and syphilis has greatly reduced case investigations overall and within priority groups. The resulting decreased identification of partners places communities at greater risk of STI transmission.

Equipping Small Businesses to Navigate Health Orders and Occupational Safety During the COVID-19 Pandemic

From July 2020 to June 2021, the UC San Diego COVID-19 Small Business Outreach Project conducted COVID-19-related educational outreach to small businesses in high-risk communities of San Diego County and distributed over 1,200 toolkits containing COVID-19-related safety tips, best practices, and a summary of pertinent guidelines and COVID-19 vaccine information.

Allogeneic, Off-the-Shelf, SARS-CoV-2-specific T Cells Demonstrate Reactivity Against Emerging Variant Strains

Background. The impact of COVID-19 has been profound with >170,000,000 confirmed cases worldwide and emerging variants being a cause of global concern. Defects in T-cell function and trafficking have been described among those with severe illness, and immunodeficiency is a risk factor for persistent viral shedding and prolonged symptoms. Because of our prior clinical data demonstrating that allogeneic, off-the-shelf virus-specific T cells (VSTs) can safely and effectively treat viral infections, we investigated the feasibility of targeting COVID-19 using banked, SARS-CoV-2-specific VSTs. Methods. We first screened PBMCs from convalescent individuals against 18 structural and non-structural/accessory (NSPs/APs) SARS-CoV-2 proteins and identified 5 [Spike (S), Membrane (M), Nucleoprotein (N), NSP4, and AP7a] as immunodominant which were then advanced to our VST production process. Results. Using overlapping peptide libraries spanning these antigens as a stimulus, we achieved a mean 7.6±0.9 fold expansion (n=13) of VSTs (96±0.5%), with a mixture of cytotoxic (CD8+) and helper (CD4+) T cells that expressed activation and central/effector memory markers. These VSTs were potent, Th1-polarized and polyfunctional, producing IFNγ, TNFα, GM-CSF and Granzyme B. Moreover, the VSTs were able to kill pepmix-loaded autologous targets with no evidence of auto- or alloreactivity, attesting to their virus selectivity and safety for clinical use (Figure 1). Finally, though initially generated against the reference strain NC-045512.2 (Wuhan), these VSTs were able to recognize other clinically important variants including B1.1.7 (UK), B1.351 (South Africa) and P1 (Brazil). This demonstrates the cross-reactive potential of these polyclonal and diverse VSTs, which were developed to provide potent antiviral effects and minimize the risk of immune escape due to sequence variation. Figure 1: SARS-CoV-2 Specific T cells Have Demonstrated Selective Cytolytic Activity against SARS-CoV-2 While Leaving Non-Virus Infected Targets Intact. Conclusion. In conclusion, it is feasible to generate polyclonal SARS-CoV-2 VSTs that provide coverage against variant strains using GMP-compliant manufacturing methodologies. We have advanced this product to the bedside for administration in a Phase I, randomized clinical trial [VSTs+ standard of care (SOC) vs SOC] in high-risk patients hospitalized with COVID-19 (NCT04401410).

Underlying principles of a proactive team quality improvement drive towards web based platforms for remote nurse and dietitian data review in 2018, was used to inform a rapid response to the Covid pandemic, ensuring safety and support for families and continuation of medical and team input remotely

A team quality improvement drive in 2018 to enable families to upload blood glucose data from home, encouraging self-review, independent management, and frequent proactive insulin adjustment, led to provision of a new nurse and dietitian led email clinic. The popularity and demand increased by 2019, and the service expanded in response to patient voice. Only a handful of families were able to review their data remotely, but within a few months of the initiative, an estimated 98% had this facility either at home, or via extended family, school or college. A remote email clinic was provided to review uploaded data. This proved so popular that the provision increased from 2 hrs a week for 4 days, to a 6 day a week service. It was well evaluated by families, and almost every review led to an insulin adjustment. The PDSA cycles for this work diminished the level of risk with each cycle by producing and adapting robust proformas to record baseline information and adjustments in a consistent format, and to encourage independent decision making from the outset. This wealth of experience was subsequently drawn upon by the medical team during Covid lockdown and the abrupt halt of face to face consultations. A rapid transition to telephone appointments could easily be made. Uploading and remote data review was already well practiced, and families felt this to be a normal way of support and reassurance. A diabetes team mobile app was provided free of charge to families at the start of lockdown to provide an immediately accessible means to share public health alerts regarding shielding, school closures, emergency advice, information about changes to hospital services, and support for well being. Communication between the multidisciplinary team for peer review and support and vulnerable patient handover was maintained by moving to Microsoft Teams and WhatsApp. Youth team support was delivered by Zoom. Families have been grateful for continuity of care in the face of other uncertainty.

Reduction of CF clinic visit time: A singlecenter quality improvement study to incorporate more subspecialists in clinic

Background: Multidisciplinary clinics are the hallmark of cystic fibrosis (CF) care, but more experts often add time to the clinic visit. CF clinic appointment time at our institution extended to 170 minutes with approximately 6-8 disciplines per patent. To embed recent CF Foundation- supported scholars from Endocrinology (ENDO) and Gastroenterology (GI) into clinic, we sought to streamline visit time for patients and families without compromising multidisciplinary care. Objective: To maintain coordinated multidisciplinary clinic visit time at 120 minutes with the addition of ENDO and GI specialists after October 2019. Methods: A multidisciplinary quality improvement team including 2 parent partners met weekly to organize the initiative. We surveyed the CF clinic team to rank perceived barriers. We asked families perceived barriers to clinic through an added question on our clinic intake form and a survey to our Parent Advisory Council. Using pareto charts, we developed interventions to target most common barriers: 1) clinic road map to communicate across team which disciplines have priority patient assessments, 2) facilitator to decrease wait time between providers, 3) nurse-doctor (RN-MD) paired visits for shared communication and earlier RN sign-out of families. We tested interventions with plan-do-study-act (PDSA) cycles. We met hospital administrators monthly to accommodate PDSA cycles and adjust templates and rooms as needed. A subset of clinics were timed and displayed on a run chart monthly with interventions annotated. Visit time was compared before (5/2019-8/2019) and after (10/2019-3/2020) integration of ENDO and GI into clinic. Results: Survey of team members' perceived barriers to clinic had 24 responses. Most parent responses (14 of 19) reported concerns of wait time or visit length. PDSAs started in June 2019 before integration of ENDO and GI. Road map PDSAs adapted processes for improved use and integration of the tool. Clinic facilitator role was adopted with a medical assistant in the role. RN-MD pairs had positive feedback from both RNs and MDs. Prior to PDSAs, average clinic visit time was 127 minutes. Of 18 timed clinics, 7 had ENDO/GI provider present. Prior to ENDO and GI integration, clinic visit time was reduced to average clinic visit time of 121 minutes. Following integration, clinic visit time was maintained at 121 minutes. Proportion of clinic visit spent between waiting between team members was 26% (total time=31 minutes) which was also stable to slightly improved to 23% (28 minutes) after integration of ENDO and GI. Team members reported high satisfaction with all clinic visits finishing on time post-integration. Some families informally shared high satisfaction/noticeable change in duration of clinic visits. Conclusion: Interventions designed to address barriers in clinic flow demonstrated improvement in clinic visit time despite embedding 2 new subspecialists. COVID-19 limited further PDSAs for in-person clinic visits, however poises our team to address care coordination and communication for hybrid in-person and virtual models.