COVID-19 Implications in Mental Health and Opioid Use Disorder Treatment: Qualitative Study

Introduction: Federal agencies announced in March 2020 regulatory changes for opioid treatment programs (OTPs) to ensure patient and staff safety - extended methadone take-home dosing and increased use of telehealth counseling. Qualitative interviews explored OTP patient and staff perceptions on how the COVID 19 pandemic and these regulatory changes impacted addiction treatment engagement and recovery support. Method(s): Semi-structured, one-to-one telephone interviews were completed between August 2020 and January 2021 with 46 patients with varying amounts of take-home doses and 6 staff from 3 rural OTPs in Oregon. Interviews were audio-recorded, and transcribed verbatim. Transcriptions were coded at the semantic level, with codes generated both deductively and inductively. Directed content analysis extracted themes in an iterative process. Result(s): Staff worried more than patients about return to opioid use due to COVID-19 related stressors. Staff were concerned about reduced contact and interaction with patients they previously had with group and individual counseling, despite telemedicine availability. Patients voiced anxiety about contracting COVID-19 or transmitting the virus to their families and communities while engaging in methadone treatment. A few patients with extended methadone take-home regimens requested to return to daily clinic dosing for enhanced staff/clinic support stating they were too new in recovery. Some patients struggled with their mental health, noting social isolation, and missing the usual recovery supports of in-person counseling at the OTP. Others, however, stated it helped to keep to yourself. Conclusion(s): OTPs perform a vital service of providing patients mental health services during public health emergencies. During COVID, patients and staff reflected on adjusting to new regulatory procedures and policies, despite increased anxiety and changing support needs. There was a range of preferences, signaling that a single approach may work for most but can be detrimental to some. To the extent it is feasible, OTPs should offer more individualized treatment plans.

Embracing the Power of Show-Me ECHO Learning Communities to Transform Clinical Practice in Missouri

Show-Me ECHO, a state-funded project, provides access to education within a community of learners in order to optimize healthcare for the citizens of Missouri. Through videoconferencing and case-based review, ECHO shifts professional development from learning about medical problems in isolation to experiential learning as part of a multidisciplinary team. The establishment of a statewide COVID-19 ECHO is allowing a rapid response to this novel, unprecedented, and unanticipated health care crisis. There are many ongoing opportunities for clinicians from across the state to join a Show-Me ECHO learning community as a means to elevate their practice and improve ability to respond amidst a constantly evolving health care environment. Copyright 2020 by the Missouri State Medical Association.

Adverse effects of COVID-19 vaccination among cancer patients: Results from an Internetbased survey

Background: The rapid development of safe and effective vaccines against SARS-CoV-2 may stem the global COVID-19 pandemic. However, since individuals with cancer were under-represented during clinical vaccine trials, experience with COVID-19 vaccines among cancer patients is limited. Methods: An internet-based survey was conducted January 15 -February 10, 2021 among members of the Inspire online health community. The 63-item survey was emailed to members of the Inspire community who had opted-in for research. Results: Out of 19,152 respondents, 4895 (25%) self-reported a cancer diagnosis. Of these, 1337 (27%) were receiving active therapy. Cancer respondents were 66% female, 77% white, 44% college educated, with a median age range 55-65 years. 88% had solid tumors and 12% hematologic malignancies. 241 (5%) had prior COVID-19 and 148 (3%) thought they had had it but were not tested. Among cancer patients with COVID-19 approximately 30% reported ongoing late symptoms. At the time of survey, 1335 (27%) cancer patients had received a COVID-19 vaccine (Moderna 51% Pfizer-BioNTech 46%, Astra-Zeneca 3%, Other/unknown >1%). Following the first injection, 63% had local adverse events (AEs): injection site pain (51%), swelling (8%), redness (6%), and itching (4%). 34% reported systemic AEs including myalgia (32%), fatigue (18%), headache (12%), joint pain (5%), and chills (5%). 199 (15%) had received the second (booster) vaccination. 76% reported local AEs including pain (69%), swelling (14%), itching (8%), and redness (7%). 67% reported systemic AEs including fatigue (49%), myalgia (30%), headache (29%), chills (23%), fever (16%), joint pain (15%), and nausea (12%). AEs were comparable to the clinical trial results obtained from the general population (fda.gov/media/144245/download &144434/download). Conclusions: In this internet-based survey drawn from the Inspire online health community 1335 cancer patients reported receiving COVID-19 vaccinations. Byself-report the vaccines were well tolerated with AEs patterns mimicking clinical trial results conducted in the general population. These safety results should be reassuring to cancer patients although attention to COVID-19 vaccine efficacy is required (and will be studied during follow-up surveys).

People with cancer are likely to accept the COVID-19 vaccine, but politics tracks with attitudes: An inspire and COSMO survey

Background: Vaccines are a major step towards control of the COVID-19 pandemic. Estimates from multiple surveys of the general public indicate that 40 to 60% plan to be vaccinated, with some data suggesting that uptake differs by political leanings. The views of people with cancer on COVID-19 vaccination have not been reported. We report survey results of people with cancer, evaluating intent and attitudes toward COVID-19 vaccinations. Methods: An online survey included self-identified patients with cancer, ≥18 years old, in the Inspire Online Community (www.inspire.com). Invitation was restricted to only members of Inspire's cancer support groups who agreed to be contacted for research. Quantitative data were summarized with descriptive statistics. Data were analyzed by chi-square, ANOVA, and post hoc Tamhane' T2 testing. Results: 750 responded with the most common cancers represented being prostate (30%), thyroid (24%) ovarian (20%), bladder (8%) and breast (4%). 44% were between 46 and 65 years old and 48% were over 65. Of these, 38% reported being on active treatment. The majority were white (91%), female (56%) and had a bachelor's degree or higher (72%). Respondents represented the South (38%), West (28%), Midwest (20%), and Northeast (18%). Nearly half of respondents lived in a suburb near a large city. Almost 40% reported an annual income of > $100,000 and 13% reported income < $50,000/year. The proportion that would 'definitely' or 'most probably' get the COVID-19 vaccine was 80%, with significantly greater interest in people with prostate (85%), bladder (82%) and ovarian cancer (81%). Those with breast cancer reported the highest levels of being uncertain (23%) and 30% of those with thyroid cancer reported they would 'probably' or 'definitely' not get vaccinated. Older age, male sex, and college graduates were significantly more likely to get vaccinated. Concerns about side effects were reported by 54%, with younger patients significantly more concerned than those 66 years and older. Of 158 participants who listed other reasons they would not get vaccinated, 23% were concerned that the research and development was rushed and 11% worried about how it might interact with a compromised immune system. Using the 2020 Electoral College map to indicate political leaning at the state level, there was no significant difference in vaccine uptake, although significantly more people from blue states agreed that vaccination was the best defense against COVID-19 compared to those from red states (67 vs 33%, p <.05). Conclusions: People with cancer are much more interested in COVID-19 vaccination compared to the general public. Despite this, a large percentage of people with cancer reported distrust in either the government and/or the healthcare industry. Although vaccine attitudes tracked with political leanings at the state level, intention to get vaccinated did not.

Assessing mortality difference across COVID-19 intubation strategies

Rationale: The optimal timing of invasive mechanical ventilation (IMV) among patients with COVID-19 related acute respiratory failure (ARF) is unknown. Use of high flow nasal cannula (HFNC) support could potentially avoid the need for IMV and related risks. However, patients failing HFNC may be at increased risk for peri-intubation complications such as cardiac arrest. At NewYork-Presbyterian Weill Cornell Medical Center (NYP-WCMC) and Lower Manhattan Hospital (LMH), an early IMV strategy prior to March 26th 2020. We subsequently switched to a prolonged observation strategy, supporting patients with non-invasive devices including HFNC. In this study, we compared in-hospital mortality in patients with ARF managed with early IMV strategy versus a prolonged observation strategy. Methods: This is a retrospective cohort study using the Weill Cornell COVID-19 Registry, which included 1869 patients admitted with a COVID-19 positive PCR test up until May 15, 2020. Patients at risk for intubation due to ARF, defined by requiring > 6 liters/min nasal cannula, were included. Patients who met ARF criteria prior to March 26, 2020 were in the early IMV strategy group, and those who met criteria on or after March 26, 2020 were in the prolonged observation strategy group. In-hospital mortality with intubation strategy as the main exposure was modelled with cox proportional hazards regression. Confounders included age, sex, BMI, comorbidities, severity of illness (SOFA) and hospital strain (difference between daily admissions and discharges). Both SOFA and hospital strain were calculated for each patient on the day that they developed ARF for modelling purposes. Results: We identified 774 patients at risk for intubation due to ARF (table), 141 were in the early IMV group and 633 were in the prolonged observation strategy group. Death occurred in 33.3% of patients in the early IMV group compared to 34.8% in the prolonged observation group. Patients in the early IMV group had a longer length of stay among survivors (27.2 ± 26.1 days vs 21.6 ± 22.8 days, p = .0213). Age-adjusted hazard ratio for death comparing early IMV versus prolonged observation was 1.35 (95% CI 0.86-2.12, which decreases to 0.87 (95% CI 0.52-1.45) after adjusting for confounders. Conclusion: In this retrospective observational study with a modest sized sample, early IMV strategy was not associated with excess mortality compared to prolonged observation. In resource constrained settings, prolonged observation with HFNC support is a reasonable hospital-level strategy in patients with ARF.

Perceived stress, resilience, well-being, and COVID 19 response in Isha yoga practitioners compared to matched controls: A research protocol.

OBJECTIVES: The COVID-19 pandemic has been a significant stressor worldwide and reports of psychological distress, depression, sedentary lifestyles, and overall decreased wellbeing are increasing. Yoga practices have been found to improve mental and physical health. The purpose of this randomized controlled trial is to compare Isha yoga practitioners to controls on perceived stress, resilience, wellbeing, and protection and recovery from COVID-19. Trial Design. In this prospective randomized control trial, the effects of yoga practices are being compared between seasoned yoga practitioners with two controls who are age (±3 years), gender matched, and living in the same neighborhood. METHODS: Participants will be asked to complete a series of web-based surveys at baseline, six weeks, and 12 weeks. These surveys include validated scales and objective questions on COVID-19 infection and medical history. The validated questionnaires assess stress, mood states, resilience, and overall wellbeing. Questionnaires, weekly activity diaries, and medical history, will be collected using REDCap. RESULTS: We hypothesize that routine yoga practice during the COVID-19 pandemic will reduce stress, enhance well-being, and provide protective effects against COVID-19. CONCLUSION: With the growing concern about the physical and mental impacts of COVID-19 and increased interest in alternative practices such as yogic practices, this study will contribute to the growing body of evidence about the safety and efficacy of yoga for emotional, mental, and physical health conditions.

Cross-National Variation in School Reopening Measures During the COVID-19 Pandemic

To contain the initial spread of the SARS-CoV2 virus and the COVID-19 disease, many countries opted to close schools. However, the importance of schooling to mitigate inequalities motivated many economies to reopen schools after having formulated various COVID-19 mitigation and containment strategies. Using an exploratory sequential mixed method design, we explore the measures undertaken by countries when reopening schools and how these measures varied cross-nationally. We find that countries formulated a wide number (total: 242) and range of school reopening measures to mitigate the spread of the virus in the early months of the COVID-19 pandemic. From a policy diffusion theoretical perspective, findings from our statistical analyses suggest that cross-national diversity in policies is related to both internal and external country factors such as peer emulation mechanisms, income, and past pandemic experiences. We urge international agencies for more explicit guidelines for effective school reopening measures.