ABSTRACT
Introduction: The COVID-19 pandemic has disrupted health care systems worldwide, but the specific impact on pediatric surgery in low-and-middle-income countries has received little attention. This study evaluated the changes in pediatric surgical case volume at a central referral hospital in Malawi from 2019 through 2021 to quantify the impact of COVID-19. Method(s): We retrospectively reviewed all pediatric surgical cases performed at our institution from May-August 2019, 2020, and 2021. These months were chosen because they coincided with the first major wave of COVID cases in Malawi in 2020. We compared the number of cases performed per week between years and analyzed case numbers by specialty (general, orthopedic, plastic, neurosurgery, ENT, and urology). Result(s): A total of 1032 procedures were performed. There was a 32% reduction in case volume between 2019 to 2020 (344 to 235 cases, 19.5 vs 13.8 per week, p=0.04), with a subsequent 93% increase from 2020 to 2021 (235 to 435 cases, 13.8 vs 26.4 per week, p<0.001). The most significantly impacted specialties were ENT and plastics, both with 78% fewer procedures in 2020 compared with 2019, and a subsequent 4-fold and 22-fold increase in cases from 2020 to 2021, respectively (Chi-Square;p=0.007 and p<0.001). Orthopedic and Neurosurgical case numbers were impacted the least, with reductions ranging from 22% to 35%. Conclusion(s): The COVID-19 pandemic significantly reduced the number of pediatric surgical cases performed at the central referral hospital in Malawi across all specialties, thereby further limiting essential surgical services to an already marginalized patient population.
ABSTRACT
Background: Transient viremia has been reported after COVID-19 mRNA vaccination in ART-suppressed PWH, suggesting a stimulatory effect on the HIV reservoir. A recent study also reported that Nef-specific CD8+ T cells increased and acquired granzyme-B effector function following COVID-19 mRNA vaccination, and that this correlated with markers of immune-mediated suppression of HIV-transcribing cells. That study however did not investigate HIV viremia, nor did it detect significant reservoir size changes in the 13 participants assessed. We investigated changes in HIV viremia and reservoir size following COVID-19 mRNA vaccination in 62 ART-treated PWH. Method(s): Participants (55 male;7 female) were sampled pre-vaccination, and one month after the first and second doses. Plasma HIV loads (pVL) were measured using the Cobas 6800 (LLOQ 20 copies/mL). Intact and total HIV copies/million CD4+ T cells were measured using the Intact Proviral DNA Assay. Anti-SARS-CoV-2 S serum antibody concentrations were measured using the Roche Elecsys Anti-S assay. Result(s): Pre-vaccination, 82% of participants had pVL < 20 copies/mL (max 110 copies/mL). No significant changes in pVL were observed post-vaccination (all p >0.4): one month post-first and second doses, 79% and 85% of participants had pVL < 20 copies/mL (max 183 and 79 copies/mL), respectively. Pre-vaccination, the median intact reservoir size was 80 (IQR:28-197;n=46) HIV copies/million CD4+ T cells. Intact reservoir size did not change significantly post-vaccination (all p >0.2): one month post-first and second doses, medians were 85 (IQR: 29-184;n=46) and 65 (IQR:22-168;n=29) copies/million CD4+ T cells, respectively. No significant changes in total, nor 5' and 3' defective proviral burdens were observed post-vaccination (all p >0.1), nor were any significant changes observed in any outcome upon stratification by sex, COVID-19 vaccine regimen, or ART regimen (here, multiple tests were addressed using q-values). Finally, no correlations were observed between the SARS-CoV-2 anti-S antibody response magnitude, and either the magnitude of change in reservoir size, nor the observation of detectable viremia, following the first and second vaccine doses (all p >0.2). Conclusion(s): Despite evidence that COVID-19 mRNA vaccination may induce HIV-specific immune responses, we observed no measurable changes in reservoir size nor lasting plasma viremia following COVID-19 mRNA immunization, regardless of anti-SARS-CoV-2 antibody response magnitude. (Figure Presented).
ABSTRACT
This study develops a pedestrian microsimulation model for an international airport that implements a social force model to simulate business-as-usual as well as pandemic pedestrian movement scenarios. The study follows an extensive calibration procedure to formulate pedestrian behavior within the microsimulation environment to reflect COVID-19 restrictions. The calibration process includes three components, which are visual observations, sensitivity analysis, and parameter combinations. The calibration process identifies the combination of the parameters that yields a pedestrian behavior for maximizing the distances among pedestrians in the airport. The study tests three scenarios: (1) a base case scenario with no social distancing parameters in effect, (2) a social distancing scenario that implements calibrated social force model parameters, and (3) a social distancing scenario through a combined implementation of the calibrated parameters and an operational improvement strategy. The simulation results for calibration reveal that the identified combination of the parameters yields 3.8% of instances of pedestrian movements that demonstrate a proximity of less than 2 m between pedestrians. The social distancing scenario demonstrates a significant reduction of such instances by 93–94% in comparison to a scenario with no social distancing strategy implemented. Moreover, the results show that social distancing is likely to increase pedestrian's activity and queue time in the airport. According to the simulation results, it appears that the airport authorities may require queue management processes, infrastructure development, and additional resource deployment to alleviate the negative impacts of social distancing policies on pedestrian movements and operations within the airport. © 2021
ABSTRACT
Researchers and patients conducted an environmental scan of policy documents and public-facing websites and abstracted data to describe COVID-19 adult inpatient visitor restrictions at 70 academic medical centers. We identified variations in how centers described and operationalized visitor policies. Then, we used the nominal group technique process to identify patient-centered information gaps in visitor policies and provide key recommendations for improvement. Recommendations were categorized into the following domains: 1) provision of comprehensive, consistent, and clear information; 2) accessible information for patients with limited English proficiency and health literacy; 3) COVID-19 related considerations; and 4) care team member methods of communication.