Leading past COVID-19: An analysis of remote work now and beyond.

In response to the coronavirus disease 2019 (COVID-19) pandemic, many cancer centers and clinics deployed remote work options for their employees. Due to the rapid response needed during this crisis, little to no feedback was obtained from dosimetrists. This study aimed to assess the productivity level and job satisfaction of medical dosimetrists in response to changes in working conditions due to the COVID-19 pandemic. With the assistance from the medical dosimetrists certification board (MDCB), critical data was gathered via an original instrument conducted and distributed by The University of Texas MD Anderson Cancer Center-School of Health Professions to all current practicing certified medical dosimetrists registered with the MDCB. Data were collected using Qualtrics and analyzed with IBM's SPSS. Most (326, 77.7%) participants indicated they transitioned to a version of remote work due to COVID-19. Almost half of the participants (208, 49.5%) reported increased job satisfaction due to the option to work remotely. The participants reported being extremely satisfied with the individual (247, 58.8%) and department (201, 47.9%) productivity levels even after implementing remote work options. Most participants (225, 53.6%), independent of age and years of experience, would prefer to stay in a hybrid role even after COVID-19 abates. These findings suggest that most dosimetrists prefer to perform their job remotely or asynchronously. A one size fits all job model design may make it difficult for organizations to attract, retain, and grow top dosimetrists. Industry leaders and employers may benefit by embracing this change as dosimetrists may value work-set-up flexibility over other employer-based benefits. Further research is needed to assess the unintended consequences of remote work environments in this profession.

COVID-19 and transtympanic injections for sudden sensorineural hearing loss.

BACKGROUND: Multiple reports have linked COVID-19 infection with sudden sensorineural hearing loss (SSNHL), although other studies have failed to demonstrate this association. The current study was conceived to examine the rates of SSNHL across a large, principally national, population by characterizing the rate of transtympanic injections for SSNHL during the pandemic. METHODS: Retrospective review of all patients that underwent transtympanic injection from 2019 to 2020. RESULTS: Covering a unique beneficiary population of 9.6 million individuals of all ages in the United States, a statistically significant decrease in transtympanic injections for SSNHL was performed from 2019 to 2020 (p = 0.04, IRR = 0.91, 95 % CI = 0.84-0.99). No patient receiving a transtympanic injection also had a COVID-19 diagnosis. CONCLUSIONS: These findings support the idea that COVID-19 infections do not clinically significantly increase patients' risk of developing SSNHL. In fact, the decreased exposure through social isolation to other common viruses implicated in causing SSNHL may have actually led to a lower rate of SSNHL during the pandemic.

Outcomes of COVID-19 in Solid Organ Transplant Recipients in Canada 2020-2021: A Prospective, Multicenter Cohort Study

Purpose: To understand the outcomes and changes in disease severity of COVID-19 in Solid Organ Transplant (SOT) recipients over time in the context of therapeutic advances. Method(s): We performed a multicenter, prospective cohort study of all SOT recipients diagnosed with COVID-19, across 9 transplant programs in Canada, from March 2020-November 2021. Baseline characteristics, demographics, treatment and disease severity outcomes were collected. The primary outcome was need for supplemental oxygen. Factors associated with the primary outcome and changes in outcomes over time were analyzed. Pandemic time periods were divided into four time frames coinciding with 4 waves in North America. Result(s): We enrolled 509 SOT recipients with confirmed COVID-19 during the study period. The risk factors associated with oxygen requirement are outlined in Table 1. Severe disease and mortality were greatest in lung transplant recipients compared to other organ types (15/48 (31.3%) lung deaths vs 63/461(13.7%) nonlung organs, (p=0.001). There was no influence of 2-dose vaccination and 3 patients were infected after 3-dose vaccine. Disease with alpha or delta variant was not associated with increased oxygen requirement. In a subgroup analysis of participants requiring oxygen (n=190), remdesivir was associated with less death (p=0.035). Over the pandemic period (Figure 1), there were no significant changes in the proportion of patients requiring oxygen, ICU admission, ventilatory support or death. (Table Presented) Conclusion(s): COVID-19 is especially severe in lung transplant recipients and immunosuppression plays a significant role. The outcomes associated with COVID-19 in SOT have not appreciably changed over time despite the emergence of novel variants and changes in therapeutic regimens.

Acute Idiopathic Maculopathy Following SARS-CoV-2 Vaccination.

A 49-year-old man presented with acute unilateral blurred vision one week after SARS-CoV-2 vaccination. A unilateral serous detachment of the macula, intraretinal hemorrhages, vitritis, and anterior chamber cell was found. Diagnostic testing was negative for infectious and inflammatory causes, and a diagnosis of acute idiopathic maculopathy (AIM) was made. Symptoms and serous detachment resolved over 12 weeks, with residual retinal pigment epithelial changes consistent with the disease course. AIM is a rare diagnosis that presented in close proximity to SARS-CoV-2 vaccination without evidence of coxsackievirus infection. Further research is necessary to clarify an association between this vaccine and uveitis.

Telehealth Made EASY: Understanding Provider Perceptions of Telehealth Appropriateness in Outpatient Rheumatology Encounters.

OBJECTIVE: The purpose of this study was to evaluate a novel scoring system, the Encounter Appropriateness Score for You (EASY), to assess provider perceptions of telehealth appropriateness in rheumatology encounters. METHODS: The EASY scoring system prompts providers to rate their own encounters as follows: in-person or telehealth acceptable, EASY = 1; in-person preferred, EASY = 2; or telehealth preferred, EASY = 3. Assessment of the EASY scoring system occurred at a single academic institution from January 1, 2021, to August 31, 2021. Data were collected in three rounds: 1) initial survey (31 providers) assessing EASY responsiveness to five hypothetical scenarios, 2) follow-up survey (34 providers) exploring EASY responsiveness to 11 scenario modifications, and 3) assessment of EASYs documented in clinic care. RESULTS: The initial and follow-up surveys demonstrated responsiveness of EASYs to different clinical and nonclinical factors. For instance, less than 20% of providers accepted telehealth when starting a biologic for active rheumatoid arthritis, although more than 35% accepted telehealth in the same scenario if the patient lived far away or was well known to the provider. Regarding EASY documentation, 27 providers provided EASYs for 12,381 encounters. According to these scores, telehealth was acceptable or preferred for 29.7% of all encounters, including 21.4% of in-person encounters. Conversely, 24.4% of telehealth encounters were scored as in-person preferred. CONCLUSION: EASY is simple, understandable, and responsive to changes in the clinical scenario. We have successfully accumulated 12,381 EASYs that can be studied in future work to better understand telehealth utility and optimize telehealth triage.

Simple, sensitive, specific self-sampling assay secures SARS-CoV-2 antibody signals in sero-prevalence and post-vaccine studies.

At-home sampling is key to large scale seroprevalence studies. Dried blood spot (DBS) self-sampling removes the need for medical personnel for specimen collection but facilitates specimen referral to an appropriately accredited laboratory for accurate sample analysis. To establish a highly sensitive and specific antibody assay that would facilitate self-sampling for prevalence and vaccine-response studies. Paired sera and DBS eluates collected from 439 sero-positive, 382 sero-negative individuals and DBS from 34 vaccine recipients were assayed by capture ELISAs for IgG and IgM antibody to SARS-CoV-2. IgG and IgM combined on DBS eluates achieved a diagnostic sensitivity of 97.9% (95%CI 96.6 to 99.3) and a specificity of 99.2% (95% CI 98.4 to 100) compared to serum, displaying limits of detection equivalent to 23 and 10 WHO IU/ml, respectively. A strong correlation (r = 0.81) was observed between serum and DBS reactivities. Reactivity remained stable with samples deliberately rendered inadequate, (p = 0.234) and when samples were accidentally damaged or 'invalid'. All vaccine recipients were sero-positive. This assay provides a secure method for self-sampling by DBS with a sensitivity comparable to serum. The feasibility of DBS testing in sero-prevalence studies and in monitoring post-vaccine responses was confirmed, offering a robust and reliable tool for serological monitoring at a population level.

Hydrogen Peroxide as an Adjuvant Therapy for COVID-19: A Case Series of Patients and Caregivers in the Mexico City Metropolitan Area.

Knowledge of the antiseptic effects of hydrogen peroxide (H2O2) dates back to the late 19th century, and its mechanisms of action has been amply described. Globally, many physicians have reported using H2O2 successfully, in different modalities, against COVID-19. Given its anti-infective and oxygenating properties, hydrogen peroxide may offer prophylactic and therapeutic applications for responding to the COVID-19 pandemic. We report a consecutive case series of twenty-three COVID-19 patients (of 36 initially enrolled) who had been diagnosed by their primary care physician (mean age: 39, range: 8 months-70 years; 74% male) and twenty-eight caregivers in the Mexico City Metropolitan Area who received a complementary and alternative medicine (CAM) telemedicine treatment with H2O2 taken by mouth (PO, at a concentration of 0.06%), oral rinse (mouthwash, 1.5%), and/or nebulization (0.2%). We describe the treatment program and report the response of the COVID-19 patients and their caregivers. The patients mainly recovered well, reporting feeling "completely better" at 9.5 days on average. Two (9%) were hospitalized prior to joining the study, and one did not fully recover. Patients frequently reported nausea and sometimes dizziness or vomiting related to the oral treatment. None of the twenty-eight caregivers in close contact with the patients reported contracting COVID-19. Given its low cost and medical potential and considering its relative safety if used properly, we suggest that randomized controlled trials should be conducted. These should include both SARS-CoV-2-positive and SARS-CoV-2-negative participants, with single or combined modes of administration of H2O2, to study the benefits of this simple molecule and offer safe guidance regarding its use by health professionals.

Genomic analysis of SARS-CoV-2 reveals local viral evolution in Ghana.

The confirmed case fatality rate for the coronavirus disease 2019 (COVID-19) in Ghana has dropped from a peak of 2% in March to be consistently below 1% since May 2020. Globally, case fatality rates have been linked to the strains/clades of circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within a specific country. Here we present 46 whole genomes of SARS-CoV-2 circulating in Ghana, from two separate sequencing batches: 15 isolates from the early epidemic (March 12-April 1 2020) and 31 from later time-points ( 25-27 May 2020). Sequencing was carried out on an Illumina MiSeq system following an amplicon-based enrichment for SARS-CoV-2 cDNA. After genome assembly and quality control processes, phylogenetic analysis showed that the first batch of 15 genomes clustered into five clades: 19A, 19B, 20A, 20B, and 20C, whereas the second batch of 31 genomes clustered to only three clades 19B, 20A, and 20B. The imported cases (6/46) mapped to circulating viruses in their countries of origin, namely, India, Hungary, Norway, the United Kingdom, and the United States of America. All genomes mapped to the original Wuhan strain with high similarity (99.5-99.8%). All imported strains mapped to the European superclade A, whereas 5/9 locally infected individuals harbored the B4 clade, from the East Asian superclade B. Ghana appears to have 19B and 20B as the two largest circulating clades based on our sequence analyses. In line with global reports, the D614G linked viruses seem to be predominating. Comparison of Ghanaian SARS-CoV-2 genomes with global genomes indicates that Ghanaian strains have not diverged significantly from circulating strains commonly imported into Africa. The low level of diversity in our genomes may indicate lower levels of transmission, even for D614G viruses, which is consistent with the relatively low levels of infection reported in Ghana.

Shared Surgical Decision Making in the Era of COVID-19: Lessons From Hurricane Katrina.

The COVID-19 pandemic has challenged every surgical discipline. Lessons learned from Hurricane Katrina have informed our department's management of the current crisis. That experience impressed upon us a profound appreciation for shared decision making in the face of scarce resources, an evolving clinical context, and potential harm to patients and health care workers. To that end, we have formed a Resource Utilization Committee to prospectively review all nonemergent surgical cases during the current crisis. This has allowed "state-of-the-pandemic" otolaryngologic care in a real-time, collaborative, and high-information setting. In addition, to protect our patients and health care workers, it has influenced our institution's thoughtful application of COVID testing and the use of personal protective equipment.

Reduction in eye emergency attendance and the correlation between the COVID-19 and conjunctivitis diagnoses during the COVID-19 pandemic

During the coronavirus disease (COVID-19) pandemic, studies have described an overall reduction in the numbers of patients visiting ophthalmology emergency cases of infectious conjunctivitis (IC)in different countries(1,2). © This content is licensed under a Creative Commons Attributions 4.0 International License