ASSESSING THE IMPACT OF COVID-19 ON THE HEALTH AND WELLNESS OF THE LONG-TERM CARE WORKFORCE IN RURAL AND NORTHERN AREAS

There is growing recognition that the mental health and wellbeing of the LTCF workforce have been disproportionately impacted by COVID-19. Therefore, we sought to describe the experiences and challenges LTCF employees faced during COVID-19 in rural and northern communities and highlight factors affecting their ability to be resilient and provide high quality care. We conducted 53 qualitative interviews using zoom with LTCF care providers (care aides, nurses, social workers), staff (food service workers, recreation providers), and management between November 2021 and February 2021. Data was transcribed and thematic analysis undertaken. We will describe participants experiences stratified by LTCF employee type and highlight similarities and differences in participants experiences across geography and facility type (freestanding vs. co-located in hospital) and describe factors affecting well-being, job satisfaction, and retention. We will share an inventory of programs and strategies participants found useful to mitigate negative effects on their mental health and well-being.

Beyond the Paranoid Style - Fascism, Radical Right and the Myth of Conspiracy Fifth Convention of the International Association for Comparative Fascist Studies (comfas)

Following two years of online events, from the 14 to 16 September 2022 the fifth annual Convention of the International Association for Comparative Fascist Studies (COMFAS) took place in Florence. The title of the conference 'Beyond the Paranoid Style: Fascism, Radical Right and the Myth of Conspiracy' presented a framework for a wide variety of reflections that were both historically grounded and timely. After all, in the wake of the Covid-19 pandemic, many scholars have had new experiences of the impact of conspiracy theory thinking. © 2022 Copyright 2022 by Paul Jackson.

On the Convergence of Credit Risk in Current Consumer Automobile Loans (preprint)

Loan seasoning and inefficient consumer interest rate refinance behavior are well-known for mortgages. Consumer automobile loans, which are collateralized loans on a rapidly depreciating asset, have attracted less attention, however. We derive a novel large-sample statistical hypothesis test suitable for loans sampled from asset-backed securities to populate a transition matrix between risk bands. We find all current risk bands eventually converge to a super-prime credit, despite remaining underwater. Economically, our results imply borrowers forwent \$1,153-\$2,327 in potential credit-based savings through delayed prepayment. We present an expected present value analysis to derive lender risk-adjusted profitability. Our results appear robust to COVID-19.

Getting Water to the End of the Row: Highlighting Efforts From a Center on Rural Addiction

Objectives: Specialists in the treatment of adolescent mental health and substance use, more commonly located in academic, urban, and suburban settings, have training and expertise valuable to and needed by adolescents and families in rural communities. The increasing legalization of recreational cannabis, the opioid epidemic, and the mental health crisis accompanying the COVID-19 pandemic are all factors contributing to the increased demand for substance use and mental health services in rural areas. Increased demand has highlighted geographic constraints and underscored shortages of available evidence-based treatment. At the end of this presentation, participants will: 1) identify means of connecting with and supporting colleagues assessing and treating adolescent cannabis use in rural areas;2) recognize strategies for disseminating subspecialty expertise while strengthening capacity for local treatment within general practice settings;and 3) be able to create a stepwise plan for supporting colleagues and families in rural areas impacted by cannabis and other adolescent substance use. Method(s): The University of Vermont Center on Rural Addiction (UVM CORA) was established through a grant from the United States Health Resources and Services Administration (HRSA) to support education, distribute resources, and disseminate evidence-based treatment for substance use disorders in rural communities in Northern New England. Strategies, lessons, key points, and reproducible methods utilized to expand the impact of addiction and mental health treatment experts are reviewed. Result(s): The principles reviewed include needs assessment, telephone or videoconferencing consultation, in-person and virtual training, site visits, and connecting local resources. Subspecialists and experts in child and adolescent psychiatry and addiction treatment expand their capacity to both disseminate expertise regionally and strengthen rural treatment locally. Conclusion(s): Increasing demand for screening, identification, and treatment of cannabis and other substance use disorders among rural adolescents can be alleviated when subspecialists increase capacity to disseminate evidence-based treatment and to educate primary care colleagues in rural areas. RP, SUD, ADOL Copyright © 2022

The impact of the Coronavirus pandemic on New York City real estate: First evidence.

We investigate whether pandemic-induced contagion disamenities and income effects arising due to COVID-related unemployment adversely affected real estate prices of one- or two-family owner-occupied properties across New York City (NYC). First, ordinary least squares hedonic results indicate that greater COVID case numbers are concentrated in neighborhoods with lower-valued properties. Second, we use a repeat-sales approach for the period 2003-2020, and we find that both the possibility of contagion and pandemic-induced income effects adversely impacted home sale prices. Estimates suggest sale prices fell by roughly $60,000 or around 8% in response to both of the following: 1000 additional infections per 100,000 residents and a 10-percentage point increase in unemployment in a given Modified Zip Code Tabulation Area (MODZCTA). These price effects were more pronounced during the second wave of infections. On the basis of cumulative MODZCTA infection rates through 2020, the estimated COVID-19 price discount ranged from approximately 1% to 50% in the most affected neighborhoods, and averaged 14%. The contagion effect intensified in the more affluent, but less densely populated NYC neighborhoods, while the income effect was more pronounced in the most densely populated neighborhoods with more rental properties and greater population shares of foreign-born residents. This disparity implies the pandemic may have been correlated with a wider gap in housing wealth in NYC between homeowners in lower-priced and higher-priced neighborhoods.

Survivors of COVID-19: testing, symptoms, severity, and post-exposure conditions among new yorkers

The novel Coronavirus Disease 2019 (COVID-19) is a pandemic of great public health and clinical concern due to its high rate of infectivity, and subsequent morbidity and mortality. The objectives of the study were to (1) assess individual experiences with testing and symptoms of COVID-19 infection;(2) determine the extent to which individuals experienced COVID-19 post-exposure symptoms;and (3) determine if an association exists between pre-existing conditions and severity of COVID-19 symptoms with post-exposure symptoms. One hundred and twenty-one (N= 121) New York State residents who had COVID-19 symptoms and were tested positive for the virus participated in this study. The survey was created in Qualtrics, and the link was posted online (Facebook, Twitter, Snap Chat), and sent to New Yorkers via email and WhatsApp to gather data. Data were exported from Excel spreadsheet to Statistical Package for the Social Sciences (SPSS), version 25, where Chi-Square tests were conducted. Results indicated that most of the participants were between ages 18-35 (54.5%), African Americans (50.4%), non- Hispanic (65%), female (69.4%), had less than a college degree (51%), and made an income in 2019 of less than $55,000 per year (62%). Eighty-seven (approximately 73%) of the participants reported that getting access to testing was easy/very easy. More than one-half reported that they experienced fatigue (66.9%), lack of energy (61.2%), headache (57.9%), muscle ache (53.7%), cough (50.4%), and loss of smell (50.4%) while infected with COVID-19. Participants who experienced symptoms described their most bothersome symptom as severe (37%), followed by mild (33%), and moderate (27%). There was a statistically significant relationship between severity of symptoms and post-exposure problems experienced by participants (X² = 13.69;df = 2;p = .001);as well as between pre-existing conditions and post-exposure problems experienced by participants (X² = 10.53;df = 1;p = .001). Information from this study could benefit public health practitioners and clinicians by improving their knowledge about COVID-19 and its impacts on survivors.

The Impact of the Coronavirus Pandemic on New York City Real Estate: First Evidence (preprint)

We investigate whether pandemic-induced contagion disamenities and income effects arising due to COVID-related unemployment adversely affected real estate prices of one- or two-family owner-occupied properties across New York City (NYC). First, OLS hedonic results indicate that greater COVID case numbers are concentrated in neighborhoods with lower-valued properties. Second, we use a repeat-sales approach for the period 2003 to 2020, and we find that both the possibility of contagion and pandemic-induced income effects adversely impacted home sale prices. Estimates suggest sale prices fell by roughly $60,000 or around 8% in response to both of the following: 1,000 additional infections per 100,000 residents; and a 10-percentage point increase in unemployment in a given Modified Zip Code Tabulation Area (MODZCTA). These price effects were more pronounced during the second wave of infections. Based on cumulative MODZCTA infection rates through 2020, the estimated COVID-19 price discount ranged from approximately 1% to 50% in the most affected neighborhoods, and averaged 14%. The contagion effect intensified in the more affluent, but less densely populated NYC neighborhoods, while the income effect was more pronounced in the most densely populated neighborhoods with more rental properties and greater population shares of foreign-born residents. This disparity implies the pandemic may have been correlated with a wider gap in housing wealth in NYC between homeowners in lower-priced and higher-priced neighborhoods.

Tnf-alpha but not il-6 at admission is associated with duration of stay and oxygen requirement in a diverse cohort of patients with COVID-19

Introduction: SARS-COv-2, the novel coronavirus responsible for COVID19 causes a wide range of pathology. While some patients may experience mild or asymptomatic infection, others will progress to respiratory failure and death. Although some clinical parameters have been shown to predict patient outcomes, the role of cytokine measurements is controversial. The aim of the study was to determine whether admission cytokine levels can predict the clinical course of patients with COVID19. Methods: Blood was collected at admission from 41 patients with COVID19 at Virginia Commonwealth University from April-July 2020. A panel of 27 pro-inflammatory cytokines was measured in serum by multiplex assay. 20 patients were selected for analysis;10 with moderate disease (hospital admission, <4L O2 need) and 10 severe COVID patients (ICU admission);patients with active malignancy were excluded. Multivariate principal component and correlation analysis (PCA) was performed. Patient severity (ICU admission, max O2 requirement, duration of hospital stay), patient demographics (gender, race, BMI), and serum cytokine levels were analyzed. Results: The only significant correlation with disease severity was duration of stay with TNF-α (0.5772,p=0.0097, Fig. 1A). IL-6 was not correlated with severity. PCA clustered severe patients together, with more variability being observed in the moderate cases (Fig.1B). Disease severity parameters cluster together with limited association with the cytokine and demographics parameters (Fig.1C). PCA identified 2 main clusters of cytokines, but neither was associated with severity. TNF-α and IL-8 were separate from the other cytokines (Fig.1C). Discussion: In this small series of COVID19 patients from an urban academic medical center, PCA revealed correlation between admission TNF-α levels and the development of severe COVID19. No correlation was noted between admission IL-6 levels and disease severity. An association between TNF-α and outcomes has recently been described in a large cohort from the United States, but we were not able to determine other predictors of outcomes despite an extensive cytokine panel. The discrepancy with prior studies may be attributed to the high percentage of African-American subjects and high rates of comorbidities in our cohort. Our findings show low levels of key cytokines when compared to previous studies in non-COVID ARDS suggesting a difference in the pathophysiology of severe COVID19. The lack of IL-6 association with severe COVID19 is consistent with recent negative trials of IL-6 blockade in COVID19. Larger studies are needed to explore the role of TNF-α in the development of severe COVID19 and its potential as a therapeutic target.

Hospitalized COVID-19 patients with active lymphoma have eight times higher risk of death than COVID-19 controls

BACKGROUND: Over 790,000 patients in the United States are currently living with or are in remission from lymphoma. It is established that lymphoma patients are at greater risk for both bacterial and viral infections. While there is limited research examining the risk of COVID-19 infection in patients with an active malignancy, even fewer studies have examined those with active lymphoma. This study aimed to examine the all-cause mortality of COVID-19 patients with active lymphoma compared to hospitalized COVID-19 control patients. METHODS: We performed a retrospective case-control and cohort study of adult inpatients diagnosed with COVID-19 infection in a tertiary, academic referral center in Richmond, Virginia. We analyzed the unadjusted and adjusted association of patients with active lymphoma diagnosis and all-cause hospital mortality. We performed multiple logistic regressions adjusting for age, gender, race, the month at presentation, which captures the health system's adaptation, and the remaining 30 individual diagnostic categories of the Elixhauser comorbidity index. We externally validated our findings using compiled data from 657 institutions across the United States on patients with lymphoma hospitalized for COVID-19. RESULTS: Among 628 inpatients with COVID-19, 1.1% (7) had active lymphoma. The unadjusted mortality of patients with lymphoma was 57.1% compared to 8.4% of the corresponding patients without lymphoma. The unadjusted OR for hospital death was 15.6 (95% CI 3.2 to 67, P=0.001). The adjusted OR of death in patients with lymphoma was 79.5 (95% 6.4 to 983, P= 0.001). The average adjusted mortality in patients with lymphoma was 65% compared with 8.4% among patients of equivalent age, gender, race, month of presentation and comorbidities. From aggregate data of COVID-19 patients across 657 US institutions, the average mortality for patients with lymphoma was 41.07% (95% CI 36.8 to 45.3) and for patients without lymphoma was 12.11% (95% CI 12.7 to 11.5). CONCLUSION: Our results show that, of those patients hospitalized for COVID-19 infection, the patients with active lymphoma have a nearly 8-fold increased risk of death compared to their non-lymphoma counterparts when adjusted for age, gender, race, month of presentation, and other comorbidities. External validation data demonstrated a greater than 3-fold increased risk of death in COVID-19 patients with active lymphoma compared to non-lymphoma patients. This research highlights the importance of mitigation strategies, such as social distancing and masking, to decrease the risk of COVID-19 infection in lymphoma patients and may have implications for prioritizing vaccines or therapies in the future. FIGURE:.

Hypothyroidism associated with triple mortality in patients hospitalized with COVID-19

BACKGROUND: Many conditions have been associated with severe COVID-19 disease. To date, the risk associated with pre-existing hypothyroidism remains unclear. Hypothyroidism affects the innate immune system. Patients with hypothyroidism have higher circulating inflammatory markers, which are associated with increased mortality in COVID-19. A prior study did not find a significant difference in the risk of hospitalization or death in patients with pre-existing hypothyroidism. This study aims to investigate a possible association between pre-existing hypothyroidism and death from COVID-19. METHODS: We performed a retrospective cohort study of adult inpatients diagnosed with SARS-CoV-2 infection in a tertiary, academic referral center in Richmond, Virginia. We analyzed the unadjusted and adjusted association of patients with a past medical history of hypothyroidism and all-cause hospital mortality. We performed adjusted logistic regressions adjusting for age, gender, race, the month at presentation (an adaptation of the health system), and the remaining 30 individual diagnostic categories of the Elixhauser comorbidity index. RESULTS: Fifty-three (8.2%) of the 649 COVID-19 inpatients had hypothyroidism. Patients with hypothyroidism were, on average, 15.3 years older (95% CI 10.3 to 20.4 years). The unadjusted mortality of patients with hypothyroidism was 22.6% compared with 7.4% in patients without hypothyroidism. The unadjusted mortality OR was 3.5 (95% CI 1.7 to 7.2, P=0.001). The adjusted OR for death was 3.6 (95% CI 1.4 to 9.3, P=0.007, abstract figure). The average adjusted mortality was 18.6% for patients with hypothyroidism compared with 7.8% in patients with equivalent age, gender, race, remaining comorbidities, and month of presentation. CONCLUSION: Our results suggest that pre-existing hypothyroidism is associated with a three-fold risk of death in patients hospitalized with COVID-19. There are conflicting reports in the literature on the association between hypothyroidism and severe COVID-19. Earlier descriptive studies did not report rates of thyroid disease in their cohorts. Further research is needed on the pathophysiology and effects of SARS-CoV-2 infection in hypothyroid individuals.

Comparison of influenza and COVID-19 disease burden among black patients at a large urban care center

RATIONALE: Studies have demonstrated racial disparities in COVID-19 outcomes, with black Americans having higher rates of infection, hospitalization, and death. Similarly, CDC data has shown higher Influenza-related mortality in the black American population. While COVID-19 is a deadlier viral respiratory illness, a comparison between influenza and COVID-19 can provide insight into racial disparities and clarify if there is excess disease burden of COVID-19 on black American communities compared with another viral pneumonia. METHODS: We performed a four-year retrospective cohort study (2016-2020) of adult inpatients tested with SARS-CoV-2 or Influenza (A or B) infection in a tertiary, academic referral center in Richmond, Virginia. We compared the unadjusted and adjusted positivity rate, and mortality between black and non-black patients. We performed multiple logistic regression to adjust for age and gender and applied the models to estimate and compare the predicted adjusted mortality. RESULTS: The proportion of black patients admitted for Influenza from 2016-2020 was significantly greater than the proportion of black patients admitted with COVID-19, 66.6% vs. 57.5% (p <0.01). The unadjusted mortality for Influenza + patients was 1.6% (31). The unadjusted mortality for SARSCoV- 2 + patients were 5.6% (125). Black patients had lower unadjusted OR for death for influenza (0.6 95% CI 0.6-0.64, p<0.001) and OR of death for SARS-CoV-2 (0.84, 95% 0.73-0.96, p=0.01). The findings persisted after adjusting for age and gender in influenza patients (OR 0.68 95% CI 0.64-0.74, p<0.001) but not in SARSCoV- 2 patients (OR 0.91 95% CI 0.8-1.05, p=0.2). CONCLUSION: In our predominantly black American cohort, we found no significant association between race and in-hospital adjusted mortality related to COVID-19. Our findings are contrary to larger cohorts and CDC data which shows increased mortality in the black American population. The higher proportion of black patients with Influenza than COVID-19 also indicates that in our population there is not an excess burden from COVID-19 compared to previous Influenza data, although for both COVID-19 and Influenza black patients are overrepresented compared to demographics of VCU's catchment area. The reason for these findings is not clear. Our cohort was composed predominantly of black Americans as is Richmond, VA. It is possible that in this setting the provision of community health or outreach regarding COVID-19 disease prevention to black communities was more effective, reducing excess COVID-19 disease burden. Further research to identify how structural racism and social determinants of health affect vulnerable communities and factors that mitigate these effects is necessary.

Insurance disparities are associated with mortality from COVID-19 in central virginia

RATIONALE: The Center for Disease Control has reported that racial and ethnic groups are more susceptible to COVID-19 with worse outcomes. Inequalities in social determinants of health, particularly income, access to healthcare, and housing, may play a role in these differences. Health insurance has been shown to affect health outcomes for acute and chronic conditions. Uninsured and Medicaid recipients face worse outcomes for conditions like pneumonia, myocardial infarction, and lung cancer. Health insurance has also been described as a surrogate marker for social determinants of health. We set out to investigate these parameters in COVID-19 hospitalized patients in central Virginia. METHODS: We performed a retrospective cohort study of adult inpatients diagnosed with SARS-CoV-2 infection in a tertiary, academic referral center in central Virginia. We analyzed unadjusted and adjusted patient demographics like age, gender, race, ethnicity, insurance primary payer, and Elixhauser comorbidities with hospital all-cause mortality. We calculated adjusted and unadjusted mortality rates, odds ratios, and confidence intervals. We constructed a geospatial analysis of the adjusted mortality by zip code. RESULTS: Black patients constituted 56.1% of the cohort (276 patients out of 492). Hispanic patients 17.7%. Average age was 55.7 (SD 17) years. Majority of patients had Medicare (35.8%), followed by Medicaid (19.3%), no insurance specified or uninsured 15.7%, private insurance 14.8%, state/ prison insurance 11.8% and military insurance 2.6%. When adjusted for comorbidities, age, gender, race and ethnicity was not associated with mortality. Private insurance and unspecified insurance status were associated with both unadjusted lower mortality OR 0.09 (95% CI 0.014 - 0.63, p=0.01) and 0.04 (95% CI 0.004 - 0.63, p=0.01) and adjusted OR 0.07 (95% CI 0.01- 0.90, p =0.04) and 0.04 (95% CI 0.002 - 0.73, p=0.03) respectively. These findings persisted after removing the prison population (p=0.02). CONCLUSION: Despite nationwide trends indicating worse outcomes for specific racial groups affected by COVID-19, in our diverse cohort race was not associated with a significant difference in mortality. Private insurance was associated with lower mortality versus public insurance. This finding persisted when adjusting for confounders and removing the prison population.In central Virginia, health insurance status is a predictor of COVID-19 outcomes and may serve as a surrogate for health disparities. Uninsured/public insured individuals may have lower socioeconomic status or reside in medically underserved areas, limiting access to care. Further investigation is needed to elucidate the largest risk factors and design interventions to curtail the impact of COVID19 on this population.

Fatty acyl lipidomic changes converge towards increased inflammation with severity of covid-19

Background: COVID19 is a heterogeneous disease;while some patients experience mild or asymptomatic disease, others develop respiratory failure and death. Although there is increased understanding of clinical factors associated with severe disease, studies investigating biomarkers to predict severity and uncover treatment targets are still needed. Polyunsaturated fatty acid-derived lipid mediators (PUFA-LM) can promote inflammation or resolution of inflammation. Previous research showed differences in PUFA-LM expression in septic patients that developed ARDS. Here we evaluate the plasma PUFA-LM profile at admission in 20 patients with COVID-19 and correlate our findings with disease severity. Methods: Blood was collected at admission from 41 patients with COVID-19 at Virginia Commonwealth University between April and July, 2020. Platelet poor plasma from 20 patients were selected;10 with nonsevere COVID19 (NSC) defined by <4L O2 need and 10 severe COVID-19 subjects (SC) defined as requiring admission to the intensive care unit, for PUFA-LM analysis by liquid chromatography mass spectrometry. Patients with active malignancy were excluded. Results: Demographic data and comorbidities are similar between the two groups. Both cohorts were predominately African American (80%) and male (60%). The SC cohort exhibited higher levels of lipoxygenase metabolites, hydroxyeicosatetraenoic acids (HETEs), hydroxyeicosapentaenoic acids (HEPEs) and hydroxydocosahexaenoic acids (HDoHEs), which serve as intermediates in the synthesis of both pro-inflammatory and pro-resolving mediators. Epoxygenase metabolites were also higher in the SC cohort and were mostly diols indicating elevated epoxide hydrolase activity. Conversely PGE1 and 15-OxoETE were elevated in the NSC cohort compared to SC. Discussion: In this predominantly African-American patient cohort, admission PUFA-LM profiles differed in subjects who developed mild vs. severe COVID19. Higher levels of lipoxygenase activity in the SC cohort is of unclear significance since this pathway promotes synthesis of both pro-inflammatory and pro-resolving mediators. Given sample collection early in the disease course it may signify incomplete synthesis of resolution mediators or increased inflammation. The higher levels of diols from epoxides are intriguing. PUFA epoxides are anti-inflammatory and prevent prostaglandins from eliciting an inflammatory response. Hence, higher levels of epoxide hydrolysis in SC cohort suggests an exacerbation of inflammation by prostaglandins. Higher levels of PGE1 (a known pulmonary vasodilator) and 15-OxoETE (an anti-inflammatory mediator which inhibits NFκB activation) in the NSC group may contribute to a dampening of inflammatory response in NSC cohort. Overall, this data suggests a complex interplay of dysfunctional homeostatic and inflammatory mechanisms early in disease which may contribute to development of severe COVID-19.

Restitution of the NHS breast reconstruction service during the recovery phase of the Covid 19 pandemic.

During the recovery restitution phase of the coronavirus pandemic, breast reconstruction teams have faced particular challenges to restarting this essential service. This is due to the length and complexity of the surgery, along with the demands on healthcare staff. The Royal College of Surgeons have classified immediate breast reconstruction as priority 2 and the National Institute for Health and Care Excellence have provided a pre-operative pathway for resumption of elective procedures. We therefore describe our experience in restarting our service for providing a breast reconstruction service from the 29th June 2020.