Severe Acute Respiratory Syndrome Coronavirus 2 Infection History and Antibody Response to 3 Coronavirus Disease 2019 Messenger RNA Vaccine Doses.

BACKGROUND: Data on antibody kinetics are limited among individuals previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From a cohort of healthcare personnel and other frontline workers in 6 US states, we assessed antibody waning after messenger RNA (mRNA) dose 2 and response to dose 3 according to SARS-CoV-2 infection history. METHODS: Participants submitted sera every 3 months, after SARS-CoV-2 infection, and after each mRNA vaccine dose. Sera were tested for antibodies and reported as area under the serial dilution curve (AUC). Changes in AUC values over time were compared using a linear mixed model. RESULTS: Analysis included 388 participants who received dose 3 by November 2021. There were 3 comparison groups: vaccine only with no known prior SARS-CoV-2 infection (n = 224); infection prior to dose 1 (n = 123); and infection after dose 2 and before dose 3 (n = 41). The interval from dose 2 and dose 3 was approximately 8 months. After dose 3, antibody levels rose 2.5-fold (95% confidence interval [CI] = 2.2-3.0) in group 2 and 2.9-fold (95% CI = 2.6-3.3) in group 1. Those infected within 90 days before dose 3 (and median 233 days [interquartile range, 213-246] after dose 2) did not increase significantly after dose 3. CONCLUSIONS: A third dose of mRNA vaccine typically elicited a robust humoral immune response among those with primary vaccination regardless of SARS-CoV-2 infection >3 months prior to boosting. Those with infection <3 months prior to boosting did not have a significant increase in antibody concentrations in response to a booster.

The dynamics of discrimination, resilience, and social support in the mental health of migrants with and without citizenship.

Perceived discrimination has a significant negative impact on indices of mental health. One potential buffering factor in this is psychological resilience, which encompasses the ability to recover from or adapt successfully to adversity and use coping strategies, such as positive reappraisal of adverse events. This study examines the role of resilience as well as social support in buffering these effects in groups of migrants both with and without local residence permits. We conducted a non-experimental observational study with a cross-sectional design, collecting a variety of health variables in migrant groups in a naturalistic setting, during the COVID-19 period. The total sample consisted of 201 subjects, 88 of whom had a German residence title and 113 did not. These two groups were compared on the following variables of interest: social support, resilience, discrimination, and general mental health. There was no evidence for a difference in mental health between migrants with and without citizenship. However, our results suggested that migrants without citizenship reported less social support, less resilience, and more discrimination, which continued to have a distinct effect on mental health beyond resilience and social support. Psychological resilience mediated the link between social support and mental health, as well as being related to the perception of discrimination in the migrant group without citizenship. In conclusion, our models of migrants with and without citizenship showed that resilience specifically directly affected perceived discrimination in those without citizenship. The high levels of discrimination and lack of social support, particularly in the migrant group without citizenship, are concerning and suggest a focus for future interventions.

Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: an observational analysis.

BACKGROUND: The USA struggled in responding to the COVID-19 pandemic, but not all states struggled equally. Identifying the factors associated with cross-state variation in infection and mortality rates could help to improve responses to this and future pandemics. We sought to answer five key policy-relevant questions regarding the following: 1) what roles social, economic, and racial inequities had in interstate variation in COVID-19 outcomes; 2) whether states with greater health-care and public health capacity had better outcomes; 3) how politics influenced the results; 4) whether states that imposed more policy mandates and sustained them longer had better outcomes; and 5) whether there were trade-offs between a state having fewer cumulative SARS-CoV-2 infections and total COVID-19 deaths and its economic and educational outcomes. METHODS: Data disaggregated by US state were extracted from public databases, including COVID-19 infection and mortality estimates from the Institute for Health Metrics and Evaluation's (IHME) COVID-19 database; Bureau of Economic Analysis data on state gross domestic product (GDP); Federal Reserve economic data on employment rates; National Center for Education Statistics data on student standardised test scores; and US Census Bureau data on race and ethnicity by state. We standardised infection rates for population density and death rates for age and the prevalence of major comorbidities to facilitate comparison of states' successes in mitigating the effects of COVID-19. We regressed these health outcomes on prepandemic state characteristics (such as educational attainment and health spending per capita), policies adopted by states during the pandemic (such as mask mandates and business closures), and population-level behavioural responses (such as vaccine coverage and mobility). We explored potential mechanisms connecting state-level factors to individual-level behaviours using linear regression. We quantified reductions in state GDP, employment, and student test scores during the pandemic to identify policy and behavioural responses associated with these outcomes and to assess trade-offs between these outcomes and COVID-19 outcomes. Significance was defined as p<0·05. FINDINGS: Standardised cumulative COVID-19 death rates for the period from Jan 1, 2020, to July 31, 2022 varied across the USA (national rate 372 deaths per 100 000 population [95% uncertainty interval [UI] 364-379]), with the lowest standardised rates in Hawaii (147 deaths per 100 000 [127-196]) and New Hampshire (215 per 100 000 [183-271]) and the highest in Arizona (581 per 100 000 [509-672]) and Washington, DC (526 per 100 000 [425-631]). A lower poverty rate, higher mean number of years of education, and a greater proportion of people expressing interpersonal trust were statistically associated with lower infection and death rates, and states where larger percentages of the population identify as Black (non-Hispanic) or Hispanic were associated with higher cumulative death rates. Access to quality health care (measured by the IHME's Healthcare Access and Quality Index) was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not, at the state level. The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate. State governments' uses of protective mandates were associated with lower infection rates, as were mask use, lower mobility, and higher vaccination rate, while vaccination rates were associated with lower death rates. State GDP and student reading test scores were not associated with state COVD-19 policy responses, infection rates, or death rates. Employment, however, had a statistically significant relationship with restaurant closures and greater infections and deaths: on average, 1574 (95% UI 884-7107) additional infections per 10 000 population were associated in states with a one percentage point increase in employment rate. Several policy mandates and protective behaviours were associated with lower fourth-grade mathematics test scores, but our study results did not find a link to state-level estimates of school closures. INTERPRETATION: COVID-19 magnified the polarisation and persistent social, economic, and racial inequities that already existed across US society, but the next pandemic threat need not do the same. US states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimising COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises. FUNDING: Bill & Melinda Gates Foundation, J Stanton, T Gillespie, J and E Nordstrom, and Bloomberg Philanthropies.

Forecasting the trajectory of the COVID-19 pandemic into 2023 under plausible variant and intervention scenarios: a global modelling study (preprint)

Background The recent Omicron-related waves of the COVID-19 pandemic have resulted in unprecedented levels of population transmission due to the variant's high level of infectiousness across most of the world. China, the last large country to end its "zero-COVID" policies, is currently facing its own massive Omicron-related wave, and the final impact of that wave remains uncertain. We have seen repeatedly that the epidemiological characteristics of new variants can have profound impacts on global health outcomes. While the characteristics of these new variants are difficult to predict ahead of their emergence, considering the impact of potential future scenarios is of central importance for prudent planning and policy making. This paper samples across a range of potential variant-level characteristics to provide global forecasts of infections, hospitalisations, and deaths in the face of ongoing Omicron-related transmission and waning levels of past immunity and evaluates a range of interventions that may diminish the impact of future waves. Methods We created a susceptible-exposed-infectious dynamic model that accounts for vaccine uptake and effectiveness, antiviral administration, the emergence of new variants, and waning protection from both infection- and vaccine-derived immunity. Using this model, we first estimated past infections, hospitalisations, and deaths by variant, location, and day. We used these findings to more fully understand the global progression of the COVID-19 pandemic through December 12, 2022. Second, we forecasted these same outcome measures under five potential variant emergence scenarios. Third, we evaluated three different interventions in isolation and in concert within each potential variant scenario, to assess the impact of available intervention strategies through June 30, 2023. Findings We estimated that from November 15, 2021, through December 12, 2022, there were 8.60 billion (95% uncertainty interval [UI] 6.37-11.7) SARS-CoV-2 infections, 13.1 million (10.6-16.5) hospitalisations, and 3.04 million (2.65-3.55) deaths, the majority of which were attributable to Omicron variants (98.5% [97.4-99.1] of infections, 82.6% [76.7-86.3] of hospitalisations, and 72.4% [66.4-76.0] of deaths). Compared to the pre-Omicron pandemic period from January 1, 2020, to November 15, 2021, we estimated that there were more than twice as many infections (214% [163-286]) globally from November 15, 2021, to December 12, 2022, but only 20.6% (19.8-21.4) of the estimated deaths. The massive Omicron waves and high vaccination rates in many high-income countries have together contributed to high levels of immunity against SARS-CoV-2 infection, leaving only 97.3% (96.3-98.2) of the global population with no protection as of December 1, 2022. Concurrently, however, China, where only 17.6% [5.28-34.8] of the population have ever experienced infection due to its zero-COVID policy, requires special attention over the next few months, as all our future scenarios predict substantial increases in transmission, hospitalisation, and death in China in now that zero-COVID policies have been relaxed. Under the future scenario we consider most plausible (a scenario with another new Omicron-like variant emerging and reference levels of the drivers of transmission), we estimated there will be an additional 5.19 billion (3.11-7.78) infections, 13.6 million (8.50-21.8) hospitalisations, and 2.74 million (1.40-5.68) deaths between December 12, 2022, and June 30, 2023, with the Western Pacific region projected to sustain the highest rates of additional deaths, driven primarily by the uncontained outbreak in China. By comparison, a baseline scenario in which no new variant emerges results in 3.54 billion (2.24-5.43) infections, 6.26 million (4.11-9.65) hospitalisations, and 1.58 million (0.829-3.95) deaths in the same forecast period. The ability for a new variant to break through past infection- and vaccine-derived immunity greatly influences future outcomes: we estimate a new variant with the high severity of Delta, but correspondingly moderate immunity breakthrough rates will have difficulty overtaking current variants and will result in similar outcomes to the Omicron-like variant scenario with 3.64 billion (2.26-5.83) new infections, 7.87 million (4.81-13.0) new hospitalisations, and 2.87 million (1.03-5.56) new deaths. Finally, if we consider a variant that combines the high infectiousness and breakthrough rates of Omicron with the high severity of Delta, we again estimate 5.19 billion (3.11-7.78) new infections, but due to the presumed increase in severe outcomes, we estimate 30.2 million (13.4-51.2) new hospitalisations and 15.9 million (4.31-35.9) deaths over the forecasted period. The impacts of interventions vary by variant characteristics and region of the world, with increased mask usage and reimplementation of some mandates having massive impact in some regions while having less impact in others. Finally, assuming variant spread was as rapid as observed for Omicron, we find almost no impact of a rapidly developed and deployed variant-targeted booster. Interpretation As infection-derived and vaccine-conferred protection wanes, we expect infections to rise, but as most of the world's population has some level of immunity to SARS-CoV-2 as of December 12, 2022, all but the most pessimistic forecasts in this analysis do not predict a massive global surge by June 30, 2023. Paradoxically, China, due to its lower levels of population immunity and effective vaccination will likely experience substantial numbers of infections and deaths that, due to its large population size, will adversely affect the global toll. This could be substantially mitigated by existing intervention options including masking, vaccination, health-care preparedness, and effective antiviral compounds for those at most at risk of poor outcomes. While still resulting in morbidity and mortality, this endemic transmission provides protection from less transmissible variants and particularly protects against sub-lineages of the more severe pre-Omicron variants. In the scenarios where a new variant does emerge and spread globally, however, the speed of this spread may be too fast to rely on even the most quickly developed mRNA vaccines to provide protection soon enough. Existing vaccines and boosters have played an important role in increasing immunity worldwide, but the continued contribution of mask usage (both past and future) in the prevention of infection and death cannot be understated. The characteristics of future COVID-19 variants are inherently difficult to predict, and our forecasts do show considerable differences in outcomes as a function of these variant properties. Given the uncertainty surrounding what type of variant will next emerge, the world would be wise to remain vigilant in 2023 as we move to the next phase of the COVID-19 pandemic.

The intermingled meanings of PhoneMe: Exploring transmodal, place-based poetry in an online social network

This research paper explores how preservice teachers engaged with the transmodal place-based poetry on PhoneMe, an educational social media platform for sharing poetry and vocal performances about place. This work is situated in literature on digital place-based education and theoretical scholarship exploring transmodality and the shifting entanglement of meanings and modes. In this paper, we share findings from a research survey conducted with teacher candidates in a core teacher education literacy course that had transitioned online due to the COVID-19 pandemic. We discuss how participants engaged with the transmodal poetry in the survey and how their perceived poetic meaning and poetic connections changed with each additional modality. We share the pedagogical implications of our findings as well as ideas gleaned from the data for integrating the PhoneMe platform and pedagogy in secondary school classrooms. In the discussion, we explore how engagement with transmodal place-based digital poetry can be a unique way to draw together place-based education, digital literacies, social media literacies, and poetry pedagogy in a way that is visceral, relational, and highly relevant to contemporary lives and classrooms both on and offline. © 2022 International Literacy Association.

Timing of deployment does not affect the biodiversity outcomes of ecological enhancement of coastal flood defences in northern Europe

Timing of installation is an important factor when planning the deployment of ecological enhancements to intertidal coastal and marine infrastructure. Such nature-based solutions (NbS) are increasingly used worldwide, so understanding whether the timing of deployment affects colonisation success is crucial to enhance their success and identify any ecological sensitivities that must be taken into consideration during construction. To date, none of the previous marine eco-engineering studies globally have looked specifically at timing. An unexpected COVID19 interruption in retrofitting Ecotiles designed to improve urban marine biodiversity provided a unique window of opportunity to address this research gap. We examined if time of deployment affects the early colonisation (within 18 months) success of eco-engineering enhancements. Thirty concrete tiles (Ecotiles) cast with a novel multi-scale, multi-species textured formliner were deployed on rock armour in three sites along the coast in Edinburgh, Scotland, at two different time periods (early March and late May 2020). After two settlement seasons, the colonisation success of 85% of the studied species did not vary between the times of deployment. Early colonisation success of intertidal species equalised within two settlement seasons of deployment, along with an overall increase in species richness. Crucially, these results also show that summer construction periods designed to reduce impacts on overwintering birds, do not adversely impact intertidal species during their peak (spring-summer) recruitment period in northern Europe. This novel result provides further support for widespread use of eco-engineering to enhance large coastal infrastructure projects and achieve ecological goals in northern Europe. More widely, this work contributes to the understanding of the impact of deployment timing on the success of similar NbS worldwide.

Authentic leadership at the Cleveland Clinic: psychological safety in the midst of crisis.

OBJECTIVES: The goal of this research was to examine the leadership experiences of senior leaders at the Cleveland Clinic during the recent COVID-19 pandemic crisis. A secondary goal was to examine lessons that could inform other healthcare organisations as they move into subsequent crisis situations. DESIGN: The authors examined publicly available podcast transcripts where interviewees shared their leadership experiences on the Cleveland Clinic Beyond Leadership Podcast. SETTING/PARTICIPANTS: Twenty-one publicly available qualitative transcripts were examined inductively and deductively to assess how authentic leadership principles were applied to the experiences noted. PRINCIPAL FINDINGS: Deductively, the four leadership behaviours of authentic leadership (ie, relational transparency, internalised moral perspectives, balanced processing of information and self-awareness) were noted in the transcripts. Inductively, the participants also identified the importance of developing an organisational culture rooted in psychological safety which allowed individuals from all levels of the organisation to voice their ideas, concerns and thoughts. As part of a psychologically safe culture, it was also important to understand the influence of hierarchy in healthcare, ways to encourage employee voice and the uniqueness of leadership during crisis. PRACTICAL APPLICATIONS: We first offer insights about the importance of psychological safety, particularly during a crisis. Second, we offer a number of ways that other healthcare organisations might strive to build on their own approach to authentic leadership and develop an organisational culture built on psychological safety.

The Society of Thoracic Surgeons Intermacs 2022 Annual Report: Focus on 2018 Heart Transplant Allocation System.

The thirteenth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 27,314 patients receiving continuous flow durable left ventricular assist devices (LVAD) over the last decade (2012-2021). In 2021, 2,464 primary LVADs were implanted, representing a 23.5% reduction in the annual volume compared to peak implantation in 2019 and an ongoing trend from the prior year. This decline is likely a reflection of the untoward effects of the COVID-19 pandemic and the change in the US heart transplant allocation system in 2018. The last several years have been characterized by a shift in device indication and type with 81.1% of patients now implanted as destination therapy and 92.7% receiving an LVAD with full magnetic levitation in 2021. However, despite an older, more ill population being increasingly supported pre-implant with temporary circulatory devices in the recent (2017-2021) vs prior (2012-2016) eras, the 1- and 5-year survival continues to improve at 83.0% and 51.9%, respectively. The adverse events profile has also improved, with significant reduction in stroke, gastrointestinal bleeding, and hospital readmissions. Finally, we examined the impact of the change in heart transplant allocation system in 2018 on LVAD candidacy, implant strategy, and outcomes. In the competing outcomes analysis, the proportion of transplant eligible patients receiving a transplant has declined from 56.5% to 46.0% at 3 years, while the proportion remaining alive with ongoing support has improved from 24.1% to 38.1% at 3 years, underscoring the durability of the currently available technology.

Leveraging smartphones to observe couples remotely and illuminate how COVID-19 stress shaped marital communication.

The height of the COVID-19 pandemic was an exceptionally stressful time for families that offered a unique opportunity to understand how stressful experiences occurring outside the relationship shape behavior occurring inside the relationship. Given the social distancing requirements of the pandemic, however, most research addressing this issue has relied on self-reports of behavior, which are susceptible to bias. In the summer of 2020, we asked a sample of married individuals living in the United States, Canada, Ireland, and the United Kingdom to complete online questionnaires assessing neuroticism and attachment insecurity, their levels of chronic stress, and their levels of acute stress due to the COVID-19 pandemic. We then asked participants to submit a 10-min video of themselves and their spouse attempting to solve an important marital problem that they recorded on their smartphone or other device and uploaded to a secure server. Coders were able to reliably code the behavior of both partners using an established coding system, and the distribution of codes was similar to prior research. Consistent with predictions, participants' COVID-19 stress interacted with their neuroticism and attachment avoidance to predict their levels of oppositional behavior, controlling for their levels of chronic stress and their partner's behavior; neuroticism and attachment avoidance were associated with behaving in a more oppositional manner among participants who reported high but not low COVID-19 stress. Attachment anxiety trended toward predicting more oppositional behavior regardless of stress. These results shed light on how stress affects behavior and introduce a novel way to observe family behavior remotely. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social media behavior is associated with vaccine hesitancy.

Understanding how vaccine hesitancy relates to online behavior is crucial for addressing current and future disease outbreaks. We combined survey data measuring attitudes toward the COVID-19 vaccine with Twitter data in two studies (N 1 = 464 Twitter users, N 2 = 1,600 Twitter users) with preregistered hypotheses to examine how real-world social media behavior is associated with vaccine hesitancy in the United States (US) and the United Kingdom (UK). In Study 1, we found that following the accounts of US Republican politicians or hyper-partisan/low-quality news sites were associated with lower confidence in the COVID-19 vaccine-even when controlling for key demographics such as self-reported political ideology and education. US right-wing influencers (e.g. Candace Owens, Tucker Carlson) had followers with the lowest confidence in the vaccine. Network analysis revealed that participants who were low and high in vaccine confidence separated into two distinct communities (or "echo chambers"), and centrality in the more right-wing community was associated with vaccine hesitancy in the US, but not in the UK. In Study 2, we found that one's likelihood of not getting the vaccine was associated with retweeting and favoriting low-quality news websites on Twitter. Altogether, we show that vaccine hesitancy is associated with following, sharing, and interacting with low-quality information online, as well as centrality within a conservative-leaning online community in the US. These results illustrate the potential challenges of encouraging vaccine uptake in a polarized social media environment.

Risk Factors for Reinfection with SARS-CoV-2 Omicron Variant among Previously Infected Frontline Workers.

In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.

Left-Right-Position, party affiliation and regional differences explain low COVID-19 vaccination rates in Germany.

Established vaccine hesitancy measurement instruments, such as the Vaccine Hesitancy Determinants Matrix, are not sufficiently equipped to adequately and consistently measure political and ideological attitudes. Focusing on Germany, which is a particularly interesting case since it witnessed the establishment of the by far most well-organized and sustained 'anti-Covid' movement in Europe, this quantitative study explores the impact of political ideology and partisanship on the degree of vaccine hesitancy based on four surveys (February-October 2021) among more than 30,000 individuals. We demonstrate that party affiliation, political ideology and region of residence all impact vaccine hesitancy. In fact, they turn out to have a greater impact than two factors often analysed with respect to vaccine hesitancy: gender and educational background. Further interaction models show that the effect of political ideology on vaccine hesitancy is moderated by age, gender and region of residency. For instance, while the more rightwing a young individual is, the more hesitant they are towards SARS-CoV-2 vaccination-for older individuals, this is not the case. Our findings are relevant for future investigators measuring vaccine hesitancy and policy makers contemplating the differential impact of complex public health interventions: as the impact of political and ideological attitudes on vaccine hesitancy are not adequately captured by established vaccine hesitancy measurement instruments, we recommend its modification to include a clear and harmonised definition of the political-ideological dimension of vaccine hesitancy together with pre-validated measurement items that improve future studies. In addition, we reason that vaccine hesitancy, while being an outcome of complex socio-political factors, is in itself an indicator for societal cohesion and anomie, the degree of which is associated with trust in (health) policy makers, (public) health authorities, health service providers, etc. Therefore, we further recommend that vaccine hesitancy questions should be integrated in pertinent national surveys.

HUGS/Abrazos: A Novel Community Initiative to Improve Perinatal Mental Health in a High-Risk Urban Population

Objective: To evaluate the impact of a community-based intervention on perinatal mental health in an urban population during the COVID-19 pandemic Study Design: We performed a prospective cohort study of pregnant and postpartum individuals referred to a new community-based intervention, Helping Us Grow Stronger (HUGS/Abrazos). Participants received four virtual acute behavioral health sessions from a cognitive behavioral therapy (CBT) and trauma-informed care trained social worker, four resource navigation visits with a community health worker, and a care package. Participants completed validated survey instruments assessing mood, anxiety, stress, food insecurity, experience of discrimination, and program satisfaction before and after program completion. Result(s): 103 participants (Table) completed surveys before and after the program. In this urban obstetric population, there were high rates of food insecurity (54%), experiences of discrimination (61%), and COVID-19 infection in pregnancy (62%). Program satisfaction was high (Table). The program was associated with improvement in Edinburgh Postnatal Depression (EPDS) scores (mean 8.3 pre-HUGS vs 6.7 +-5.6 post, p=0.001), with significant reduction in those screened positive for depression (46/103 pre- vs 31/103 post, p< 0.001);improvement in Perceived Stress Scale (PSS) scores (mean 15.4 +- 8.0 (SD) pre vs 13.5+- 7.1 post, p=0.003) with significant reduction in those with moderate or high stress (56/103 pre vs 49/103 post, p< 0.001);and reduction in those screened positive on the PROMIS anxiety scale (46/103 pre vs 40/103 post, p< 0.001). In stratified analyses (Figure), food insecurity, COVID-19 in pregnancy, and experiences of discrimination were associated with improvement in PSS scores and PROMIS anxiety score. Conclusion(s): In a diverse urban cohort, this novel community-based intervention led to improvement in depression, perceived stress, and anxiety, particularly for those with toxic life stressors in pregnancy including food insecurity, discrimination, and COVID-19 infection. [Formula presented] [Formula presented] Copyright © 2022

Quantifying the effects of the COVID-19 pandemic on gender equality on health, social, and economic indicators: a comprehensive review of data from March, 2020, to September, 2021.

BACKGROUND: Gender is emerging as a significant factor in the social, economic, and health effects of COVID-19. However, most existing studies have focused on its direct impact on health. Here, we aimed to explore the indirect effects of COVID-19 on gender disparities globally. METHODS: We reviewed publicly available datasets with information on indicators related to vaccine hesitancy and uptake, health care services, economic and work-related concerns, education, and safety at home and in the community. We used mixed effects regression, Gaussian process regression, and bootstrapping to synthesise all data sources. We accounted for uncertainty in the underlying data and modelling process. We then used mixed effects logistic regression to explore gender gaps globally and by region. FINDINGS: Between March, 2020, and September, 2021, women were more likely to report employment loss (26·0% [95% uncertainty interval 23·8-28·8, by September, 2021) than men (20·4% [18·2-22·9], by September, 2021), as well as forgoing work to care for others (ratio of women to men: 1·8 by March, 2020, and 2·4 by September, 2021). Women and girls were 1·21 times (1·20-1·21) more likely than men and boys to report dropping out of school for reasons other than school closures. Women were also 1·23 (1·22-1·23) times more likely than men to report that gender-based violence had increased during the pandemic. By September 2021, women and men did not differ significantly in vaccine hesitancy or uptake. INTERPRETATION: The most significant gender gaps identified in our study show intensified levels of pre-existing widespread inequalities between women and men during the COVID-19 pandemic. Political and social leaders should prioritise policies that enable and encourage women to participate in the labour force and continue their education, thereby equipping and enabling them with greater ability to overcome the barriers they face. FUNDING: The Bill & Melinda Gates Foundation.

Hyperbaric oxygen therapy to treat lingering COVID-19 symptoms.

Background: SARs-Cov-2 infections can produce prolonged illness and significant disability. Patients recovering from COVID-19 can have persistent symptoms leading to long-term morbidity. Methods: Six patients with long-lasting (> 30 days) COVID-19 symptoms were treated with hyperbaric oxygen (HBO2) therapy. All patients were assessed for symptoms using the ImPACT questionnaire, a muscle and joint pain scale, and a modified Borg dyspnea scale. Patients were assessed before, during and after HBO2 treatments. Results: All patients saw improvements in the measured symptoms to levels that were the same as pre-infection levels (five of six patients) or had significant improvement in symptoms (one patient). Conclusion: The results suggest that HBO2 helped to improve symptom scores, reduce the length of time of symptoms, and improved the quality of life. More detailed and randomized studies are needed to confirm the results in this report.