Human Anti-Ace2 Monoclonal Antibodies as Pan-Sarbecovirus Prophylactic Agents

Background: Human monoclonal antibodies from convalescent individuals that target the SARS-CoV-2 spike protein have been deployed as therapeutics against SARS-CoV-2. However, nearly all of these antibodies have been rendered obsolete by SARS-CoV-2 variants that evolved to resist similar, naturally occurring antibodies. Moreover, Most SARS-CoV-2 specific antibodies are inactive against divergent sarbecoviruses Methods: By immunizing mice that carry human immunoglobulin variable gene segments we generated a suite of fully human monoclonal antibodies that bind the human ACE2 receptor (hACE2) rather than the viral spike protein and were engineered to lack effector functions such as ADCC. Result(s): These ACE2 binding antibodies block infection by all hACE2 binding sarbecoviruses, including emergent SARS-CoV-2 variants, with a potency that of the most potent spike binding therapeutic antibodies. Structural and biochemical analyses revealed that the antibodies target an hACE2 epitope that engages SARS-CoV-2 spike. Importantly, the antibodies do not inhibit hACE2 enzymatic activity, nor do they induce ACE depletion from cell surfaces. The antibodies exhibit favorable pharmacology in human ACE2 knock in mice and provide near complete protection of hACE2 knock-in mice against SARS-CoV-2 infection. Conclusion(s): ACE2 binding antibodies should be useful prophylactic and treatment agents against any current and future SARS-CoV-2 variants, as well as hACE2-binding sarbecoviruses that might emerge as future pandemic threats.

COVID-19 and the Motorcycle Taxi Sector in Sub-Saharan African Cities: A Key Stakeholders' Perspective

This article assesses the impact of the COVID-19 outbreak on the urban motorcycle taxi (MCT) sector in Sub-Saharan Africa (SSA). MCToperators in SSA provide essential transport services and have shown ingenuity and an ability to adapt and innovate when responding to different challenges, including health challenges. However, policymakers and regulators often remain somewhat hostile toward the sector. The article discusses the measures and restrictions put in place to reduce the spread of COVID-19 and key stakeholders' perspectives on these and on the sector's level of compliance. Primary data were collected in six SSA countries during the last quarter of 2020. Between 10 and 15 qualitative interviews with key stakeholders relevant to the urban MCT sector were conducted in each country. These interviews were conducted with stakeholders based in the capital city and a secondary city, to ensure a geographically broader understanding of the measures, restrictions, and perspectives. The impact of COVID-19 measures on the MCT and motor-tricycle taxi sector was significant and overwhelmingly negative. Lockdowns, restrictions on the maximum number of passengers allowed to be carried at once, and more generally, a COVID-19-induced reduction in demand, resulted in a drop in income for operators, according to the key stakeholders. However, some key stakeholders indicated an increase in MCT activity and income because of the motorcycles' ability to bypass police and army controls. In most study countries measures were formulated in a non-consultative manner. This, we argue, is symptomatic of governments' unwillingness to seriously engage with the sector. © National Academy of Sciences: Transportation Research Board 2021.

Current Evidence for Infection Prevention and Control Interventions in Emergency Medical Services: A Scoping Review.

OBJECTIVES: The aim of this review was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. REPORT AND METHODS: PubMed, Embase, CINAHL, and SCOPUS were searched from January 1, 2006 through March 15, 2022 for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven (11) observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing (survey-weight adjusted odds ratio [OR] 4.20; 95% confidence interval [CI], 1.02 to 17.27) and less frequent hand hygiene after glove use (survey-weight adjusted OR 10.51; 95% CI, 2.54 to 43.45) were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity (unadjusted risk ratio [RR] 4.2; 95% CI, 1.03 to 17.22). Workers were more likely to be vaccinated against influenza if their employer offered the vaccine (unadjusted OR 3.3; 95% CI, 1.3 to 8.3). Active, targeted education modules for H1N1 influenza were effective at increasing vaccination rates and the success of on-site vaccine clinics. CONCLUSIONS: Evidence from the United States exists on the effectiveness of IPC practices in EMS clinicians, including hand hygiene, standard precautions, mandatory vaccine policies, and vaccine clinics. More research is needed on the effectiveness of PPE and vaccine acceptance.

"Should I stay or should I go?”—Why the future of global work may be less binary: Lessons on approaches to global crises from the experiences of expatriates during the COVID-19 pandemic

COVID-19 has significantly impacted expatriates, affecting their ability to work effectively and their personal and family lives. This study explores their experiences in different phases of the pandemic, and their perspectives on the future of international living in light of such global disruption. Involving over 600 expatriates in 48 countries, the research shows shifts in motivation and priorities as a result of the crisis and reveals how family (extended and immediate) topped expatriates' concerns. The study examines if and how support systems worked and looks at coping mechanisms, skills, traits, previous experience, and attitudes which participants found useful. A common theme was "falling between two stools”—where expatriates were ineligible for support in either their home country or in their host country. Others described being "pulled in different directions” or "torn by a dilemma” with pros and cons in either choice. The study contributes to the questions about the future of global work with results of the survey revealing changing norms for expatriation and global mobility raising the possibility of more nuanced approaches to global projects and less binary options for global professionals and their families. © 2022 The Authors. Thunderbird International Business Review published by Wiley Periodicals LLC.

An exploratory study on the impact of COVID-19 on U.S. State boards of accountancy

In the United States (U.S.) individual state boards of accountancy govern the accounting profession within each state. When COVID-19 struck the U.S., state boards worked to maintain normal operations. This study examines how COVID-19 affected the regulatory and oversight activities of the state boards of accountancy and the ways in which boards adapted to the pandemic. We interview executive directors from 21 state boards to determine the pandemic's impact on board operations and continuing professional education requirements. We also evaluate whether state boards implemented guidance from parties such as the National Association of State Boards of Accountancy (NASBA), and the resources boards had available to navigate the pandemic. Finally, we examine our analyses and findings through the lens of institutional theory. In doing so, we describe how state boards' individual reactions to the pandemic resulted in a largely homogenous response, as affected by coercive, mimetic, and normative isomorphic mechanisms. © 2022 Elsevier Inc.

The impacts of COVID-19 on black, indigenous, artists and arts administrators of color in the U. S. (Special Issue: Arts and social justice.)

This study investigated the impacts of COVID-19 on Black, Indigenous, and artists and arts administrators of Color. We addressed the primary research question, in what ways has COVID-19 impacted BIPOC artists and arts administrators? We also answered the secondary research question, do differences in impacts exist in health and wellness for BIPOC artists and administrators based on demographic characteristics? By centering BIPOC artists and arts administrators in this study, we initiated an area of critical scholarly inquiry that explored the impacts of COVID-19 on creatives who identify as historically marginalized and oppressed based on their race in U. S. society.

Infection Prevention and Control for the Emergency Medical Services and 911 Workforce

OBJECTIVES: To summarize current evidence on exposures to infectious pathogens in the emergency medical services (EMS) and 911 workforce, and on practices for preventing, recognizing, and controlling occupationally acquired infectious diseases and related exposures in that workforce.

A review of infectious disease epidemiology in emergency medical service clinicians.

BACKGROUND: The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce. METHODS: We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections. RESULTS: Of the 25 studies that met the inclusion criteria, most focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with prevalence rates ranging from 1.1% to 36.2% (median 6.7%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in 4 studies ranged from 1.9% to 6.4%, and the prevalence of Hepatitis C in 1 study was 1.3%. Few studies reported incidence rates. The prevalence or incidence of these infections generally did not differ by age or gender, but 4 studies reported differences by race or ethnicity. In the 4 studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2 (odds ratio 4.23), a higher prevalence of Hepatitis C in another study (odds ratio 1.74), and no significant difference in MRSA colonization in a separate study. CONCLUSIONS: More research is needed to better characterize the incidence and severity of occupationally-acquired infections in the EMS workforce.

An Exploratory Study on the Impact of COVID-19 on U.S. State Boards of Accountancy

In the United States (U.S.) individual state boards of accountancy govern the accounting profession within each state. When COVID-19 struck the U.S., state boards worked to maintain normal operations. This study examines how COVID-19 affected the regulatory and oversight activities of the state boards of accountancy and the ways in which boards adapted to the pandemic. We interview executive directors from 21 state boards to determine the pandemic’s impact on board operations and continuing professional education requirements. We also evaluate whether state boards implemented guidance from parties such as the National Association of State Boards of Accountancy (NASBA), and the resources boards had available to navigate the pandemic. Finally, we examine our analyses and findings through the lens of institutional theory. In doing so, we describe how state boards’ individual reactions to the pandemic resulted in a largely homogenous response, as affected by coercive, mimetic, and normative isomorphic mechanisms.

Transition to Universal Same Day Discharge (SDD) in Times of Corona Virus Disease-19 (COVID): A Success Story

Study Objective To evaluate success of universal SDD after minimally invasive hysterectomy. The COVID pandemic presented a unique scenario in which universal SDD was implemented abruptly across study institutions. This allowed for evaluation of patients with characteristics under-represented in SDD literature: large uteri due to leiomyoma, obesity defined as body mass index (BMI) ≥30, and later surgical end time. Design Retrospective chart review with before/after study design comparing pre-COVID to COVID cohorts. Setting High-volume, academic and academic-affiliated medical centers. Due to COVID, in the after-cohort, surgery could only be scheduled if SDD was planned. Patients or Participants Patients undergoing benign, laparoscopic or robotic-assisted hysterectomy during two 11-month periods: September 2018-July 2019 and May 2020-March 2021. Interventions Minimally invasive hysterectomy performed by three Minimally Invasive Gynecologic Surgeons. Measurements and Main Results 320 patients met inclusion criteria, 107 pre-COVID and 213 COVID. Mean age for both groups was 44.9. Patients were predominately non-Hispanic Black (40.2% pre- vs. 34.7% COVID) and non-Hispanic White (55.1% pre- vs. 63.4% COVID). Mean BMI was 33 for both groups. Pre-COVID, 2% of patients were discharged same day, whereas COVID 92% were discharged same day. Mean specimen weight was 478.2gm vs. 436.3gm for the two periods. In the COVID cohort, there was no difference in SDD success based on BMI (p 0.678), BMI <30 (49.5%), 30-39.9 (29.1%), 40-49.9 (15.3%), and ≥50 (6.1%). There was no difference in SDD success by specimen weight (p 0.077) stratified as <250gm (48.5%), 250-499gm (15.3%), or ≥500gm (36.2%). SDD success was not dependent on surgical end time (p 0.678) with end time stratified into ≤12:00 (45.4%), 12:01-14:59 (35.7%), and ≥15:00 (18.9%). There were no re-admissions in either cohort. Conclusion Abrupt transition to SDD is safe and feasible, including for patients with obese BMI and enlarged uterus. SDD success was not affected by later surgical end time.

Challenges and opportunities of remote public involvement and community engagement during a pandemic: refining the MapMe childhood healthy weight intervention.

AIMS: Including parents and other stakeholders in the development of interventions to address the sensitive public health issues such as childhood obesity, through public involvement is critical. However, the Covid-19 pandemic has created a challenge for public involvement and engagement activities (PICE). The aim of this paper is to describe the process and challenges of setting up, maintaining, evaluating, and recording impact of three public and stakeholder groups via remote methods in the context of the MapMe2 study during the Covid-19 pandemic. Parental reaction to result letters received as part of the National Child Measurement Programme (NCMP) informing parents of their child's overweight status is often one of hostility or disbelief. As a result, parents often do not act on these letters to address child overweight. The MapMe2 study is working in collaboration with the NCMP and local authorities, building on previous work (MapMe) and aims to support parents of primary school-aged children to recognise and maintain a healthy weight in their child. The existing MapMe Intervention includes an enhanced NCMP child weight result letter, supplemented with Body Image Scales (BIS), and an intervention website with material to support healthy eating, physical activity, and signposting supporting information. The intervention was to be refined and the evaluation informed with PICE input. METHODS: Covid-19 restrictions meant that planned face-to-face PICE methods had to be altered with all recruitment, all correspondence, and activities taking place remotely. A Parent Involvement Panel (PIP), a child panel, and an expert panel were established. Several adaptations were made to accommodate a new way of involving the public in research. RESULTS/CONCLUSIONS: Working remotely created many challenges and was a learning experience for all involved. However, an active group was successfully established. Using continuous assessment and evaluation methods, we were able to demonstrate successful involvement and engagement in the refinement of the MapMe2 study. Through the sharing of PICE methods practice, this paper adds to the literature, the value of partnership working.

Assessing impacts to national park visitation from COVID-19: A new normal for yosemite?

Yosemite National Park is a popular tourist destination with high visitation levels that have increased throughout the summer season over the past several decades. Like with other protected areas, high visitation levels pose challenges for coordinating resources, infrastructural capacity, and visitor experiences. Use limits, including rationing vehicle entry at gates by reservation, are one possible strategy to manage visitation levels. After an initial full closure, the park chose to operationalize a multiphased permit system for day-use and overnight entry over the course of the pandemic in accordance with local and national guidelines for operational safety. While park closures and other entry restrictions have been common in recent years due to wildland fires and other natural hazards, the pandemicrelated entry limits represent a nearly yearlong experiment. The prolonged entry ration along with restrictions to group activities has limited visitation and potentially reduced transmission of the novel coronavirus. We review the per capita COVID-19 case count in surrounding counties given the flow of tourism from outside the region, assess the changes in access to the park with the novel reservation system, compare monthly visitation during the 2020 use limits with prior decadal averages, detail how high visitation levels and crowding persist, and review the Park's plans for an ongoing day-use permit system. We conclude with the ongoing challenges managers face in light of continued high visitation. Readers will be able to debate the efficacy of use limits and what may be a sustainable level of visitation for the park. © 2021 by the Regents of the University of California. All rights reserved.

Red-blue team exercises for cybersecurity training during a pandemic

The COVID-19 pandemic has given rise to a remote workforce and education system which is vulnerable to a number of unique cybersecurity risks. There is a need for training cybersecurity professionals to deal with cyber threats during the pandemic and its aftermath. We present a series of red-blue team exercises related to pandemic threats, developed for undergraduate cybersecurity students. Implementation and experimental verification of macro virus attacks leveraging social engineering, building command-and-control services and conscripting devices into a botnet, and mitigating man-in-the middle attacks using a Raspberry Pi for website filtering will be discussed.

911 EMS Activations by Pregnant Patients in Maryland (USA) during the COVID-19 Pandemic.

INTRODUCTION: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, United States Emergency Medical Services (EMS) experienced a decrease in calls, and at the same time, an increase in out-of-hospital deaths. This finding led to a concern for the implications of potential delays in care for the obstetric population. HYPOTHESIS/PROBLEM: This study examines the impact of the pandemic on prehospital care amongst pregnant women. METHODS: A retrospective observational study was conducted comparing obstetric-related EMS activations in Maryland (USA) during the pandemic (March 10-July 20, 2020) to a pre-pandemic period (March 10-July 20, 2019). Comparative analysis was used to analyze the difference in frequency and acuity of calls between the two periods. RESULTS: There were fewer obstetric-related EMS encounters during the pandemic compared to the year prior (daily average during the pandemic 12.5 [SD = 3.8] versus 14.6 [SD = 4.1] pre-pandemic; P <.001), although the percent of total female encounters remained unchanged (1.6% in 2020 versus 1.5% in 2019; P = .091). Key indicators of maternal status were not significantly different between the two periods. African-American women represented a disproportionately high percentage of obstetric-related activations (36.2% in 2019 and 34.8% in 2020). CONCLUSIONS: In this state-wide analysis of EMS calls in Maryland early in the pandemic, no significant differences existed in the utilization of EMS by pregnant women. Prehospital EMS activations amongst pregnant women in Maryland only decreased slightly without an increase in acuity. Of note, over-representation by African-American women compared to population statistics raises concern for broader systemic differences in access to obstetric care.

Implementation of a clinical pathway for the surgical treatment of colorectal cancer during the COVID-19 pandemic.

AIM: This report summarizes the early experience of implementing elective colorectal cancer surgery during the COVID-19 pandemic. METHODS: A pathway to minimize the risk of including COVID-19-positive patients for elective surgery was established. Prioritization and additional safety measures were introduced into clinical practice. Minimal invasive surgery was used where appropriate. RESULTS: Thirty-eight patients were prioritized, and 23 patients underwent surgery (eight colon, 14 rectal and one anal cancer). The minimal invasive surgery rate was 78%. There were no major postoperative complications or patients diagnosed with COVID-19. Histopathological outcomes were similar to normal practice. CONCLUSION: A safe pathway to offer standard high-quality surgery to colorectal cancer patients during the COVID-19 pandemic is feasible.