Evaluation of Face Shields, Goggles, and Safety Glasses as a Virus Transmission Control Measure to Protect the Wearer Against Cough Droplets.

Face shields (also referred to as visors), goggles and safety glasses have been worn during the COVID-19 pandemic as one measure to control transmission of the virus. However, their effectiveness in controlling facial exposure to cough droplets is not well established and standard tests for evaluating eye protection for this application are limited. A method was developed to evaluate face shields, goggles, and safety glasses as a control measure to protect the wearer against cough droplets. The method uses a semi-quantitative assessment of facial droplet deposition. A cough simulator was developed to generate droplets comparable to those from a human cough. The droplets consisted of a UV fluorescent marker (fluorescein) in water. Fourteen face shields, four pairs of goggles and one pair of safety glasses were evaluated by mounting them on two different sizes of breathing manikin head and challenging them with the simulated cough. The manikin head was positioned in seven orientations relative to the cough simulator to represent various potential occupational exposure scenarios, for example, a nurse standing over a patient. Droplet deposition in the eyes, nose and mouth regions were visualised following three 'coughs'. Face shields, goggles, and safety glasses reduced, but did not eliminate exposure to the wearer from droplets such as those produced by a human cough. The level of protection differed based on the design of the personal protective equipment and the relative orientation of the wearer to the cough. For example, face shields, and goggles offered the greatest protection when a cough challenge was face on or from above and the least protection when a cough challenge was from below. Face shields were also evaluated as source control to protect others from the wearer. Results suggested that if a coughing person wears a face shield, it can provide some protection from cough droplets to those standing directly in front of the wearer.

Severity of COVID-19 among Residents in Aged Care Facilities in Victoria, Australia: A Retrospective Cohort Study Comparing the Delta and Omicron Epidemic Periods.

OBJECTIVES: During the COVID-19 pandemic, no country with widespread community transmission has avoided outbreaks or deaths in residential aged care facilities (RACFs). As RACF residents are at high risk of morbidity and mortality from COVID-19, understanding disease severity risk factors is imperative. DESIGN: This retrospective cohort study aimed to compare COVID-19 disease severity (hospitalization and deaths) and associated risk factors among RACF residents in Victoria, Australia, across Delta and Omicron epidemic periods. SETTINGS AND PARTICIPANTS: Resident case hospitalization risk (HR) and case fatality risk (CFR) were assessed using Victorian RACFs COVID-19 outbreaks data across 2 epidemic periods; Delta, 994 resident cases linked to 86 outbreaks; and Omicron, 1882 resident cases linked to 209 outbreaks. METHODS: Adjusting for outbreak-level clustering, age, sex, up-to-date vaccination status, and time since last vaccination, the odds of hospitalization and death were compared using mixed effects logistic regression. RESULTS: The HR and CFR was lower during the Omicron period compared with the Delta period [HR 8.2% vs 24.6%, odds ratio (OR) 0.17, 95% CI 0.11-0.26, and CFR: 11.4% vs 18.7%, OR 0.40, 95% CI 0.28-0.56]. During both periods, males had higher odds of hospitalization and odds of death; being up to date with vaccination reduced odds of hospitalization by 40% (excluding nonemergency patient transfers) and odds of death by 43%; and for each month since last vaccination, odds of hospitalization increased by 9% and odds of death by 16%. CONCLUSIONS AND IMPLICATIONS: This study provides empirical evidence of lower COVID-19 severity among RACF residents in the Omicron period and highlights the importance of up-to-date and timely vaccination to reduce disease severity in this cohort.

Simulating the Environmental Spread of SARS-CoV-2 via Cough and the Effect of Personal Mitigations.

BACKGROUND: A cough is known to transmit an aerosol cloud up to 2 m. During the COVID-19 pandemic of 2020 the United Kingdom's National Health Service (NHS), other UK government agencies and the World Health Organization (WHO) advised people to cough into their elbows. It was thought that this would reduce viral spread and protect the public. However, there is limited peer reviewed evidence to support this. OBJECTIVES: To determine if cough related interventions reduce environmental contamination, protecting members of the public from infection. METHODS: Scientists and engineers at the Health and Safety Executive (HSE) laboratory used a human cough simulator that provided a standardised cough challenge using a solution of simulated saliva and a SARS-CoV-2 surrogate virus; Phi6. Pseudomonas syringae settle plates were used to detect viable Phi6 virus following a simulated cough into a 4 × 4 m test chamber. The unimpeded pattern of contamination was compared to that when a hand or elbow was placed over the mouth during the cough. High speed back-lit video was also taken to visualise the aerosol dispersion. RESULTS AND DISCUSSION: Viable virus spread up to 2 m from the origin of the cough outwards in a cloud. Recommended interventions, such as putting a hand or elbow in front of the mouth changed the pattern of cough aerosol dispersion. A hand deflected the cough to the side, protecting those in front from exposure, however it did not prevent environmental contamination. It also allowed for viral transfer from the hand to surfaces such as door handles. A balled fist in front of the mouth did not deflect the cough. Putting an elbow in front of the mouth deflected the aerosol cloud to above and below the elbow, but would not have protected any individuals standing in front. However, if the person coughed into a sleeved elbow more of the aerosol seemed to be absorbed. Coughing into a bare elbow still allowed for transfer to the environment if people touched the inside of their elbow soon after coughing. CONCLUSIONS: Interventions can change the environmental contamination pattern resulting from a human cough but may not reduce it greatly.

A Worldwide Survey of Activities and Practices in Clinical Islet of Langerhans Transplantation.

A global online survey was administered to 69 islet transplantation programs, covering 84 centers and 5 networks. The survey addressed questions on program organization and activity in the 2000-2020 period, including impact on activity of national health care coverage policies. We obtained full data from 55 institutions or networks worldwide and basic activity data from 6 centers. Additional data were obtained from alternative sources. A total of 94 institutions and 5 networks was identified as having performed islet allotransplantation. 4,365 islet allotransplants (2,608 in Europe, 1,475 in North America, 135 in Asia, 119 in Oceania, 28 in South America) were reported in 2,170 patients in the survey period. From 15 centers active at the start of the study period, the number of simultaneously active islet centers peaked at 54, to progressively decrease to 26 having performed islet allotransplants in 2020. Notably, only 16 centers/networks have done >100 islet allotransplants in the survey period. Types of transplants performed differed notably between North America and the rest of the world, in particular with respect to the near-absence of simultaneous islet-kidney transplantation. Absence of heath care coverage has significantly hampered transplant activity in the past years and the COVID-19 pandemic in 2020.

Granulomatosis With Polyangiitis Presenting as Complete Hearing Loss.

Granulomatosis with Polyangiitis is a rare autoimmune vasculitis that is classically characterized by effects on the upper respiratory tract, lungs, and kidneys. Delay in diagnosis is often attributed to variable and sequential presentation of symptoms rather than concurrent symptomatology. It is important to recognize the wide range of initial presenting symptoms as early diagnosis and treatment is critical in preventing potentially irreversible damage resulting from delayed diagnosis. We present a case of a 29-year-old male with history of mixed sensorineural-conductive hearing loss presumed to be secondary to chronic otitis media who presented to the emergency department with complaint of hematemesis with a subsequent diagnosis of granulomatosis with polyangiitis.

What is the right level of spending needed for health and care in the UK?

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health.

Randomised controlled trial for high-dose intravenous zinc as adjunctive therapy in SARS-CoV-2 (COVID-19) positive critically ill patients: trial protocol.

INTRODUCTION: SARS-CoV-2 (COVID-19) has caused an international pandemic of respiratory illness, resulting in significant healthcare and economic turmoil. To date, no robust vaccine or treatment has been identified. Elemental zinc has previously been demonstrated to have beneficial effects on coronaviruses and other viral respiratory infections due to its effect on RNA polymerase. Additionally, zinc has well-demonstrated protective effects against hypoxic injury-a clear mechanism of end-organ injury in respiratory distress syndrome. We aimed to assess the effect of high-dose intravenous zinc (HDIVZn) on SARS-CoV-2 infection. The end of study analyses will evaluate the reduction of impact of oxygen saturations or requirement of oxygen supplementation. METHODS AND ANALYSIS: We designed a double-blind randomised controlled trial of daily HDIVZn (0.5 mg/kg) versus placebo. Primary outcome measures are lowest oxygen saturation (or greatest level of supplemental oxygenation) for non-ventilated patients and worst PaO2/FiO2 for ventilated patients. Following power calculations, 60 hospitalised patients and 100 ventilated patients will be recruited to demonstrate a 20% difference. The duration of follow-up is up to the point of discharge. ETHICS AND DISSEMINATION: Ethical approval was obtained through the independent Human Research Ethics Committee. Participant recruitment will commence in May 2020. Results will be published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER: ACTRN126200000454976.

Are surgical masks manufactured from sterilisation wrap safe?

BACKGROUND: Due to regional shortages some health services have proposed using surgical masks manufactured from sterilisation wrap. However, there has been little assessment of the safety of this practice. Therefore, we developed our own prototypes and evaluated whether they met regulatory standards. METHODS: Surgical mask prototypes were manufactured from two thickness grades of commercial sterilisation wrap. Safety was assessed in the context of regulatory standards. As it was not previously reported, we developed and performed differential pressure and synthetic blood penetration resistance experiments in accordance with official methodology. RESULTS: Bacterial filtration efficiency was comparable between sterilisation wrap and commercial surgical masks. Both prototypes met regulatory standards for synthetic blood resistance, whilst only our thinner mask fulfilled acceptable differential pressure ('breathability') thresholds. CONCLUSION: Acceptable barrier and breathability properties can be achieved with surgical masks produced from sterilisation wrap. Therefore, this may be a reasonable method to supplement stock if required. Unless there are shortages mandating alternatives, health-care workers should always use approved personal protective equipment.