Disasters and the blood community (including COVID-19)

This chapter is an attempt to explain and link the reader to the resources available to guide the development of an organization wide disaster preparedness process. Issues presented by the COVID-19 pandemic are also discussed. National governmental authorities generally have agencies responsible for the coordination of disaster planning and response in their respective countries. Important exemplars of international sources of information and training on disaster planning and emergency operations are provided. The blood community is highly regulated worldwide and even slight changes to processes and procedures can have far-reaching effects for facilities and patients, especially during an emergency. Blood collection and transfusion facilities must address regulatory impacts as part of their disaster planning. Vital records must be secured and maintained. These documents include records of donors, donations, manufacturing, testing, quality assurance, product disposition, as well as transfusion records. © 2022 John Wiley & Sons Ltd.

Rise in pediatric type 2 diabetes mellitus diagnoses in Philadelphia during the COVID-19 pandemic

Introduction: Concurrent with the obesity epidemic in children in the US, there has been a marked rise in type 2 diabetes mellitus (T2DM) in youth. Objective(s): Our objective was to ascertain the trend of new diagnoses of T2DM during the COVID pandemic at our institution and as part of the Philadelphia Pediatric Diabetes Registry. Method(s): New diagnoses of T2DM from 2017 to 2021 were identified through the EMR. They were divided into two groups, those from the city of Philadelphia, and those from outside the city limits. Result(s): We found an increase in the diagnoses of T2DM overall at our center, with a marked increase post-pandemic (n = 29, 30, 59, 86, 97;2017, 2018, 2019, 2020, 2021), and also within the city of Philadelphia (n = 12, 14, 26, 40, 50;2017, 2018 2019, 2020, 2021). African-Americans comprised 61%-66% of the new diagnoses, followed by Latinos at 10%-16%, Whites and Asians. The majority of the patients were females (61% to 65%), with roughly the same proportion in both groups. Mean age at diagnosis for females was consistent throughout at 13.6 years, whereas it was 14.5 years for males. Mean BMI for females and males in both groups was noted to increase (32.8, 33.0, 36, 38.9, 39.7;2017, 2018, 2019, 2020, 2021) and (34.0, 34.2, 35.5, 38.9, 39.2). In 2019, 4 patients presented with DKA, increasing to 6 in 2020 and 9 in 2021, whereas 2 patients presented in HHS in 2020, 4 in 2021, and none in 2017, 2018, or 2019. Approximately 10% had anti-insulin antibodies across all 5 years, and around 64% presented in the fall-winter months (October-February). The mean HbA1c at diagnosis was also found to increase among both groups, from 8.6% in 2019 to 9.3% in 2020 and 10.1% in 2021, versus 8.8% in 2017 and 8.5% in 2018. Conclusion(s): The number of new T2DM diagnoses in children has increased substantially during the pandemic, likely correlating with higher BMI scores and behavioral changes. We did not see a significant number of new diagnoses being admitted with COVID, though there were more presentations to the ICU.

COVID-19 is Associated with Long-term Elevated Fecal Calprotectin Levels in Patients with Crohn's Disease but not in Ulcerative Colitis

Background: Data regarding the long-term effects of COVID-19 on patients with Inflammatory bowel disease is scarce. Fecal calprotectin (FC) correlates with IBD clinical and endoscopic activity. We compared fecal calprotectin levels between patients with COVID-19 to a control group tested negative to SARS-CoV-2. Methods: We gathered data from a large health medical organization in Israel of insured individuals who underwent a SARS-COV-2 PCR test from March 1, 2020, to December 31, 2020. Among patients with IBD, data regarding fecal calprotectin taken 30-365 days before SARS-CoV-2 testing was gathered. We compared fecal calprotectin levels taken at least 30 days following COVID-19 infection to those who tested negative. Results: 1924 Crohn's disease (CD) patients and 949 Ulcerative Colitis (UC) patients were tested for SARS-CoV-2. 322 (16.7%) were tested positive in the CD group and 114 (13.7%) in the UC group. Pre-COVID-19 calprotectin levels did not show statistically significant differences between patients who ended up testing positive for SARS-CoV-2 and those who tested negative in CD (377 ±759.08 vs. 451.84±869, p-value = 0.4) and in UC (466.93±766.69 vs. 617.91 ±1243.99 p-value=0.37). Post-COVID-19 fecal calprotectin was higher among patients with CD who were tested positive than those who tested negative for SARS-CoV-2 (617.42±832.68 vs. 355.94±1207.46, p value=0.04). In a multivariate linear regression controlling for age, gender, BMI, smoking status, and pre-COVID-19 fecal calprotectin, SARS-CoV-2 positivity was associated with higher fecal calprotectin levels (p value=0.03). In contrast, there was no statistically significant change in fecal calprotectin levels among patients with UC and SARS-CoV-2 positivity (547.2±1089 vs.458.32± 689 p value=0.9). In a 2:1 propensity score-matched cohort (n=264), calprotectin levels were higher among patients with CD who suffered from COVID-19 compared to controls (657.64 vs. 384.94 p-value = 0.03) Conclusion: Patients with CD who had COVID-19 have higher FC levels compared to similar CD patients who did not have COVID-19. This finding was not found in patients with UC.

Implications of Social Distancing Policies on Drinking Water Infrastructure: An Overview of the Challenges to and Responses of U.S. Utilities during the COVID-19 Pandemic

Social distancing policies (SDPs) implemented throughout the United States in response to COVID-19 have led to spatial and temporal shifts in drinking water demand and, for water utilities, created sociotechnical challenges. During this unique period, many water utilities have been forced to operate outside of design conditions with reduced workforce and financial capacities. Few studies have examined how water utilities respond to a pandemic;such methods are even absent from many emergency response plans. Here, we documented how utilities have been impacted by the COVID-19 pandemic. We conducted a qualitative analysis of 30 interviews with 53 practitioners spanning 28 U.S. water utilities. Our aim was to, first, understand the challenges experienced by utilities and changes to operations (e.g., demand and deficit accounts) and, second, to document utilities' responses. Results showed that to maintain service continuity and implement SDPs, utilities had to overcome various challenges. These include supply chain issues, spatiotemporal changes in demand, and financial losses, and these challenges were largely dependent on the type of customers served (e.g., commercial or residential). Examples of utilities' responses include proactively ordering extra supplies and postponing capital projects. Although utilities' adaptations ensured the immediate provision of water services, their responses might have negative repercussions in the future (e.g., delayed projects contributing to aging infrastructure).

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis.

OBJECTIVE: To describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality. DESIGN: Cross-sectional study based on secondary surveillance database analysis. SETTING: Nationwide Brazil. POPULATION OR SAMPLE: 978 Brazilian pregnant and postpartum women notified as COVID-19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020. METHODS: Data was abstracted from the Brazilian ARDS Surveillance System (ARDS-SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. MAIN OUTCOME MEASURES: Case fatality rate. RESULTS: We identified 124 maternal deaths, corresponding to a case fatality rate among COVID-19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID-19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect. CONCLUSIONS: Negative outcomes of COVID-19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. TWEETABLE ABSTRACT: A total of 124 COVID-19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.

COVID-19 and pregnancy. (Special issue.)

Objectives: Reviewing the available literature on COVID-19 infection and the maternal and perinatal outcomes.

General aspects of the COVID-19 pandemic. (Special Issue: Transparency in research and publications on COVID-19.)

Objectives: To review the available literature on the general aspects of SARS-CoV-2 infec-tion.

General aspects of the COVID-19 pandemic

Objectives: to review the available literature on the general aspects of SARS-CoV-2 infection. Methods: this is a narrative literature review carried out from March to September 2020. Results: COVID-19 caused by the new coronavirus or SARS-CoV-2, grows with devas-tating effects worldwide. The literature describes epidemiological data and mortality risk groups of the disease, which presents a high rate of transmission. Prevention is the most effective way to fight the disease, persisting the absence of strong evidence on the treatment. Vaccines are not yet available. Dexamethasone is effective in reducing mortality in severe forms. Conclusions: despite great efforts, as the number of confirmed cases increases, evidence on transmission, incidence, disease progression, lethality, effects and outcomes remain limited and without any high levels of evidence. Studies are still necessary for all aspects of the disease. © 2021, Instituto Materno Infantil Professor Fernando Figueira. All rights reserved.

COVID-19 and pregnancy

Objectives: Reviewing the available literature on COVID-19 infection and the maternal and perinatal outcomes. Methods: This is a narrative review oftheliteraturecarried out from March to September 2020, usingthe MESH: Coronavirus, Covid 19, SARS-CoV-2, pregnancy, gravidity, pregnancy complications and pregnancy complications infectius. All study designs, reviews, recommendations and technical notes were included, without distinction of language and that would bring the approach ofthe new coronavirus in the gestational and perinatal scenario. Results: The COVID-19 pandemic has had devastating effects, affecting millions of people and claiming almost a million lives worldwide. Initially, pregnant women were not seen as a risk group for the disease, however as the proportion of women affected during the pregnancy- puerperal cycle increased, several studies were published showing an increased risk of complications. Brazilian studies have also warned of a high number of maternal deaths, associated with the presence of comorbidities but, above all, with the social determinants of the disease and serious failures in care. Conclusion: The need for new studies with an adequate research design was observed, as many studies are only letters or small series of cases, in addition expert recommendations, without the necessary scientific rigor.