Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO).

BACKGROUND: The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS: The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION: PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.

A media surveillance analysis of COVID-19 workplace outbreaks in Canada and the United States

A media surveillance analysis was conducted to identify COVID-19 workplace outbreaks and associated transmission risk for new and emerging occupations. We identified 1,111 unique COVID-19 workplace outbreaks using the Factiva database. Occupations identified in the media articles were coded to the 2016 National Occupational Classification (V1.3) and were compared and contrasted with the same occupation in the Vancouver School of Economics (VSE) COVID Risk/Reward Assessment Tool by risk rating. After nurse aides, orderlies, and patient service associates (n = 109, very high risk), industrial butchers and meat cutters, and poultry preparers and related workers had the most workplace outbreaks reported in the media (n = 79) but were rated as medium risk for COVID-19 transmission in the VSE COVID Risk Tool. Outbreaks were also reported among material handlers (n = 61) and general farm workers (n = 28), but these occupations were rated medium-low risk and low risk, respectively. Food and beverage services (n = 72) and cashiers (n = 60) were identified as high-risk occupations in the VSE COVID Risk Tool. Differences between the media results and the risk tool point to key determinants of health that compound the risk of COVID-19 exposure in the workplace for some occupations and highlight the importance of collecting occupation data during a pandemic.

INEQUITY EXISTS IN TELEMEDICINE USE DURING THE COVID-19 PANDEMIC FOR GASTROINTESTINAL SURGERY PATIENTS IN THE DEEP SOUTH

Introduction: Telemedicine is designed to increase healthcare access and is increasingly used during the COVID-19 pandemic. However, its use among historically vulnerable populations is poorly characterized and may further exacerbate healthcare disparities. We aimed to characterize telemedicine use among a diverse surgical population in the Deep South during the COVID-19 pandemic. Methods: All patients seen in gastrointestinal (GI) surgery clinics at a tertiary care academic center in Alabama were reviewed from March 18, 2020 to September 30, 2020. Demographics including age, race, sex, insurance, date of service, and home ZIP code were recorded. Internet availability according to the FCC and median income of home ZIP codes were recorded. Patients were stratified by clinic visit type (in-person versus telemedicine, and within telemedicine, phone versus video) and compared by socioecological factors. Chi-square and ANOVA tests were performed to compare patient groups and logistic regression was used to predict telemedicine use. Results: Of the 2,580 GI surgery patients seen, 50.5% (n=1,302) were in-person and 49.5% (n=1,278) were via telemedicine, including video (43.4%) and phone (56.6%) visits. Patients were predominantly female (59.3%) and white (62.1%), with private insurance (53.8%) and a mean age of 52.1 years. Patients seen in-person and via telemedicine were similar except patients using telemedicine lived further from the hospital (mean distance 60.6 mi vs 49.6 mi, p<0.001). Living 100 mi or more from the hospital and in a ZIP code with the highest quintile of median income were independent predictors of telemedicine use (OR 1.51, 95% CI 1.16-1.97;OR 1.39, 95% CI 1.04-1.85, respectively). Among patients who used telemedicine, those with phone use were more likely to be Black compared to those with video use (35.3%, vs 29.4%, p=0.043). Patients with phone use were older (mean age = 54.0 yr vs 50.5 yr, p<0.001) and came from ZIP codes with lower median income ($35,618 vs $37,846, p=0.037). They were more likely to have Medicaid (10.7% vs 6.1%) or Medicare (32.1% vs 25.0%) and less likely to be privately insured (50.5% vs 60.2%) compared to patients with video use (p=0.001). Living 100 mi or more from the hospital was an independent predictor of video use (OR 2.27, 95% CI 1.56-3.30). Having Medicaid and age greater than 80 were independent predictors of phone use (OR 0.46, 95% CI 0.29-0.73;OR 0.37, 95% CI 0.16-0.86, respectively). Conclusion: Patients who live further from the hospital are more likely to use telemedicine. Phone visits are used more by patients who are Black, older, from lower income ZIP codes, publicly insured, and live closer to the hospital. Variations in patient telemedicine use exist across a diverse surgical population in the Deep South, suggesting telemedicine be tailored to patient preferences and available resources.

A media surveillance analysis of COVID-19 workplace outbreaks in Canada and the United States

Introduction The news media is one of the most accessible sources of information regarding COVID-19 transmission in the workplace in the absence of other occupational data. Only a few public health agencies in Canada and the United States have publically reported detailed occupation information for non-health care worker COVID-19 cases. Objective We conducted a media surveillance analysis to identify new or emerging occupational groups at risk of exposure to the SARS-CoV-2 virus ('COVID-19 exposure'). Methods We searched the Factiva database for media articles reporting COVID-19 workplace outbreaks (February 1-December 22, 2020). Job titles were coded to the 2016 National Occupational Classification (V1.3) and industries to the 2017 North American Industry Classification System (V3.0). Occupations with COVID-19 workplace transmission identified in media articles were compared and contrasted with the same occupation in the Vancouver School of Economics (VSE) COVID Risk Tool by risk rating (seven categories between very high to very low). Results We identified 1,111 unique COVID-19 workplace outbreaks in the media. After nurse aides, orderlies and patient service associates, industrial butchers and meat cutters, poultry preparers and related workers had the most workplace outbreaks reported in the media (n=79) but were rated as medium risk occupations for COVID-19 transmission in the VSE COVID Risk Tool. Outbreaks were also reported in the media among material handlers (n=61) and general farm workers (n=28) but were rated medium-low risk and low risk, respectively. Outbreaks reported in the media among food and beverage services (n=72) and cashiers (n=60) were identified as high risk occupations in the VSE COVID Risk Tool. Conclusion Media surveillance can identify COVID-19 workplace outbreaks and indicate transmission risk. Our results point to key determinants of health that compound the risk of COVID-19 exposure in the workplace, and highlight the importance of collecting occupation data during a pandemic.

Fearful intimacies COVID-19 and the reshaping of human–microbial relations

This article explores how COVID-19 could be reshaping human–microbial relations in and beyond the home. Media sources suggest that intimacies of companionability or ambivalence are being transformed into those of fearfulness. While a probiotic sociocultural approach to human–microbial relations has become more powerful in recent times, it seems that health and hygiene concerns associated with COVID-19 are encouraging the wholesale use of bleach and other cleaning agents in order to destroy the potential microbial ‘enemies’ in the home. We provide a brief background to shifting public health discourses on managing microbes in domestic settings over recent decades across the industrialised world, and then contrast this background with emerging advice on COVID-19 from news and advertisement sources. We conclude with key areas for future research. © Berghahn Books and the Association for Anthropology in Action.