Mental health in rural america during COVID-19 and beyond

COVID-19 has had remarkable impacts in rural America. Although the onset of the pandemic was in urban areas, it quickly spread to rural areas and ultimately resulted in higher mortality rates for rural populations. Due to this and other associated impacts, the pandemic has resulted in mental health issues across rural America. In this chapter, the authors first describe the state of rural America pre-pandemic, then detail the overall and mental health impacts of the pandemic on rural people. Following this, the authors report results of a case study on COVID-19 in the rural America West and conclude with recommended steps for addressing the unfolding crisis. Many of the steps the authors can take to improve rural mental health following the pandemic have long-been necessary. However, given the impacts of COVID-19, they are now needed more than ever. © 2023 The authors.

The importance of physical proximity for team cohesion–a case study of USA Rugby 7s

Research Question: This paper seeks to contribute to the theoretical understanding of team cohesion in sport. While a robust foundation of research on team cohesion in sport exists, there is a dearth of research examining the role of physical proximity. With physical group exercise temporarily suspended due to COVID-19, herein lies an opportunity to examine team cohesion throughout different stages of physical distancing. Research Methods: A single case mixed method study was employed comprised of semi-structured interviews (19 total) conducted at three different time points (September 2019;March 2020;June 2020) and a baseline/post administration of the GEQ Survey (September 2019 (N = 26);August 2020 (N = 27)). Qualitative data were analysed in NVivo 12, and survey data were analysed via paired t-tests. Results and Findings: Levels of team cohesion remained stable throughout the season and during physical distancing on all three cohesion sub-scales (i.e. ATG-T, GI-S, GI-T). Three qualitative themes emerged: task and collective loyalty, resilience through social cohesion, and digital engagement. Implications: Digital communication can temporarily fill the void of face-to-face interaction but cannot replace it long-term to build team cohesion. Adding physical proximity to the theoretical conceptualization of team cohesion makes the model more contemporary and especially relevant during times of physical distancing (e.g. pandemic, off-season, remote teams). © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Rural-urban differences in the labor-force impacts of COVID-19 in the United States

COVID-19 has had dramatic impacts on economic outcomes across the United States, yet most research on the pandemic’s labor-market impacts has had a national or urban focus. We overcome this limitation using data from the U.S. Current Population Survey’s COVID-19 supplement to study pandemic-related labor-force outcomes in rural and urban areas from May 2020 through February 2021. We find the pandemic has generally had more severe labor-force impacts on urban adults than their rural counterparts. Urban adults were more often unable to work, go unpaid for missed hours, and be unable to look for work due to COVID-19. However, rural workers were less likely to work remotely than urban workers. These differences persist even when adjusting for adults’ socioeconomic characteristics and state-level factors. Our results suggest rural-urban differences in the nature of work during the pandemic cannot be explained by well-known demographic and political differences between rural and urban America.

Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises

PURPOSE: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. METHODS: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. RESULTS: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships;(2) positive presence and communication;and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.

University of Chicago Pathology Novel SARS-CoV-2 Autopsy Protocol

Background: While all autopsies pose a potential risk of exposure to infectious agents, the recent emerging SARS-CoV-2 (COVID) pandemic reminds us of this elevated potential. During this outbreak there are still few detailed protocol recommendations, limited data, and much uncertainty about how exactly to handle such a case. Furthermore, it has been estimated that SARS-CoV-2 autopsies take at least three times longer than a standard autopsy. We designed an institutional autopsy protocol to mitigate occupational risk, increase efficiency, limit exposure, and maximize educational value. Design: The personal protective equipment (PPE) for the evisceration component of the autopsy consisted of Powered Air Purifying Respirator (PAPR), two layers of long cuff disposal gloves, plastic apron, fluid proof gown, and fluid resistant leg covers. All SARS-CoV-2 autopsies were conducted by a limited number of trained personnel including an attending pathologist, resident and pathologist assistant using the Virchow evisceration method. The cranium was opened using a bone saw with an integrated vacuum. Organ retrieval, weight, and photographing of the cut surface were performed on the day of evisceration and could be completed within one hour, including cleaning of the autopsy suite. Sectioning was performed after fixation for 48-72 hours in 10% neutral buffered formalin. On the day of sectioning, a PAPR was replaced with a N95 respirator. Results: Over 10 members of our department have contributed to performing 40 COVID autopsies since 2019. No personnel became infected with SARS-CoV-2. Our complete protocol has provided our institution with resources to further study the pathogenesis of COVID in humans. It also differs from other modifications by for example, having multiple body cavities open at a time and not having autopsy rooms dedicated only to infected cadavers. Using these methods we have been able to supply numerous institutional labs with organ sections for various research protocols. Conclusions: Although post-mortem examination of COVID-infected decedents has inherent risk, only complete autopsies are a source of invaluable and irreplaceable information. This protocol was originally designed for SARS-CoV-2, but we recognize the potential application for other high-risk infectious cases. It is our hope that as more practical evidence-based biosafety guidance is disseminated the need for limited autopsies and partially or completely suspended autopsy services will be obviated.

End-Stage Kidney Disease is Underreported in Death Certificates

Background: End-stage kidney disease (ESKD) impacts more than 785,000 Americans and often occurs with multiple comorbid conditions, especially cardiovascular diseases, which are the most common cause of death (COD) in ESKD. Many complications directly arise from ESKD, but its deadly impact can be overlooked. At our institution, the death certificate is completed by clinicians and a majority by clinical house staff. We reviewed the death certificates of ESKD autopsies to understand the clinicians' perspectives on the range of CODs in this clinical setting. Design: We searched our database for autopsies of adult ESKD patients (2012-2021) that had accessible death certificates. COVID-positive cases were excluded. We evaluated the COD section of death certificates and correlated them with autopsy findings. The frequency of autopsy findings directly identifying CODs or resulting in amendments of death certificates was also noted. Results: Of 68 autopsy reports, the majority of CODs reported in death certificates were related to sepsis/infection (30%), and cardiovascular diseases (26%). There was no documentation of ESKD in the majority (78%,53/68) of death certificates. Of these 53 cases, 89% had COD either due to fatal complications of ESKD (98%) or increased mortality of another comorbid condition due to the underlying ESKD. The remaining 11% had COD unrelated to ESKD. Among the fatal complications of ESKD, cardiovascular complications were the most commonly noted (72%) followed by sepsis (20%). Autopsy findings were used to identify the COD on death certificates in only 6% of cases. No amendments were made on any of these death certificates. Conclusions: ESRD is often not mentioned in death certificates, which underestimates its mortality burden. The death certificate is a source for mortality statistics and used by government for public health policy and allocation of research funding. Hence, accurate accounting of death certificates is essential for this complex and silent disease.

In Situ Calibration of Passive Samplers for Viruses in Wastewater

Wastewater surveillance for SARS-CoV-2 RNAhas rapidly developed worldwide. In low-prevalence settings, sampling in sewage networks is proposed to monitor community transmission. Passive samplers are cost-effective and suitable for catchments where autosamplers cannot be operated. This resulted in their pioneering applications in some countries, even though their sampling kinetics for viruses remains unclear. We conducted in situ calibration of passive sampling materials (membranes, swabs, gauzes, and tampons) for the uptake of pepper mild mottle virus (PMMoV), enterovirus, and human adenovirus 40/41. Passive samplers were deployed in wastewater influent and retrieved sequentially over 48 h. Membranes performed continuous sampling over 48 h with estimated linear sampling rates of 1 mL h-1 for PMMoV, 0.3 mL h-1 for enterovirus, and 33.1 mL h-1 for adenovirus. Tampons and swabs showed a rapid initial uptake of viruses and reached equilibrium after 8 h, while gauze uptake rates were potentially confounded by either inhibitors or viral losses during extended exposure. Additionally, monitoring SARS-CoV-2 at 17 sewer manholes showed that the detection ratio of membranes (14 of 17) was higher than that of tampons (8 of 17). This study demonstrated the ability of passive samplers to retain viral fragments, making them a practical tool for wastewater surveillance for the detection of disease outbreaks in communities. © 2022 American Chemical Society. All Rights Reserved.

Long COVID 1 year after hospitalisation for COVID-19: a prospective bicentric cohort study

AIMS OF THE STUDY: There is increasing interest in better understanding of long COVID, a condition characterised by long-term sequelae-appearing or persistingafter the typical convalescence period-of coronavirus disease 2019 (COVID-19). Herein, we describe long-term outcomes regarding residual symptoms and psychological distress in hospitalised patients 1 year after COVID-19. METHODS: This prospective cohort study included consecutive adult patients hospitalised for confirmed COVID-19 in two Swiss tertiary-care hospitals between March and June 2020. The primary endpoint was evidence of long COVID 1 year after discharge, defined as =1 persisting or new symptom related to COVID-19, from a predefined list of symptoms. Secondary endpoints included psychological distress and symptoms of post-traumatic stress disorder (PTSD). RESULTS: Among 90 patients included in the study, 63 (70%) had symptoms of long COVID 1 year after hospitalisation, particularly fatigue (46%), concentration difficulties (31%), shortness of breath (21%) and post-exertion malaise (20%). Three predictors, namely duration of hospitalisation (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.00-1.22;p = 0.041), severity of illness (OR 1.19, 95% CI 1.04-1.37;p = 0.013), and self-perceived overall health status 30 days after hospitalisation (OR 0.97, 95% CI 0.94-1.00;p = 0.027) were associated with long COVID. Regarding secondary endpoints, 16 (18%) experienced psychological distress and 3 (3.3%) patients had symptoms of PTSD. CONCLUSION: A high proportion of COVID-19 patients report symptoms of long COVID 1 year after hospitalisation, which negatively affects their quality of life. The most important risk factors were severe initial presentation of COVID-19 with long hospital stays.

Elevated serious psychological distress, economic disruption, and the COVID-19 pandemic in the nonmetropolitan American West.

In this study we examined the psychological distress, self-rated health, COVID-19 exposure, and economic disruption of a sample of the nonmetropolitan western U.S. population and labor force one year after the start of the COVID-19 pandemic. Using novel primary survey data from non-metropolitan counties in the eleven contiguous western United States collected from February 28 until April 3, 2021 (n = 1203), we descriptively analyzed variables and estimated binomial and multinomial logit models of the association between economic disruption, COVID-19 exposure, self-rated health, and psychological distress. Results showed there was widespread presence of psychological distress, COVID-19 exposure, and economic disruption among the overall sample and members of the labor force. There was extremely high incidence of serious psychological distress (14.8% CI [12.1,17.8] of the weighted sample), which was heightened among the labor force (16.6%, CI [13.0,20.9] of those in the labor force). We found economic disruption was associated with severe psychological distress, but exposure to infection was not. Comparatively, overall self-rated health was at similar levels as prior research and was not significantly associated with economic disruption or COVID-19 exposure. COVID-19, particularly its associated economic effects, had a significant relationship with serious psychological distress in this sample of adults in the nonmetropolitan western United States.

Impact of COVID-19 Controls on the Use of Illicit Drugs and Alcohol in Australia

Methamphetamine, MDMA, cocaine, cannabis, and alcohol in samples from 20 wastewater treatment plants servicing the eight state or territory capitals of Australia were analyzed, with equivalent coverage of >45% of the national population. Trends in drug consumption were calculated and assessed from samples collected from 2016 to 2020, with a focus on pre-COVID-19 (August 2016 to December 2019), versus February to June 2020, when Australia observed a nationwide lockdown. Results showed delayed but significant decreases in methamphetamine, >50% in Western Australia. In contrast, significant increases in cannabis in most jurisdictions were observed. This suggests changes in consumption may be somewhat linked to reduced supply of imported substances, with increased use of locally produced drugs. Initial decreases in cocaine and MDMA consumption were evident in many parts of the country, but pre-COVID trends were re-established after April 2020. Interestingly, weekend-weekday differences were narrowed for cocaine, MDMA, and alcohol during lockdown, which might be expected due to bars being closed and social gathering not allowed. With this study providing insight into the first four months of COVID-19 restrictions in Australia, it remains to be seen what the longer-term effect of the pandemic will be. © 2021 American Chemical Society.

Novel Multiplexed Amplicon-Based Sequencing to Quantify SARS-CoV-2 RNA from Wastewater

The application of wastewater-based epidemiology (WBE) to support the global response to the COVID-19 pandemic has shown encouraging outcomes. The accurate, sensitive, and high-throughput detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in municipal wastewater is critical for WBE. Here, we present a novel approach based on multiplexed amplicon-based sequencing, namely the ATOPlex platform, for detecting SARS-CoV-2. The ATOPlex platform is capable of quantifying SARS-CoV-2 RNA at concentrations that are at least 1 order of magnitude lower than the detection limit of reverse transcription quantitative polymerase chain reaction (RT-qPCR). Robust and accurate phylogenetic placement can be done at viral concentrations 4 times lower than the detection limit of RT-qPCR. We further found that the solid fraction in wastewater harbors a considerable amount of viral RNA, highlighting the need to extract viral RNA from the solid and liquid fractions of wastewater. This study delivers a highly sensitive, phylogenetically informative, and high-throughput analytical workflow that facilitates the application of WBE. ©

Assessment of differences in demographic characteristics and clinical diagnoses among black and white oncology patients with COVID

Background: Health disparities between black and white COVID-positive patients are well documented. To help address these disparities, clinicians need to understand the specific health challenges faced by black COVID patients compared to their white counterparts. These challenges are understudied in the oncologic setting. Hence, we present the demographic and clinical features of black COVID-positive cancer patients compared to whites. Methods: We used ConcertAI's database of oncology EMR data, which includes clinical data from CancerLinQ Discovery. We conducted twosample t-tests and chi-squared tests to measure the differences in black and white COVIDpositive cancer patients across age, gender, ethnicity, state, region, ECOG, BMI, all cancer indications, stage, and Charlson comorbidities. COVID positivity was defined using claims data. Only relevant significant results are reported to save space. Results: Table summarizes the differences in 429 black and 980 white cancer patients with COVID. Black patients were younger, more likely to have an elevated BMI, and have a higher prevalence of breast cancer, congestive heart failure, diabetes, multiple myeloma, peptic ulcer disease, and renal disease. They also had less melanoma. Results were statistically significant at 0.05 level. Analyzing only black patients by COVID status shows very similar results. Conclusions: Black cancer patients suffer from multiple comorbid conditions that increase their risk of adverse outcomes when infected with COVID-19. The CDC lists eight comorbidities that put patients at a higher risk of severe COVID infection. Black patients in our cohort have a higher prevalence of four out of eight of these conditions- elevated BMI, renal disease, congestive heart failure, and diabetes. Clinicians should inspect for these comorbidities while treating this atrisk population. Demographic and clinical characteristics of patients.

'His-story': The clinical key leading to a diagnosis of evali

Introduction-We present the case of a young male with constitutional symptoms thought to be consistent with community-acquired or COVID-19 pneumonia, who was instead found to have a history of vaping tetrahydrocannabinol (THC) and was diagnosed with EVALI (E-cigarette, or Vaping, Product Use-Associated Lung Injury). Case Presentation-21-year-old male college student presented to the hospital in July 2020 with a 2-week history of abdominal pain, vomiting, diarrhea, headache and generalized myalgias. More recently, he had a fever and dry cough associated with worsening shortness of breath. In the hospital, the patient was initially requiring minimal oxygen and was febrile to 102°F. Physical exam was consistent with a young, diaphoretic male with tachypnea who had bilateral basilar crackles on auscultation of lungs. Bloodwork revealed a leukocytosis of 19.2k/mm3, ferritin of 1081ng/mL and a CRP of 64mg/dL. An initial chest x-ray was consistent with bilateral interstitial markings. 2 days later, he was admitted to the intensive care unit since he was requiring high-flow nasal cannula. A Computed Tomography (CT) of the chest (Figure 1A, 1B) showed extensive peribronchial groundglass opacity with subpleural sparing. Complete respiratory viral panel, COVID-19, Tuberculosis, HIV and tickborne illnesses testing were all negative. By this time, the patient had been treated with antibiotics for presumed community-acquired pneumonia. The pulmonary service was consulted, and detailed social history-taking revealed that the patient had started vaping THC obtained from a less well-known brand, shortly before the onset of his symptoms. A bronchoscopy was performed which revealed evidence of anthracotic pigment present in distal airways. Bronchoalveolar lavage (BAL) ultimately revealed no evidence of infection or malignancy and showed foamy macrophages. Based on his presentation, a diagnosis of EVALI was made and the patient was started on intravenous corticosteroids. During the next 3 days, the patient's fever defervesced and his inflammatory markers down-trended. He was discharged home on room air with a corticosteroid taper. Discussion-Targeted history taking which addressed the specifics of the 'off-brand' or counterfeit THC vaping brands was key in revealing the etiology of the patient's symptoms and allowed the initiation of the correct treatment in a timely manner. Vitamin-E acetate has emerged as a potential common exposure among affected patients who use a variety of counterfeit products. Clinicians should be well versed with asking specific questions focused on type, duration and brand of products when EVALI is suspected.

Rural-urban differences in the labor-force impacts of COVID-19 in the United States.

COVID-19 has had dramatic impacts on economic outcomes across the United States, yet most research on the pandemic's labor-market impacts has had a national or urban focus. We overcome this limitation using data from the U.S. Current Population Survey's COVID-19 supplement to study pandemic-related labor-force outcomes in rural and urban areas from May 2020 through February 2021. We find the pandemic has generally had more severe labor-force impacts on urban adults than their rural counterparts. Urban adults were more often unable to work, go unpaid for missed hours, and be unable to look for work due to COVID-19. However, rural workers were less likely to work remotely than urban workers. These differences persist even when adjusting for adults' socioeconomic characteristics and state-level factors. Our results suggest rural-urban differences in the nature of work during the pandemic cannot be explained by well-known demographic and political differences between rural and urban America.

Supporting Weight Management during COVID-19 (SWiM-C): A randomised controlled trial of an acceptance-based behavioural intervention to prevent weight gain during the pandemic

Introduction: The social distancing and isolation measures imposed during the COVID-19 pandemic mean that adults with overweight and obesity in the UK are at increased vulnerability to weight gain and the associated negative impacts on physical and mental wellbeing. There is growing evidence that interventions based on Acceptance and Commitment Therapy (ACT) are more effective for weight management compared with standard behavioural treatment. In collaboration with patient and public representatives and other stakeholders, we developed an ACT-based behavioural intervention to support adults with overweight and obesity to prevent weight gain during the COVID-19 pandemic (SWiM-C). This study evaluated whether SWiM-C reduced weight and achieved greater improvements in eating behaviour, physical activity and mental wellbeing compared with standard advice, over four months during the pandemic. Methods: We randomised adults (BMI≥25kg/m2) to the SWiM-C intervention or to a standard advice wait list control group. SWiM-C is an ACT-based guided self-help intervention consisting of weekly webbased sessions for 12 consecutive weeks, with two remote contacts (by telephone and email) from a trained non-specialist coach. The control group received standard advice from the European Association for the Study of Obesity (EASO) on diet, physical activity, and mental wellbeing during the COVID-19 pandemic. The planned sample size was 360 to give us 90% power to detect a 1kg difference between groups at the 5% level. Participants completed outcome assessments online at baseline and 4 months follow-up. The primary outcome was change in self-measured weight from baseline to four months;secondary outcomes included depression, anxiety, stress, psychological flexibility, eating behaviour (cognitive restraint, uncontrolled eating and emotional eating), physical activity, and health-related quality of life. Analysis was based on the intention-to-treat principle. We estimated baseline-adjusted differences between the study groups in change in weight (and secondary outcomes) from baseline to 4 months using linear regression models, also adjusting for randomisation stratifiers (sex, BMI group). Results: We recruited and randomised 388 participants (196 standard advice, 192 SWiM-C). 187 (97%) SWiM-C participants started the intervention, 167 (87%) completed the coach call, 161 (84%) were sent tailored coach emails, and 93 (48%) completed at least 8 sessions. Follow-up for the primary outcome was completed by 325 (84%) participants. Analysis of the effectiveness of SWiM-C is currently underway and will be completed before the conference. Conclusion: There is a need for user-friendly and remotely delivered weight management interventions to support adults with overweight and obesity during the COVID-19 pandemic. SWiM-C has demonstrated excellent uptake and engagement levels for a predominantly digital intervention, and we will report on the effectiveness of this approach. Findingswill inform the evidence base on digital interventions for weight management and can be used to inform existing services which are currently transitioning from face-to-face to online delivery.

Wastewater monitoring for SARS-CoV-2

Wastewater monitoring (WM) of SARS-CoV-2 from sewers was applied throughout the world early in the COVID-19 pandemic. Sharing of protocols and experiences in WM of SARS-CoV-2 by national and international researchers and practitioners has been vital to ensuring the sensitivity and specificity of the methods. WM has been a valuable adjunct to human clinical testing, and when positive results occur in sewage, community testing has been increased. WM findings allow public health officials to track and respond to the impacts of loosening lockdown restrictions, demonstrating when return to normal social activities might occur without a resurgence of rapid community transmission, and they are particularly useful in areas with low human case numbers and/or low clinical testing rates. New research is required to address several practical knowledge gaps, for example, sampling protocols, prediction of case prevalence from viral numbers by modelling, and determination of detection limits. Communication to the Australian public of WM of SARS-CoV-2 has been via interactive, visual dashboards. Once SARS-CoV-2 vaccinations are introduced, WM could help track the underlying circulation of the virus in the population, the spread of known variants and its future evolution.