World Tuberculosis Day 2023 theme "Yes! We Can End TB!"

INTRO: Viruses, including SARS-CoV-2, which causes COVID-19, are constantly changing. These genetic changes (aka mutations) occur over time and can lead to the emergence of new variants that may have different characteristics. After the first SARS-CoV-2 genome was published in early 2020, scientists all over the world soon realized the immediate need to obtain as much genetic information from as many strains as possible. However, understanding the functional significance of the mutations harbored by a variant is important to assess its impact on transmissibility, disease severity, immune escape, and the effectiveness of vaccines and therapeutics. METHODS: Here in Canada, we have developed an interactive framework for visualizing and reporting mutations in SARS-CoV-2 variants. This framework is composed of three stand-alone yet connected components;an interactive visualization (COVID-MVP), a manually curated functional annotation database (pokay), and a genomic analysis workflow (nf-ncov-voc). Findings: COVID-MVP provides (i) an interactive heatmap to visualize and compare mutations in SARS-CoV-2 lineages classified across different VOCs, VOIs, and VUMs;(ii) mutation profiles including the type, impact, and contextual information;(iii) annotation of biological impacts for mutations where functional data is available in the literature;(iv) summarized information for each variant and/or lineage in the form of a surveillance report;and (v) the ability to upload raw genomic sequence(s) for rapid processing and annotating for real-time classification. DISCUSSION: This comprehensive comparison allows microbiologists and public health practitioners to better predict how the mutations in emerging variants will impact factors such as infection severity, vaccine resistance, hospitalization rates, etc. CONCLUSION: This framework is cloud-compatible & standalone, which makes it easier to integrate into other genomic surveillance tools as well. COVID-MVP is integrated into the Canadian VirusSeq data portal (https://virusseqdataportal.ca) - a national data hub for SARS-COV-2 genomic data. COVID-MVP is also used by the CanCOGeN and CoVaRR networks in national COVID-19 genomic surveillance.

Encountering pandas and their valleys in precarious times: A tourism assemblage perspective

This paper analyses the precarity of tourism in viral pandemic times through an analysis of animal-human relations in China's panda and valley tourism at Dajiuzhai. Drawing on a tour to Dajiuzhai to see giant pandas and the valleys of Jiuzhai, which was disrupted midway by increased viral infections, we trace ethnographically how disruptions in tourism emerge in the micro-setting of a single viral-hit tour and highlight the roles of natural agents, pandas, valleys and virus play, alongside humans in tourism's fluid assemblages. Desire/wish to encounter pandas motivated the formation of a fluid constellation of tourism objects, species and humans, which was aligned towards the goal of a stable tourism experience but persistently disturbed. Animal-human relation-based tourism assemblage at Dajiuzhai was found to be a fluid spatiality that coped with Covid-19 disruptions through responses at attractions involving health checks and declarations but remained precarious despite its transformational potentialities. © The Author(s) 2023.

Neurologic Manifestations of Patients Hospitalized with COVID-19 in the SCCM VIRUS Registry

Objective: To describe the prevalence, associated risk factors, and outcomes of serious neurologic manifestations (encephalopathy, stroke, seizure, and meningo-encephalitis) among patients hospitalized with coronavirus disease 2019 (COVID-19). Background: Though case series abound, limited prospective multi-center data exists describing neurologic manifestations of COVID-19 Design/Methods: Prospective observational study of hospitalized adults in 179 hospitals in 24 countries with laboratory-confirmed SARS-CoV-2 infection within the SCCM Discovery Viral Infection and Respiratory Illness University Study (VIRUS) COVID-19 Registry Results: Of 16,225 patients enrolled in the registry with discharge status available, 2,092 (12.9%) developed serious neurologic manifestations including 1,656 (10.2%) with encephalopathy at admission, 331 (2.0%) with stroke, 243 (1.5%) with seizure, and 73 (0.5%) with meningitis/encephalitis at admission or during hospitalization. Patients with serious neurologic manifestations were older with median (IQR) age 72 (61.0-81.0) vs. 61 (48.0-72.0) years and had higher prevalence of chronic medical conditions, including vascular risk factors. Systemic viral symptoms (fever, dyspnea, and cough) were less commonly reported in patients with severe neurologic manifestations as were milder neurologic symptoms including anosmia, dysgeusia, and headache. Adjusting for sex and time since the onset of the pandemic, serious neurologic manifestations were associated with more severe disease (OR 1.82, p<0.001) as defined by the WHO ordinal disease severity scale. Patients with neurologic manifestations were more likely to be admitted to the ICU (OR 1.45, p<0.001) and ICU interventions (ECMO: OR 1.78, p=0.009 and RRT: OR 1.99, p<0.001). Hospital and 28-day mortality for patients with neurologic manifestations was higher (OR 1.51 and 1.58, p<0.001), and patients had fewer ICU-free, hospital-free, and ventilator-free days (OR -0.84, -1.34, and -0.84, p<0.001). Conclusions: Encephalopathy at admission is common in COVID-19 infection and is associated with worse outcomes. While serious neurologic manifestations including stroke, seizure, and meningitis/encephalitis were less common, all were associated with increased ICU support utilization, more severe disease, and worse outcomes.

Accelerating TB diagnosis during the COVID-19 pandemic.

SETTING: The COVID-19 pandemic has caused significant disruption worldwide to economies and healthcare systems, even those with well-developed infrastructure.OBJECTIVE: To examine the effects of COVID-19 on TB diagnosis in Singapore, and to identify any factors that could facilitate early detection of TB among persons screened.DESIGN: To assess the impact of testing and diagnosis of the pandemic on TB, the number of TB-related tests from January 2018 to December 2020 were collected. We also conducted a retrospective case-control study of all adult patients admitted for COVID-19, TB or coinfection from 23 January to 31 May 2020.RESULTS: Nationwide testing for TB from 2018 to 2020 increased by 24.2%. We analysed 253 adult inpatients, of whom 107 (42.3%) were diagnosed with COVID-19, 134 (53.0%) had TB, while 12 (4.7%) had co-infection. Patients with TB were more likely to have chest X-ray abnormalities than those with COVID-19 (89.9% vs. 76.0%; P < 0.01). Patients with TB were more likely to have prolonged cough vs. those with COVID-19 infection (28 vs. 5 days; P < 0.01).CONCLUSION: Early screening for TB, even among patients with COVID-19, could lead to earlier diagnosis and treatment, thereby breaking the chain of transmission.

Unanticipated learning effects in videoconference continuous professional development

Introduction: The COVID-19 pandemic accelerated use of technology like videoconferencing (VC) in healthcare settings to maintain clinical teaching and continuous professional development (CPD) activities. Sociomaterial theory highlights the relationship of humans with sociomaterial forces, including technology. We used sociomaterial framing to review effect on CPD learning outcomes of morbidity and mortality meetings (M&M) when changed from face-to-face (FTF) to VC. Methods: All surgical department staff were invited to participate in a survey about their experience of VC M&M compared to FTF M&M. Survey questions focused on technological impact of the learning environment and CPD outcomes. Respondents used 5-point Likert scale and free text for qualitative responses. De-identified data was analysed using Chi-squared comparative analysis with p<0.05 significance, and qualitative responses categorised. Results: Of 42 invited, 30 (71.4%) responded. There was no significant difference in self-reported perception of CPD learning outcomes between FTF and VC M&M. Participants reported that VC offered more convenient meeting access, improved ease of presentation and viewing but reduced engagement. VC technology allowed alternative communication channels that improved understanding and increased junior participation. Participants requested more technological support, better connectivity and guidance on VC etiquette. Conclusion: VC technology had predictable effects of improved access, learning curve problems and reduced interpersonal connection. Sociomaterial perspective revealed additional unexpected VC behaviours of chat box use that augmented CPD learning. Recognising the sociocultural and emotional impact of technology improves planning and learner support when converting FTF to VC M&M. © 2021 TAPS. All rights reserved.

A Pilot Randomized Controlled Trial of Online-Delivered ACT-Enhanced Behavior Therapy for Trichotillomania in Adolescents

Treatment of adolescent trichotillomania is understudied, and treatment providers are difficult to find. In this pilot study, we compared ACT-enhanced behavior therapy to a waitlist, with treatment delivered over Zoom, to 28 adolescents who met criteria for trichotillomania. This study partially occurred during the COVID-19 pandemic. A detailed description of the treatment protocol is provided for ACT-enhanced behavior therapy adapted to a Zoom format for adolescents. Pretreatment assessments were completed over Zoom by an assessor unaware of study condition;pretreatment and posttreatment questionnaires were completed online. Results indicated that therapy was delivered with fidelity and competence over Zoom, with 100% session completion. Adolescents reported that pulling severity decreased significantly more in the treatment condition than waitlist. No differences were seen in other adolescent or parent-reported pulling severity or distress. However, significant medium to large within-condition effect sizes were observed in the treatment condition. Medium effect size changes were seen in the treatment group on a measure of trichotillomania-related psychological flexibility, and a small effect size was seen for psychological distress. Overall, pilot results provide preliminary support for ACT-enhanced behavior therapy, delivered over Zoom, for adolescent trichotillomania, indicating the need for a fully powered confirmatory efficacy trial.

O04.1 The Impact of the Coronavirus Disease (COVID-19) on the Health and Social Needs of Sex Workers in Singapore

BackgroundWe evaluated the impact of the Coronavirus Disease (COVID-19) on the sex work industry, and assessed how it has impacted the health and social conditions of sex workers in Singapore.MethodsWe conducted a sequential exploratory mixed methods study amidst the COVID-19 pandemic from April to October 2020, including in-depth interviews with 24 stakeholders from the sex work industry and surveyor-administered structured surveys in the field with 171 sex workers. The in-depth interviews allowed the team to qualitatively explore and generate themes around how COVID-19 had impacted sex workers in Singapore, and informed the design of the quantitative surveyor-administered survey questionnaire. Qualitative data were analyzed through framework analysis while survey data were analyzed through descriptive statistics, and multivariable Poisson regression models.ResultsCOVID-19 had a substantial impact on sex workers’ income, while the illegality of sex work, stigma, and the lack of work documentation were cited as exclusionary factors for access to alternative jobs or government relief. Sex workers had experienced an increase in food insecurity (57.3%), housing insecurity (32.8%), and sexual violence and compromise (8.2%), as well as a decrease in access to medical services (16.4%). Being transgender female was positively associated with increased food insecurity (aPR=1.23, 95%CI [1.08, 1.41]), housing insecurity (aPR=1.28, 95%CI [1.03, 1.60]) and decreased access to medical services (aPR=1.74, 95%CI [1.23, 2.46]), being a venue-based sex worker was positively associated with increased food insecurity (aPR=1.46, 95%CI [1.00, 2.13]), and being a non-Singaporean citizen or permanent resident was positively associated with increased housing insecurity (aPR=2.59, 95%CI [1.73, 3.85]).ConclusionsOur findings suggest that COVID-19 has led to a loss of income for sex workers, leading to a worsening of social and health conditions for sex workers. A lack of access to government relief among sex workers exacerbated such conditions.

Tuberculosis and COVID-19 interaction: A review of biological, clinical and public health effects.

Evidence is accumulating on the interaction between tuberculosis (TB) and COVID-19. The aim of the present review is to report the available evidence on the interaction between these two infections. Differences and similarities of TB and COVID-19, their immunological features, diagnostics, epidemiological and clinical characteristics and public health implications are discussed. The key published documents and guidelines on the topic have been reviewed. Based on the immunological mechanism involved, a shared dysregulation of immune responses in COVID-19 and TB has been found, suggesting a dual risk posed by co-infection worsening COVID-19 severity and favouring TB disease progression. The available evidence on clinical aspects suggests that COVID-19 happens regardless of TB occurrence either before, during or after an active TB diagnosis. More evidence is required to determine if COVID-19 may reactivate or worsen active TB disease. The role of sequeale and the need for further rehabilitation must be further studied Similarly, the potential role of drugs prescribed during the initial phase to treat COVID-19 and their interaction with anti-TB drugs require caution. Regarding risk of morbidity and mortality, several risk scores for COVID-19 and independent risk factors for TB have been identified: including, among others, age, poverty, malnutrition and co-morbidities (HIV co-infection, diabetes, etc.). Additional evidence is expected to be provided by the ongoing global TB/COVID-19 study.

The “super green pathway’’;what have we learned so far? The experience and outcomes of elective urgent and cancer surgery in a district general hospital in the united kingdom during covid-19 pandemic

Background The coronavirus disease (COVID-19) had so far claimed more than 600 000 lives worldwide. Many urgent and elective surgeries were postponed to cope with the pandemic, with the latest data found a substantial postoperative mortality risk (25.6%, 18.9%) after an emergency and elective surgery, respectively. Our institution was one of the first few in the country to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic. This study aims to analyze the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK. Methods Retrospective analysis of outcomes of all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway.” The primary endpoints were 30 days mortality and COVID-related morbidities, and the secondary end-points were surgically related complications and oncological outcomes. Results A total of 92 patients (Male: 45%;Female: 55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications. There were 7 postoperative surgical complications managed at the acute hospital site. The waiting time for surgery ranges from 6 to 191 days, mean of 30 days, and a median of 23 days. Conclusion It is possible to mitigate the high mortality risk of post-operative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.

Overview of rapid mitigating strategies in Singapore during the COVID-19 pandemic.

This article describes the rapid mitigation strategies in addressing the rising number of coronavirus disease 2019 (COVID-19) cases in Singapore. Learning from the severe acute respiratory syndrome experience in 2003, early preparation started in January 2020 when Wuhan was declared as the epicentre of the epidemic. The government had constructed a three-pronged approach which includes travel, healthcare and community measures to curb the spread of COVID-19.