A Pandemic Snapshot: Libraries' Digital Shifts and Disparities to Overcome

In the fall and winter of 2020, New America embarked on a snapshot study to gather data on how – or if – people were discovering, accessing, and using their public libraries during the COVID-19 pandemic, with a focus on materials that libraries made available online. A full report on our findings, titled Public Libraries and the Pandemic: Digital Shifts and Disparities to Overcome, was published in March 2021. This article draws heavily from that report and also includes a policy update related to passage of the Infrastructure Investment and Jobs Act in the Fall of 2021. Analyzing data from a national survey in Fall 2020 of 2,620 people, we found mixed awareness of the public library's online resources, a shift toward online resources, mostly positive attitudes toward the public library and its online resources, and disparities in access to and use of the public library's online resources. This article also describes one library's creation of a digital navigator program to support digital literacy as an example of how to overcome some of these disparities. We conclude with specific recommendations for improving inclusivity, helping community members gain affordable internet access at home so they can use their library's online materials, and building awareness of library offerings via local organizations and schools. The aim is to leverage the lessons of the pandemic to help libraries launch more equitable ecosystems of learning across communities, providing access to knowledge, resources, and training, online and off. [ FROM AUTHOR] Copyright of Public Library Quarterly is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Persistence of SARS-CoV-2 in saliva: Implications for late-stage diagnosis and infectious duration.

Saliva has been a COVID-19 diagnostic specimen of interest due to its simple collection, scalability, and yield. Yet COVID-19 testing and estimates of the infectious period remain largely based on nasopharyngeal and nasal swabs. We sought to evaluate whether saliva testing captured prolonged presence of SARS-CoV-2 and potential infectiousness later in the disease course. We conducted an observational study of symptomatic COVID-19 patients at University Hospital in Newark, NJ. Paired saliva and nasal specimens from 96 patients were analyzed, including longitudinal analysis of paired observations from 28 of these patients who had multiple time-points. Saliva detected significantly more cases of COVID-19 beyond 5 days (86.1% [99/115] saliva vs 48.7% [56/115] nasal, p-value < 0.001), 9 days (79.4% [50/63] saliva vs 36.5% [23/63] nasal, p-value < 0.001) and 14 days (71.4% [20/28] saliva vs 32.1% [9/28] nasal, p-value = 0.010) of symptoms. Additionally, saliva yielded lower cycle thresholds across all time periods, indicative of higher viral loads in saliva. In the longitudinal analysis, a log-rank analysis indicated that the survival curve for saliva was significantly different from the curve for nasal swabs (p<0.001) with a median survival time for saliva of 18 days compared to 13 days for nasal swabs. We additionally performed saliva viral cultures among a similar COVID-19 patient cohort and noted patients with positive saliva viral cultures between 7 to 28 days of symptoms. Findings from this study suggest that SARS-CoV-2 RNA persists longer and in higher abundance in saliva compared to nasal swabs, with potential of prolonged propagating virus. Testing saliva may thus increase yield for detecting potentially infectious virus even beyond the first five days of symptomatic COVID-19.

A Pandemic Snapshot: Libraries’ Digital Shifts and Disparities to Overcome

In the fall and winter of 2020, New America embarked on a snapshot study to gather data on how – or if – people were discovering, accessing, and using their public libraries during the COVID-19 pandemic, with a focus on materials that libraries made available online. A full report on our findings, titled Public Libraries and the Pandemic: Digital Shifts and Disparities to Overcome, was published in March 2021. This article draws heavily from that report and also includes a policy update related to passage of the Infrastructure Investment and Jobs Act in the Fall of 2021. Analyzing data from a national survey in Fall 2020 of 2,620 people, we found mixed awareness of the public library’s online resources, a shift toward online resources, mostly positive attitudes toward the public library and its online resources, and disparities in access to and use of the public library’s online resources. This article also describes one library’s creation of a digital navigator program to support digital literacy as an example of how to overcome some of these disparities. We conclude with specific recommendations for improving inclusivity, helping community members gain affordable internet access at home so they can use their library’s online materials, and building awareness of library offerings via local organizations and schools. The aim is to leverage the lessons of the pandemic to help libraries launch more equitable ecosystems of learning across communities, providing access to knowledge, resources, and training, online and off. [ FROM AUTHOR] Copyright of Public Library Quarterly is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Sample collection and transport strategies to enhance yield, accessibility, and biosafety of COVID-19 RT-PCR testing.

Introduction. Non-invasive sample collection and viral sterilizing buffers have independently enabled workflows for more widespread COVID-19 testing by reverse-transcriptase polymerase chain reaction (RT-PCR).Gap statement. The combined use of sterilizing buffers across non-invasive sample types to optimize sensitive, accessible, and biosafe sampling methods has not been directly and systematically compared.Aim. We aimed to evaluate diagnostic yield across different non-invasive samples with standard viral transport media (VTM) versus a sterilizing buffer eNAT- (Copan diagnostics Murrieta, CA) in a point-of-care diagnostic assay system.Methods. We prospectively collected 84 sets of nasal swabs, oral swabs, and saliva, from 52 COVID-19 RT-PCR-confirmed patients, and nasopharyngeal (NP) swabs from 37 patients. Nasal swabs, oral swabs, and saliva were placed in either VTM or eNAT, prior to testing with the Xpert Xpress SARS-CoV-2 (Xpert). The sensitivity of each sampling strategy was compared using a composite positive standard.Results. Swab specimens collected in eNAT showed an overall superior sensitivity compared to swabs in VTM (70 % vs 57 %, P=0.0022). Direct saliva 90.5 %, (95 % CI: 82 %, 95 %), followed by NP swabs in VTM and saliva in eNAT, was significantly more sensitive than nasal swabs in VTM (50 %, P<0.001) or eNAT (67.8 %, P=0.0012) and oral swabs in VTM (50 %, P<0.0001) or eNAT (58 %, P<0.0001). Saliva and use of eNAT buffer each increased detection of SARS-CoV-2 with the Xpert; however, no single sample matrix identified all positive cases.Conclusion. Saliva and eNAT sterilizing buffer can enhance safe and sensitive detection of COVID-19 using point-of-care GeneXpert instruments.

Variation in SARS-CoV-2 molecular test sensitivity by specimen types in a large sample of emergency department patients.

BACKGROUND: Provider-collected nasopharyngeal specimens for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular testing are the standard of care in many clinical settings, but patient-collected saliva and anterior nares specimens are less invasive and more flexible alternatives. Prior studies comparing specimen types for SARS-CoV-2 molecular testing have been limited by small sample sizes and low pretest probability. We conducted a large observational study among symptomatic adults at 7 emergency departments of Kaiser Permanente Southern California to examine sensitivity of SARS-CoV-2 molecular tests by specimen type and patient characteristics. METHODS: Provider-collected nasopharyngeal/oropharyngeal (NP/OP) specimens and patient-collected saliva and anterior nares specimens were collected at the same visit and analyzed with the Roche cobas® SARS-CoV-2 assay. Patients were considered truly positive for SARS-CoV-2 if any of the three specimens was positive and negative if all three specimens were negative. Factors associated with discordant and missed positive results were examined with multivariable logistic regression. RESULTS: Of 2112 patients, 350 (16.6%) were positive for SARS-CoV-2. Sensitivity of NP/OP was 93.7% (95% confidence interval [CI] 90.6%-96.0%), sensitivity of saliva was 87.7% (83.8%-91.0%), and sensitivity of anterior nares was 85.4% (81.3%-89.0%). Patients ages 18-39 years versus ≥40 years were more likely to have discordant results [adjusted odds ratio (aOR) 1.97 (1.12-3.45)], as were patients with <4 symptoms versus ≥4 [aOR 2.43 (1.39-4.25)]. Cycle threshold values were higher for saliva and anterior nares than NP/OP specimens, as well as for specimens in discordant versus concordant sets and patients with fewer symptoms. CONCLUSION: This study provides robust evidence that patient-collected saliva and anterior nares are sensitive for SARS-CoV-2 molecular testing in emergency department settings, particularly among adults ages ≥40 years and those with multiple symptoms. Higher sensitivity of provider-collected NP/OP specimens must be weighed against the benefits of patient-collected specimens in tailored strategies for SARS-CoV-2 testing.

Online Competency-Based Assessment for Ultrasound Training

Introduction Competency assessment and quality assurance are significant aspects of point-of-care ultrasound (POCUS) training for residents and medical students. However, due to the COVID-19 pandemic, alterations in programs have caused a need to develop new models of online assessments for students. While novel alterations in the curriculum have been made, clear learning outcomes and strategies must still teach the best practices. At the California University of Science and Medicine, School of Medicine (CUSM-SOM), we aim to adapt training and assessment tools that include SonoSim LiveScan experiences. Sonosim, Inc. has developed a tool that students can use remotely to mimic the clinical applications traditionally done in person. This would allow students to familiarize themselves with normal and pathologic scans remotely and hone their diagnostic abilities without requiring in-person faculty-led sessions. There have already been multiple medical schools that have added SonoSim to supplement their curriculum and assess students? competencies. This study aims to develop an online system of reliable competency-based assessments for medical students in the teaching of POCUS. Methods After completing each ultrasound module on SonoSim LiveScan alongside the schools? corresponding system-based courses, students will be assessed for achievement of competencies and learning outcomes. Students will take an online quiz and submit sonographic images that they obtained on their own time using provided standardized patients. The students will submit the images taken according to the guidelines mapped by the courses? learning outcomes. Submissions will be through a secured online system. Quizzes will be graded with a predetermined grading system. Using a standardized rubric, three faculty members/instructors will assess scans for competency and quality. Results Assessment will be completed in two steps. The first step will include an assessment of medical knowledge and concepts via an online quiz. The quiz will have still images and short video clips from SonoSim LiveScan to gauge the mastery of knowledge. The second step of the assessment will include a review of the ultrasound images obtained by the student. They will complete this part of the assessment on their own, asynchronously, and within a defined period of time. Then, three faculty members will score the images independently. To maintain the quality of the assessment, all instructors must agree that the required competencies have been achieved. All major discrepancies between the instructors regarding the results and assessment will be addressed according to the predetermined guidelines. Conclusion This competency-based assessment and training identifies students? areas of weakness and makes review and remediation easy and straightforward. Clear objectives, teaching modalities, and assessments set the foundation for a successful ultrasound program. Competency-based assessment as outlined above could be the best possible method to ensure students are involved and learning accurately during primarily remote learning times. By outlining a program that is easily implementable and accessible, ultrasound education will be made more available and widespread to medical students who would otherwise not be exposed.

Pediatric Vaccination During the COVID-19 Pandemic.

OBJECTIVES: The impact of the coronavirus disease 2019 pandemic on vaccination coverage, critical to preventing vaccine-preventable diseases, has not been assessed during the reopening period. METHODS: Vaccine uptake and vaccination coverage for recommended vaccines and for measles-containing vaccines at milestone ages were assessed in a large cohort of children aged 0 to 18 years in Southern California during January to August 2020 and were compared with those in the same period in 2019. Differences in vaccine uptake and vaccination coverage (recommended vaccines and measles-containing vaccines) in prepandemic (January to March), stay-at-home (April to May), and reopening (June to August) periods in 2020 and 2019 were compared. RESULTS: Total and measles-containing vaccine uptake declined markedly in all children during the pandemic period in 2020 compared with 2019, but recovered in children aged 0 to 23 months. Among children aged 2 to 18 years, measles-containing vaccine uptake recovered, but total vaccine uptake remained lower. Vaccination coverage (recommended and measles-containing vaccines) declined and remained reduced among most milestone age cohorts ≤24 months during the pandemic period, whereas recommended vaccination coverage in older children decreased during the reopening period in 2020 compared with 2019. CONCLUSIONS: Pediatric vaccine uptake decreased dramatically during the pandemic, resulting in decreased vaccination coverage that persisted or worsened among several age cohorts during the reopening period. Additional strategies, including immunization tracking, reminders, and recall for needed vaccinations, particularly during virtual visits, will be required to increase vaccine uptake and vaccination coverage and reduce the risk of outbreaks of vaccine-preventable diseases.