Evaluating the cost implications of integrating SARS-CoV-2 genome sequencing for infection prevention and control investigation of nosocomial transmission within hospitals.

BACKGROUND: The COG-UK hospital-onset COVID-19 infection (HOCI) trial evaluated the impact of SARS-CoV-2 whole-genome sequencing (WGS) on acute infection, prevention, and control (IPC) investigation of nosocomial transmission within hospitals. AIM: To estimate the cost implications of using the information from the sequencing reporting tool (SRT), used to determine likelihood of nosocomial infection in IPC practice. METHODS: A micro-costing approach for SARS-CoV-2 WGS was conducted. Data on IPC management resource use and costs were collected from interviews with IPC teams from 14 participating sites and used to assign cost estimates for IPC activities as collected in the trial. Activities included IPC-specific actions following a suspicion of healthcare-associated infection (HAI) or outbreak, as well as changes to practice following the return of data via SRT. FINDINGS: The mean per-sample costs of SARS-CoV-2 sequencing were estimated at £77.10 for rapid and £66.94 for longer turnaround phases. Over the three-month interventional phases, the total management costs of IPC-defined HAIs and outbreak events across the sites were estimated at £225,070 and £416,447, respectively. The main cost drivers were bed-days lost due to ward closures because of outbreaks, followed by outbreak meetings and bed-days lost due to cohorting contacts. Actioning SRTs, the cost of HAIs increased by £5,178 due to unidentified cases and the cost of outbreaks decreased by £11,246 as SRTs excluded hospital outbreaks. CONCLUSION: Although SARS-CoV-2 WGS adds to the total IPC management cost, additional information provided could balance out the additional cost, depending on identified design improvements and effective deployment.

Impact of supplementary air filtration on aerosols and particulate matter in a UK hospital ward: a case study.

BACKGROUND: Aerosol spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a major problem in hospitals, leading to an increase in supplementary high-efficiency particulate air filtration aimed at reducing nosocomial transmission. This article reports a natural experiment that occurred when an air cleaning unit (ACU) on a medicine for older people ward was switched off accidentally while being commissioned. AIM: To assess aerosol transport within the ward and determine whether the ACU reduced airborne particulate matter (PM) levels. METHODS: An ACU was placed in a ward comprising two six-bedded bays plus three single-bed isolation rooms which had previously experienced several outbreaks of coronavirus disease 2019. During commissioning, real-time measurements of key indoor air quality parameters (PM1-10, CO2, temperature and humidity) were collected from multiple sensors over 2 days. During this period, the ACU was switched off accidentally for approximately 7 h, allowing the impact of the intervention on PM to be assessed. FINDINGS: The ACU reduced the PM counts considerably (e.g. PM1 65.5-78.2%) throughout the ward (P<0.001 all sizes), with positive correlation found for all PM fractions and CO2 (r=0.343-0.817; all P<0.001). PM counts rose/fell simultaneously when the ACU was off, with correlation of PM signals from multiple locations (e.g. r=0.343-0.868; all P<0.001) for particulates <1 µm). CONCLUSION: Aerosols migrated rapidly between the various ward subcompartments, suggesting that social distancing alone cannot prevent nosocomial transmission of SARS-CoV-2 as this fails to mitigate longer-range (>2 m) transmission. The ACU reduced PM levels considerably throughout the ward space, indicating its potential as an effective intervention to reduce the risk posed by infectious airborne particles.

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.

Preliminary outcomes for non-metastatic breast cancer before and during the coronavirus disease 2019 pandemic at community cancer centers

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has changed the delivery of cancer care and may have impacted the treatment outcomes. This study described the preliminary outcomes in non-metastatic breast cancer (BC) patients before and during the COVID-19 pandemic. Methods: This retrospective study included adult patients newly diagnosed with non-metastatic BC at two community cancer centers in southeast Texas. Patients diagnosed from 1/2018-10/2018 were included in the control group. Patients diagnosed from 4/2020-1/2021 were included in the COVID-19 group. The key outcomes were progression free survival (PFS), overall survival (OS), breast conserving surgery (BCS) rate, pathological complete response (PCR) rate, and time to treatment initiation (TTI). Results: The study included 74 patients (Table). The proportion of patients with self-detected BC was numerically higher in the COVID-19 group (55%) compared to the control group (36%), although this was not statistically significant (P = 0.09). The median follow-up periods were 38 (IQR: 36-43) months in the control group and 15 (IQR: 13-17) months in the COVID-19 group. No significant difference was observed in PFS (P = 0.74), with 1-year PFS of 93% (95%CI: 80%-98%) in the control group and 100% in the COVID-19 group. No significant difference was observed in OS (p = 0.22), with 1-year OS of 98% (95%CI 85%-100%) in the control group and 100% in the COVID-19 group. No significant difference was observed in TTI between control (51 days) and COVID-19 groups (52 days) (95%CI: -14 to 13;P = 0.91). Among patients who received neoadjuvant systemic therapy and surgery, BCS rates were 29% (5/17) in the control group and 50% (5/10) in the COVID-19 group (P = 0.42). Among patients who had triple negative or HER2 positive BC and received neoadjuvant systemic therapy and surgery, PCR rates were 57% (4/7) in the control group and 33% (1/3) in the COVID-19 group. Conclusions: Although total patient volume decreased during the COVID-19 pandemic, no significant difference was observed in clinical outcomes when comparing patients diagnosed with non-metastatic BC during and prior to the pandemic. Ongoing monitoring with a larger study population and longer followup period will help to elucidate the long-term impact of COVID-19 on BC treatment.

Community-engaged prison-based research in a pandemic: the efficacy of summative content analysis for understanding prison culture and climate

The challenges presented by COVID-19 in prison settings highlight the need for research that captures the lived experiences and needs of incarcerated individuals. Primary data collection among people living in prison during the global pandemic, however, presents unfamiliar obstacles that require innovation and invite opportunities to adopt methods not traditional in criminal-legal research. This manuscript details the application of summative content analysis to consider incarcerated persons' perceptions of institutional culture and climate. This research was conducted as part of the Prison Research and Innovation Initiative (PRII). A written open-ended questionnaire yielded data from 84 individuals incarcerated in a medium-security institution in the Midwest region of the United States. The results highlight several prominent themes in prison culture and climate and endorse the use of open-ended questionnaires analyzed with summative content analysis as a viable approach to collecting and examining high-quality data from people living in prison. The results from this work also underscore the efficacy of this method as a part of community-engaged research in prison settings.

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.

Boxed in: Covid-19, comedy, and a captive audience

This article considers the place of screenwriting practice in relation to comedic television projects created during an extended lockdown period in Australia and internationally. During times of global disruption, society has repeatedly relied on the literary and performing arts to entertain and inform. I will use the television series Retrograde (2020) as a case study to consider screenwriters’ resilience during times of turbulence and unrest and how they were able to create television in isolation to deliver comic relief to an online audience. Retrograde was written and produced entirely online in direct response to the restriction of movement and face-to-face interactions imposed due to the global Covid-19 pandemic. The comedic television show was written for a multiscreen performance and features a predominantly female writing team and cast. It is set in the online video conferencing space, which many have become accustomed to using for educational, professional, and social encounters during lockdown. Retrograde’s characters depict the intersection of cultures of disability, sexuality, gender, race, and class, with the shared experience of being stuck at home, alone together. The Retrograde project proves intercultural representations can flourish within screenwriting practice when given the opportunity, and intermedial collaboration is possible despite the imposed hindrance of isolation. © 2021, Australasian Association of Writing Programs. All rights reserved.

Airborne protection for staff is associated with reduced hospital-acquired COVID-19 in English NHS trusts.

INTRODUCTION: The rate of hospital-acquired coronavirus disease 2019 has reduced from 14.3% to 4.2% over the last year, but substantial differences still exist between English National Health Service (NHS) hospital trusts. METHODS: This study assessed rates of hospital-acquired infection (HAI), comparing NHS hospital trusts using airborne respiratory protection (e.g. FFP3 masks) for all staff, as a marker of measures to reduce airborne spread, with NHS hospital trusts using mainly droplet precautions (e.g. surgical masks). RESULTS/DISCUSSION: The use of respiratory protective equipment was associated with a 33% reduction in the odds of HAI in the Delta wave, and a 21% reduction in the odds of HAI in the Alpha wave (P<0.00001). It is recommended that all hospitals should prioritize airborne mitigation.

Evaluating the Utility of Using Text Messages to Communicate With Patients During the COVID-19 Pandemic

INTRODUCTION: We evaluated the use of text messages to communicate information to patients whose surgeries were postponed because of the COVID-19 restriction on elective surgeries. Our hypothesis was that text messaging would be an effective way to convey updates. METHODS: In this observational study, 295 patients received text messaging alerts. Eligibility included patients who had their surgery postponed and had a cell phone that received text messages. Engagement rates were determined using embedded smart links. Patient survey responses were collected. RESULTS: A total of 3,032 texts were delivered. Engagement rates averaged 90%. Survey responses (n = 111) demonstrated that 98.2% of patients liked the text messages and 95.5% said that they felt more connected to their care team;91.9% of patients agreed that the text updates helped them avoid calling the office. Patients with higher pain levels reported more frustration with their surgery delay (5.3 versus 2.8 on 1 to 10 scale, P value < 0.01). More frustrated patients wished they received more text messages (24.4% versus 4.6%, P value = 0.04) and found the content less helpful (8.2 versus 9.2 on 1 to 10 scale, P value = 0.01). CONCLUSION: Text messaging updates are an efficient way to communicate with patients during the COVID-19 pandemic.

Outcomes of virtual appointments at GOSH

Background The need to upscale virtual consultations has been made apparent during the COVID pandemic. This study explores the effectiveness of virtual visits. Method A questionnaire was sent to clinicians about their experience and the effectiveness of face-to-face, video and telephone appointments based on ease of assessment and decision-making. Ethical approval was not required. Survey results were compared to outpatient clinic visit outcomes of June 2019 and June 2020. Results Survey - Of 95 completed questionnaires, over 75% reported they were often able to complete a medical and social history and make a diagnosis during virtual visits. Identifying non-verbal cues, ascertaining clinical signs, and starting treatment was more challenging, especially via telephone. CLINIC VISIT OUTCOMES: June'19 Further contact required - 35% (32% F2F;3% Tel) Discharge - 6% (5% F2F;1% Tel) Decision to Admit - 5% (5% F2F;1% Tel) June'20 Further contact required - 46% (14% F2F;21% Tel;11% Vid) Discharge - 7% (1% F2F;4% Tel;2% Vid) Decision to admit - 4% (1% F2F;2% Tel;1% Vid) DNA/WNB OUTCOMES Further Contact Required June'19 - 71% (70% F2F;1% Tel) June'20 - 81% (20% F2F;43% Tel;18% Video) Discussion Virtual appointments can be an effective alternative when examination is not required. There was no relationship between decision to admit and appointment type, and the highest percentage of patients were discharged following telephone visits, highlighting that virtual visits may be more appropriate for some patients. Video visits bridge the gap between face-to-face and telephone appointments, easing the identification of non-verbal cues and clinical signs. Lack of additional cues however may explain why clinicians reschedule more telephone visits following WNB attendances than other visit types. Conclusion Results suggest that clinicians are able to deliver care virtually in a meaningful manner, allowing for clinical assessment and appropriate decision-making.

Cancer center support forunderstanding statewide COVID-19 prevalence and earlydetection

NCI-funded cancer centers are committed to serving the needs of their catchment area at no other time havethese needs been greater or more explicit. To this end many cancer institutes are redirecting the efforts ofCommunity Outreach and Engagement (COE) programs to address COVID-19 related needs. The Knight CancerInstitute, recognizing the substantial resources they bring in community engagement and population science, hastaken a lead role in establishing a statewide study of the prevalence of COVID-19 related symptoms and activedisease. The Knight team has developed and implemented a syndromic and active surveillance system that allowsmonitoring of COVID-19 related symptoms as early indicators of COVID-19 accompanied by symptomatic andasymptomatic testing. The Key to Oregon study, started with state funding, will create a cohort of up to 100,000individuals. Participants are identified with household statewide random sampling with stratification andoversampling for geography (rural/urban) and race/ethnicity. A secure, HIPAA-compliant web-based data entryportal was developed and individuals are consented to provide daily information of symptoms related to COVID-19and a series of additional surveys addressing issues such as financial impact, mental health impact, and physicalimpacts (including cancer screening behaviors) of the COVID-19 pandemic. Individuals meeting symptomthresholds consistent with potential coronavirus infections are offered a mailed, home-based COVID-19 testing kit.Additionally, asymptomatic testing of randomly selected individuals will be conducted at regular intervals. In the first2 weeks of recruitment, nearly 10,000 individuals have enrolled. Weekly review of data assesses for recruitmentbias and provides focus for community engagement efforts. The Knight COE team leverages their existingrelationships and infrastructure to support engagement in communities of color, Native American, Latin X, and ruralgroups. Listening sessions have been held and Knight will direct resources to support community organizationscommitted to assisting with outreach for the Key to Oregon study. The value of this study as a mechanism forinforming public health policy and health care resource distribution is immense. Further, the impact, while notimmediate, on cancer research and cancer care is substantial, from building community-level trust that will longoutlast the pandemic, to providing early indicators of infection hot spots that allow susceptible individuals to makepotentially life-saving decisions, to establishing a statewide cohort of individuals who may be re-approached forfuture cancer-related studies. The ability of an NCI-designated cancer center to rapidly and effectively redirect andrepurpose resources has allowed for the development of this innovative statewide resource.