Self-Reported COVID-19 Infections and Social Mixing Behavior at Oncology Meetings

Purpose/Objective(s) The COVID-19 pandemic largely suspended conventional in-person scientific meetings because of the risk of disease spread. In the era of vaccination and social distancing practices, meetings have slowly begun to return to in-person formats. We surveyed attendees and potential attendees of two United States oncology meetings to identify rates of mixing behavior and the subsequent rate of self-reported COVID-19 infection. Materials/Methods We collected reported social mixing behavior and COVID-19 positivity of actual and potential in-person oncology meeting attendees of the American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, Massachusetts on September 24-25, 2021, and the American Society for Radiation Oncology (ASTRO) Annual Meeting in Chicago, Illinois on October 24-27, 2021 via survey. Participants were identified through publicly available meeting materials and targeted via email when possible. Recruitment was also conducted through Twitter and a radiation oncology newsletter, as well as an anonymous link made available to emailed recruits, with sharing encouraged. In-person respondents to the later ASTRO survey who had attended the ASCO meeting were excluded from the analysis. Statistical significance was determined using Fisher's exact test for rates of COVID-19 positivity and the chi-squared statistic for differences in group characteristics, with a cutoff for statistical significance p<0.05. Results Response rates from attendees with publicly available emails were 27.4% for the ASCO meeting and 14.3% for the ASTRO meeting. The ASCO survey produced 94 responses, with 48 responding as in-person attendees. The ASTRO survey produced 370 responses, with 267 responding as in-person attendees. Across both meetings, 3 of 308 (1.0%) of in-person attendees versus 2 of 141 (1.4%) of non-attendees tested positive for COVID-19 (p=0.65). Among in-person attendees, there were similar low COVID-19 positivity rates among those spending more (>20) vs less (≤20) hours attending live sessions (2.2% vs 0%, p=0.25) and between those who went to indoor social events vs those who did not during the meeting periods (0.8% vs 1.9%, p=0.44). Attendees largely felt that they would feel comfortable attending additional in-person meetings after experiencing the ASCO (87.5%) or ASTRO (91.9%) meetings and that mask compliance was good or excellent at the ASCO (100%) and ASTRO (94.6%) meetings. Conclusion This study indicates that in-person meetings do not seem to be contributing to high rates of new COVID-19 infections in the setting of mask mandates, vaccine mandates, and decreased room capacity allowances. The rate of self-reported COVID-19 infection of both in-person attendees and non-attendees was very low and the meetings were successful at creating an environment where participants felt safe. These findings support the possibility of a path forward for at least partially in-person conferences as new variants emerge and COVID-19 becomes endemic.

Global patterns of daily CO2 emissions reductions in the first year of COVID-19

Observed daily changes in CO2 emissions from across the globe reveal the sectors and countries where pandemic-related emissions declines were most pronounced in 2020. Day-to-day changes in CO2 emissions from human activities, in particular fossil-fuel combustion and cement production, reflect a complex balance of influences from seasonality, working days, weather and, most recently, the COVID-19 pandemic. Here, we provide a daily CO2 emissions dataset for the whole year of 2020, calculated from inventory and near-real-time activity data. We find a global reduction of 6.3% (2,232 MtCO(2)) in CO2 emissions compared with 2019. The drop in daily emissions during the first part of the year resulted from reduced global economic activity due to the pandemic lockdowns, including a large decrease in emissions from the transportation sector. However, daily CO2 emissions gradually recovered towards 2019 levels from late April with the partial reopening of economic activity. Subsequent waves of lockdowns in late 2020 continued to cause smaller CO2 reductions, primarily in western countries. The extraordinary fall in emissions during 2020 is similar in magnitude to the sustained annual emissions reductions necessary to limit global warming at 1.5 degrees C. This underscores the magnitude and speed at which the energy transition needs to advance.

Global fossil carbon emissions rebound near pre-COVID-19 levels

Fossil CO2 emissions in 2021 grew an estimated 4.2% (3.5%–4.8%) to 36.2 billion metric tons compared with 2020, pushing global emissions back close to 2019 levels (36.7 Gt CO2).

Patterns in Attending and Resident Remote Work Policies in Academic Radiation Oncology Departments

Purpose/Objective(s): Historically, work from home (WFH) policies were not common in radiation oncology (RO). With the onset of the COVID-19 pandemic and without oversight from professional organizations, many departments individually generated WFH policies. This study reports WFH policies and perceived impact on workflow and work-life balance within United States (US) academic RO departments for both residents and faculty. Materials/Methods: An IRB-approved questionnaire was developed and sent to one resident and one faculty member at each of the 92 US academic RO departments. Purposive sampling for residents and faculty was utilized. For residents, this consisted of the most senior resident and for faculty, a senior faculty member or the program director. If no reply was obtained after 3 weeks, an alternate member was selected. The survey remained open for 75 days. Categorical and continuous variables, along with free-responses were aggregated and reported. Results: 135 responses (residents n = 65, faculty n = 70) were received, representing 70.7% and 77.2% of the 92 programs respectively. A new WFH policy was reported by 83% faculty (58/70) and 92% residents (60/65), predominantly initiated within 2 months of the pandemic (60% faculty and 79% residents respectively). The initial WFH policy allowed moderate WFH for 40% faculty and 46% residents, while minimal WFH was offered for 30% faculty and 32% residents. Full WFH was reported by 14% of respondents in both categories. Policies have since contracted for 39% faculty and 62% of residents, being revoked for 11% of faculty and 22% of residents. 15/70 (21.4%) faculty and 12/65 (18.5%) residents report dissatisfaction with their current WFH policy. 18/70 (25.7%) faculty and 14/65 (21.5%) residents perceived negative sentiments from others regarding utilization of WFH. On a 4-point scale, residents and faculty reported personal/family life, research, and day-to-day productivity were positively impacted by WFH policy, while patient care was perceived as negatively impacted. No difference was reported for leadership or education. Conclusion: A variety of WFH policies have been adopted in RO. Understanding perceptions of the impact of different approaches can help to inform future policy and practice.

Management of resected stage III/IV melanoma with adjuvant immunotherapy

Background: Adjuvant anti-PD1 therapy reduces the risk of recurrence in resected stage III/IV melanoma and is now standard care. Limited data exist beyond registration trials. We sought to explore the use of adjuvant immunotherapy in routine clinical practice. Methods: Patients (pts) from 11 Australian centres who received adjuvant nivolumab (nivo) for resected stage III/IV melanoma were included in this study. Efficacy, toxicity, surveillance, recurrence characteristics, management and further treatment outcomes were examined. Results:471 pts received adjuvant nivo between 8/2018 to 3/2020. 318 (68%) were male, median age 64y (range 17-94), 28 (6%) were AJCC v8 IIIA, 194 (41%) IIIB, 175 (37%) IIIC, 11 (2%) IIID, and 63 (13%) IV. 65 (14%) pts had intransit only disease, 152 (37%) pts were sentinel lymph node biopsy (SLNB+) and only 9 (6%) of these had CLND. 128 (27%) had BRAF mutant (BRAFmt) melanoma. Median time from resection to start of adjuvant nivo was 1.8 months (mo) (range 0.2-4.0). Median FU was 17.5 mo. 256 (54%) pts completed 12 months of nivo, 86 (18%) ceased early for toxicity, 76 (16%) for disease recurrence, 25 (5%) other reasons (COVID-19 8, co-morbidities 7, pt choice 10);28 (6%) pts were still receiving nivo at data cut. Median duration of treatment was 10.4 mo (range 0-16.8). 117 (25%) pts recurred;76 (65%) while ON nivo and 41 (35%) OFF nivo ( > 1 month after last dose, including 20 pts who stopped early for toxicity). 24 mo RFS was 69%. Median time to recurrence was 6.0 mo (95% CI 5.1, 7.5). 56 (48%) had first recurrence with locoregional (LR) disease only and 61 (52%) had distant +/- LR recurrence. Of those who recurred with LR disease only, 46/56 (82%) underwent surgery, 15/46 (33%) then had adjuvant radiotherapy, and 15/46 (33%) had 'second adjuvant' therapy with BRAF/MEK inhibitors (15/21, 71% BRAFmt pts). 10/56 (37%) pts who recurred with LR disease subsequently recurred distantly. 58/80 (73%) pts received systemic therapy at either 1st or subsequent unresectable recurrence. For recurrences ON nivo, 18 pts received combination ipilimumab (ipi) and nivo (ORR 44%), 4 pts had ipi monotherapy (ORR 0%), 7 pts had anti-PD1 + investigational agent (ORR 57%), 11 pts had BRAF/MEK inhibitors (ORR 82%). 1 pt had PD with ongoing PD1 monotherapy. For recurrences OFF nivo, no patients responded to PD1 alone (n = 1) or with an investigational agent (n = 1), ipi+nivo (n = 3), ipi monotherapy (n = 4) or chemotherapy (n = 2);6 pts received BRAF/MEK inhibitors (ORR 50%). 2-year OS was 92%. Conclusions: Despite higher rates of discontinuation due to toxicity compared with clinical trial cohorts, the efficacy data appear similar. Most early recurrences are distant, and many with LR recurrence soon recur distantly thereafter. Second line adjuvant BRAF/MEK inhibitors are frequently used for resected LR recurrence. Both ipi+nivo and BRAF/MEK inhibitors appear to have activity after distant recurrence.

9 Reasons to smile: At home psychosocial support for cleft lip and/or palate families around the world

Background/Purpose: The physical effects of clefting can obscure the psychosocial aspects of the disease. With this in mind, the idea for a unique mental health booklet arose. 9 Reasons to Smile: Family Fun Activity Booklet was developed when Smile Train international programs suspended all cleft treatment for patients at the height of the COVID-19 pandemic. Patients could not receive cleft surgery and other nonsurgical treatments, such as nutritional support, orthodontic care, dental care, psychosocial care, and speech therapy, to ensure long-term, successful rehabilitation. Suspension of cleft treatment poses significant challenges for children and families. Recognizing these challenges, Smile Train developed this booklet to raise awareness for psychosocial health as it is not readily accessible or prioritized around the world. The booklet includes art projects on self-love, engaging games to help children explore their emotions, their relationships, and their self-confidence. Methods/Description: The booklet was developed with support from Fundaci'on Cl'inica Noel, a Smile Train Partner in Colombia. It was first launched in English, French, and Spanish during the World Health Organization Walk the Talk Virtual Event on May 17, 2020. A global launch for the booklet in 10 languages took place on June 17, 2020. To further increase awareness for psychosocial health, Smile Train hosted a live, virtual celebration of 9 Reasons to Smile on July 21st and Smile Train Brazil and Mexico participated in their own local celebrations. The event convened representatives from the global health and global cleft communities to discuss art, health, clefts, and the importance of maintaining self-esteem and positivity through adversity. Results: The booklet is now available in 15+ languages and is shared through WhatsApp messaging platforms worldwide. The global virtual celebration had over 4000 views on Facebook and YouTube, and its reach continues to grow. Smile Train has received thousands of photos and stories from families and partners sharing their experiences using the booklet and its tremendous impact on their lives. The overwhelming response confirms the demand for programs and resources that focus on cleft patients and their psychosocial health needs. Conclusions: There is a need for supporting psychosocial services in global cleft care which is particularly evident during the COVID-19 pandemic. Access to these services is not always prioritized in many countries around the world and the enthusiasm for the 9 Reasons to Smile booklet indicates the positive impact such resources have on mental health. Smile Train is committed to raising awareness on the importance of psychosocial health in global cleft care and will continue to support and scale initiatives for cleft patients and their families around the globe.

Fossil CO2 emissions in the post-COVID-19 era

Growth in CO2 emissions has slowed since the Paris Agreement 5 years ago. The COVID-19 pandemic has caused a drop in emissions of about 7% in 2020 relative to 2019, but strong policy is needed to address underlying drivers and to sustain a decline in global emissions beyond the current crisis. Five years after the adoption of the Paris Climate Agreement, growth in global CO2 emissions has begun to falter. The pervasive disruptions from the COVID-19 pandemic have radically altered the trajectory of global CO2 emissions. Contradictory effects of the post-COVID-19 investments in fossil fuel-based infrastructure and the recent strengthening of climate targets must be addressed with new policy choices to sustain a decline in global emissions in the post-COVID-19 era.

Temporary reduction in daily global CO₂ emissions during the COVID-19 forced confinement

Government policies during the COVID-19 pandemic have drastically altered patterns of energy demand around the world. Many international borders were closed and populations were confined to their homes, which reduced transport and changed consumption patterns. Here we compile government policies and activity data to estimate the decrease in CO₂ emissions during forced confinements. Daily global CO₂ emissions decreased by -17% (-11 to -25% for +/-1sigma) by early April 2020 compared with the mean 2019 levels, just under half from changes in surface transport. At their peak, emissions in individual countries decreased by -26% on average. The impact on 2020 annual emissions depends on the duration of the confinement, with a low estimate of -4% (-2 to -7%) if prepandemic conditions return by mid-June, and a high estimate of -7% (-3 to -13%) if some restrictions remain worldwide until the end of 2020. Government actions and economic incentives postcrisis will likely influence the global CO₂ emissions path for decades.

Perspective of comprehensive and comprehensible multi-model energy and climate science in Europe

Europe’s capacity to explore the envisaged pathways that achieve its near- and long-term energy and climate objectives needs to be significantly enhanced. In this perspective, we discuss how this capacity is supported by energy and climate-economy models, and how international modelling teams are organised within structured communication channels and consortia as well as coordinate multi-model analyses to provide robust scientific evidence. Noting the lack of such a dedicated channel for the highly active yet currently fragmented European modelling landscape, we highlight the importance of transparency of modelling capabilities and processes, harmonisation of modelling parameters, disclosure of input and output datasets, interlinkages among models of different geographic granularity, and employment of models that transcend the highly harmonised core of tools used in model inter-comparisons. Finally, drawing from the COVID-19 pandemic, we discuss the need to expand the modelling comfort zone, by exploring extreme scenarios, disruptive innovations, and questions that transcend the energy and climate goals across the sustainability spectrum. A comprehensive and comprehensible multi-model framework offers a real example of “collective” science diplomacy, as an instrument to further support the ambitious goals of the EU Green Deal, in compliance with the EU claim to responsible research.