Understanding factors related to decision making by state health officials in a public health emergency

Background and Purpose - State Health Officials (SHOs), as the leaders of state governmental public health agencies, play a critical role in their respective states. Their decisions guide the overall actions of their organizations in executing programs, policies and activities that ultimately affect the health of the state's population. This study will add to the research and serve as a potential guide to future SHO training, specific to decision making, in a public health emergencyMethods - Twenty-one individuals, who are either currently working as SHOs or who were former SHOs, were interviewed to understand their perspectives on issues that may impact their response to a public health emergency: decision-making, interaction with the public and the media and the role of politics in public health, and other areas of consequence. Results - While the study was focused more broadly, all of the respondents specifically mentioned the COVID19 pandemic as the most complicated public health emergency they have responded to as a SHO. All respondents also mentioned that they did not have a specific decision-making tool to utilize during this emergency and primarily relied on a consensus-driven decision-making process. Additionally, issues such as the challenges of managing the media and the politicization of public health during this pandemic, were mentioned by many of the respondents. Conclusion - These findings pointed to the need for a step-by-step decision-making tool to be utilized by SHOs in a public health emergency. This has the potential to lead to a more methodical approach to SHOs decision-making during a public health emergency, including a focus on various operational aspects such as understanding the role of the media in a public health emergency, managing elected officials in a public health emergency, and lessons learned from past public health emergencies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Understanding Factors Influencing Decision Making by State Health Officials in a Public Health Emergency.

State and territorial health officials (STHOs) play a critical role in leading public health emergency response in their respective states. Through an exploratory qualitative study with 21 current or former STHOs, we sought to understand the issues that impact STHO decision making in public health responses. Initial findings suggest the need for structured decision making tools for use by leaders responding to public health emergencies, including COVID-19. Such tools could lead to more systematic responses by STHOs during public health crises.

Schools reopening and the COVID-19 pandemic: a case study from Macaé, Rio de Janeiro, Brazil.

Since the first reported case of COVID-19 in Brazil, the public and private educational system started to close. Up to November 2020, scientific discussions about the return of schooling activities have been rarely performed by the national scientific community and police-makers. The great delay of school returning in Brazil contrasts with successful international strategies of school reopening worldwide and seems counterintuitive with the reopening of non-essential activities. Here, important issues to be considered before and during school reopening are reviewed and discussed. COVID-19 testing is essential to avoid disease spreading, but high cost of individual RT-qPCRs impairs an extensive testing strategy for school returning. To reduce costs and increase the speed of diagnosis, we tested the efficiency of a pooled-sample PCR strategy in a cohort of the educational staff in the city of Macaé/RJ, finding five asymptomatic individuals (0,66%) among the 754 people tested. Thus, a polled-sample PCR testing strategy of the educational staff might prevent infection spreading in schools at a reasonable cost. We discuss how our test strategy could be coupled with internationally recognized safety rules to allow for a safe school return and how countries from different world regions are dealing with educational activities during COVID-19 pandemic.

Anxiety is more related to inadequate eating habits in inactive than in physically active adults during COVID-19 quarantine.

BACKGROUND & AIMS: Anxiety can be related to reduced diet quality during pandemics such as COVID-19. However, it is not clear whether these relationships would be similar in inactive and physically active participants. The aim of this study was to analyze associations between anxiety and eating habits in physically active and inactive individuals during the COVID-19 pandemic. METHODS: The sample consisted of 1826 adults (58.5% women) who were invited through social media to answer an online questionnaire. The instrument included questions related to physical activity, eating habits, health behavior, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Anxiety, food habits (high food habits consumption ≥5 times per week) and physical activity (≥150 min per week) were assessed during the COVID-19 pandemic. The relationship between anxiety and eating habits according to levels of physical activity (inactive vs. active) was assessed using binary logistic regression adjusted for sex, age, education level, social isolation, and body mass index. RESULTS: Among the inactive participants, anxiety was related with high consumption of sweets (OR = 1.43; 95% CI = 1.11-1.83) and fast foods (OR = 2.23; 95% CI = 1.05-4.74) while quarantining during the COVID-19 pandemic. No relationship was observed between anxiety and food consumption among physically active participants in the final model. CONCLUSION: Anxiety was associated with less desirable eating habits among physically inactive adults during the COVID-19 pandemic.

Technological Determinants of Health: Factors Associated With Equitable Utilization Among Adolescents and Young Adults receiving Sexual Health Services

Purpose: As clinics limited face-face appointments during the COVID-19 pandemic, youth at risk of sexually transmitted infections (STI) were vulnerable to disruptions in medical care. While utilization of telehealth platforms has the potential to address pandemic related disruptions in care, and are likely to be maintained in a post-pandemic world, there are inequities in access and utilization of telehealth. The goal of this presentation is to explore telehealth acceptability and digital inequities (device access, internet access, and digital literacy) affecting utilization of telehealth for sexual health services among adolescents and young adults (AYA). Methods: The setting was a nine-clinic system that provides free preventive primary care and reproductive health services to >10,000 Medicaid, low-income, and uninsured AYA annually. Majority (97.9%) of patients fall below the 250% Federal Poverty Level threshold and 96% belong to racial and ethnic minority groups. We surveyed youth aged 18 – 24 who requested an appointment for a sexual health related concern. A 70 question survey, compiled using psychometrically validated instruments, was administered via email, text link, or telephone survey (if expressed inability to access the survey electronically). Sexual behavior and demographic information were collected. The constructs of interest included attitudes, intentions, barriers, and facilitators for telehealth. Results: A total of 347 AYA responded to the survey, with 250 completing the entire survey. A majority of the population identified as female (89%), non-Hispanic (58%), and Black (52%). 37% of the respondents had scheduled their planned visit as a video or telephone visit. Overall respondents reported favorable attitudes towards telehealth with 69% agreeing that it could save them time, and 59% agreeing that they could be satisfied with a telehealth visit. A minority of respondents agreed that they had concerns about privacy (8%), difficulty with using technology (12%), and did not like the lack of physical contact (39%). Nearly all respondents reported having access to a computer, tablet, or smartphone (99.6%) and to the internet (99.2%);however 37% reported that they could not always trust the equipment to work. While 96% of respondents were willing/very willing to have an in-person visit if they were experiencing sexual health symptoms, ∼ 80% of respondents were willing/ very willing to discuss sexual behaviors via telephone or video visit, and ∼ 36% were willing/ very willing to have an examination via video. Race, education, ethnicity, and insurance status were not associated with telehealth utilization. Individuals who used telemedicine services had significantly more positive attitudes towards telehealth than those who did not, as assessed by a questionnaire of beliefs and attitudes about telehealth, d =.50, p <.001. Conclusions: Utilization of telehealth is affected by attitudes towards telehealth. Minimizing concerns for privacy, improving patient experience and comfort with using technology, and addressing negative attitudes towards the lack of physical contact may improve utilization. These findings will lay ground-work for subsequent research focused on action-oriented steps to develop innovative interventions that will improve health care access for STI-related outcomes, and health equity among AYA. Sources of Support: Baylor College of Medicine, Office of the President Health Disparity Grant.

Confidentiality and Patient Satisfaction in Adolescent Telehealth Visits

Purpose: Due to social isolation required during the COVID-19 pandemic, many practices made a sudden transition to telehealth with minimal preparation or telehealth training. Telehealth has been extensively studied in the adult population and shown to improve patient satisfaction in multiple settings with satisfactory clinical outcomes. However, the use of telehealth has been rarely studied in the adolescent and young adult population, where providers face unique challenges regarding consent and confidentiality. The Society of Adolescent Health and Medicine considers the confidential interview an essential component of health care for adolescents as it is consistent with their development of maturity and autonomy. Without it, some adolescents will forgo care leading to poor health outcomes. Though the field of Adolescent Medicine recognizes the importance of speaking with patients alone, it is difficult to establish confidentiality when conferencing with a patient over a telephone or video call. The purpose of this study is to compare patient satisfaction and visit confidentiality between telehealth and in person visits in adolescents and young adults. Methods: Patients were recruited from a subspecialty adolescent medicine clinic associated with a large children’s hospital, as well as from a system of free reproductive and primary care clinics with both school based and community sites. Data was gathered via anonymous survey, with questions modeled from the Child and Adolescent Health Measurement Initiative Young Adult Health Care Survey and the University of Rochester Telemedicine and Non-Telemedicine Visit Experience Interview. Online surveys were sent via email to patients seen both in person and via telehealth at all sites. Results: Survey results were obtained from both the telehealth (n=46, 28% of respondents) and in person (n=116, 71.6% of respondents) populations. Age of respondents varied between age 13-25. Respondents were majority female (95% telehealth vs 93% in person). 91.5% of telehealth respondents reported previous experience with teleconferencing technology for school or work compared to 83.5% of in person respondents. Of telehealth responses, 70.2% participated in a video visit, while 29.8% participated in a visit via telephone. 97.8% of telehealth respondents reported that they were able to meet with their provider one on one, compared to 97.4% of in person visits (p>0.05). When asked to rank their provider on a scale of 10, ratings were not significantly different, with a higher proportion of telehealth respondents ranking their provider as a 9 or 10 out of 10. 83% telehealth respondents agreed or strongly agreed that they would recommend telemedicine to a friend, and 100% of these respondents agreed or strongly agreed that it was easy to communicate with their provider during their visit. Conclusions: Adolescent and young adult patients perceive that confidentiality in telehealth visits is not significantly inferior to that of in-office visits and they generally have a positive evaluation of their telehealth experience. Future work should be done to evaluate best practices for how confidentiality is established and maintained in telehealth visits and to evaluate parental perception of telehealth visits in those adolescent patients who are under age 18. Sources of Support: None.

Serology as a Tool to Assess Infectious Disease Landscapes and Guide Public Health Policy.

Understanding the local burden and epidemiology of infectious diseases is crucial to guide public health policy and prioritize interventions. Typically, infectious disease surveillance relies on capturing clinical cases within a healthcare system, classifying cases by etiology and enumerating cases over a period of time. Disease burden is often then extrapolated to the general population. Serology (i.e., examining serum for the presence of pathogen-specific antibodies) has long been used to inform about individuals past exposure and immunity to specific pathogens. However, it has been underutilized as a tool to evaluate the infectious disease burden landscape at the population level and guide public health decisions. In this review, we outline how serology provides a powerful tool to complement case-based surveillance for determining disease burden and epidemiology of infectious diseases, highlighting its benefits and limitations. We describe the current serology-based technologies and illustrate their use with examples from both the pre- and post- COVID-19-pandemic context. In particular, we review the challenges to and opportunities in implementing serological surveillance in low- and middle-income countries (LMICs), which bear the brunt of the global infectious disease burden. Finally, we discuss the relevance of serology data for public health decision-making and describe scenarios in which this data could be used, either independently or in conjunction with case-based surveillance. We conclude that public health systems would greatly benefit from the inclusion of serology to supplement and strengthen existing case-based infectious disease surveillance strategies.

Impact of COVID-19 pandemic on physical activity level and screen time is associated with decreased mental health in Brazillian adults: A cross-sectional epidemiological study.

The objective was to verify whether the impact of COVID-19 on physical activity and screen time was associated with the impact on quality of life and symptoms of anxiety and depression in a sample of Brazilian adults. The invitation was made through social networks and the collection was carried out through electronic research. There was a decrease in quality of life and physical activity, and an increase in symptoms of anxiety and depression and screen time. These findings are important for new strategies that promote physically active habits during the pandemic .

Short Communication: S100A8 and S100A9, Biomarkers of SARS-CoV-2 Infection and Other Diseases, Suppress HIV Replication in Primary Macrophages.

S100A8 and S100A9 are members of the Alarmin family; these proteins are abundantly expressed in neutrophils, form a heterodimer complex, and are secreted in plasma on pathogen infection or acute inflammatory diseases. Recently, both proteins were identified as novel biomarkers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were shown to play key roles in inducing an aggressive inflammatory response by mediating the release of large amounts of pro-inflammatory cytokines, called the "cytokine storm." Although co-infection with SARS-CoV-2 in people living with HIV-1 may result in an immunocompromised status, the role of the S100A8/A9 complex in HIV-1 replication in primary T cells and macrophages is still unclear. Here, we evaluated the roles of the proteins in HIV replication to elucidate their functions. We found that the complex had no impact on virus replication in both cell types; however, the subunits of S100A8 and S100A9 inhibit HIV in macrophages. These findings provide important insights into the regulation of HIV viral loads during SARS-CoV-2 co-infection.

Active Symptom-Based Surveillance of Adverse Events Following Immunization Among Individuals Vaccinated with ChAdOx1 nCoV-19 Coronavirus Vaccine in a Tertiary Hospital of Kerala.

BACKGROUND: The reports on adverse experiences following vaccination are scanty from India. It is important to know the real-world post-vaccination experience outside of clinical trial conditions. OBJECTIVES: The study aims to estimate the incidence of adverse events following immunization with the ChAdOx1 nCoV-19 coronavirus vaccine and to identify the predictors for the development of vaccine adverse events. METHODS: A prospective observational study was conducted among health care workers who received the ChAdOx1 nCoV-19 coronavirus vaccine. Study participants were monitored at the site for 30 min following vaccination and were followed up for 7 days after receiving the second dose, with a purpose-specific designed online surveillance form to enquire about any adverse events following vaccination. We used the Chi-squared test for categorical variables and multivariate regression analysis to identify predictors for the development of vaccine adverse effects. RESULTS: Of 411 participants, the mean age was 30.77 ± 12.5 years and 76.2% were females. Overall, 207 (50.4%) respondents reported at least one post-vaccination symptom receiving either dose of coronavirus vaccination. Fever (34.8%), local pain at the injection site (28.0%), tiredness (25.5%), chills (20%), myalgia (18.7%), headache (17.8%), injection site stiffness (5.4%), joint pain (4.6%) and nausea-vomiting (3.8%) were the most prevalent symptoms following the first dose. Adverse reactions reported after the second dose were milder and less frequent. Postvaccination symptoms were more likely in the younger age group, those with comorbidity particularly, bronchial asthma , and a history of allergy to food/drugs. CONCLUSION: All the adverse reactions were of a minor type and non-serious. Side effects were less common in older adults (>60 years). Reactions to the second dose were lesser in intensity and frequency. Younger age, history of allergy, and comorbidities, particularly asthma, were found to be major predictors for the development of adverse events and require more watchful vaccine administration.

Depressive Symptoms Associated With Musculoskeletal Pain in Inactive Adults During COVID-19 Quarantine

Background Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level. Aim To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels. Design Cross-sectional study. Methods This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872;58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants’ level of physical activity. Results Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain. Conclusion During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.

S100A8 and S100A9, biomarkers of SARS-Cov-2-infected patients, suppress HIV replication in primary macrophages (preprint)

S100A8 and S100A9 are members of the Alarmin family; these proteins are abundantly expressed in neutrophils and form a heterodimer complex. Recently, both proteins were identified as novel biomarkers of SARS-CoV-2 infection and were shown to play key roles in inducing an aggressive inflammatory response by mediating the release of large amounts of pro-inflammatory cytokines, called the cytokine storm. Although co-infection with SARS-CoV-2 in people living with HIV-1 may result in an immunocompromised status, the role of the S100A8/A9 complex in HIV-1 replication in primary T cells and macrophages is still unclear. Here, we evaluated the roles of the proteins in HIV replication to elucidate their functions. We found that the complex had no impact on virus replication in both cell types; however, the subunits of S100A8 and S100A9 inhibits HIV in macrophages. These findings provide important insights into the regulation of HIV viral loads during SARS-CoV-2 co-infection.

Physical Activity Is Associated With Improved Eating Habits During the COVID-19 Pandemic.

The aim of this study was to analyze the association between physical activity and eating habits during the COVID-19 pandemic among Brazilian adults. A sample of 1,929 participants answered an online survey, however 1,874 were included in the analysis. The impact of the COVID-19 pandemic on eating habits was assessed inquiring about participants' intake of fruits, vegetables, fried foods, and sweets during the pandemic. Physical activity was assessed by asking participants about their weekly frequency, intensity and number of minutes/hours engaging in structured physical activities per week. Participants were then stratified into categories based on moderate-to-vigorous intensity (0-30; 31-90; 91-150; 151-300; and >300 min/week) and into active (≥150 min) or inactive (<150 min). Increased sweets consumption was the most commonly reported change to eating habits (42.5%), followed by an increase in the consumption of vegetables (26.6%), fruits (25.9%), and fried foods (17.9%). Physical activity practice was related to lower consumption of fried foods (OR = 0.60; p < 0.001) and sweets (OR = 0.53; p < 0.001). A cluster analysis revealed subjects with higher the level of physical activity was more likely to follow a healthy diet (p < 0.001). Thus, physical activity was positively associated with healthier eating habits. Health authorities must recommend regular physical as a strategy to improve overall health during the COVID-19 pandemic. Future studies should address the physical activity interventions to improve health status during a pandemic.

Deep Transfer Learning Approach for Automatic Recognition of Drug Toxicity and Inhibition of SARS-CoV-2.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes COVID-19 and is responsible for the ongoing pandemic. Screening of potential antiviral drugs against SARS-CoV-2 depend on in vitro experiments, which are based on the quantification of the virus titer. Here, we used virus-induced cytopathic effects (CPE) in brightfield microscopy of SARS-CoV-2-infected monolayers to quantify the virus titer. Images were classified using deep transfer learning (DTL) that fine-tune the last layers of a pre-trained Resnet18 (ImageNet). To exclude toxic concentrations of potential drugs, the network was expanded to include a toxic score (TOX) that detected cell death (CPETOXnet). With this analytic tool, the inhibitory effects of chloroquine, hydroxychloroquine, remdesivir, and emetine were validated. Taken together we developed a simple method and provided open access implementation to quantify SARS-CoV-2 titers and drug toxicity in experimental settings, which may be adaptable to assays with other viruses. The quantification of virus titers from brightfield images could accelerate the experimental approach for antiviral testing.

Reduction of Physical Activity Levels During the COVID-19 Pandemic Might Negatively Disturb Sleep Pattern.

BACKGROUND: The outbreak of novel coronavirus disease 2019 (COVID-19) has caused a global panic and public concern due to its mortality ratio and lack of treatments/vaccines. Reduced levels of physical activity have been reported during the outbreak, affecting the normal daily pattern. OBJECTIVE: To investigate (i) the relationship of physical activity level with sleep quality and (ii) the effects of reduction physical activity levels on sleep quality. METHODS: A Google form was used to address personal information, COVID-19 personal care, physical activity, and mental health of 1,907 adult volunteers. Binary logistic regression was used to verify the association of physical activity parameters and sleep quality. RESULTS: Insufficient physical activity levels were a risk factor to have disturbed sleep pattern [OR: 1.28, 95% CI (1.01-1.62)]; however, when the BMI was added to the analysis, there was no more statistical difference [OR: 1.23, 95% CI (0.96-1.57)]. On the other hand, we found that the reduction of physical activity levels was associated with negative changes in sleep quality [OR: 1.73, 95% CI (1.37-2.18)], regardless all the confounders [OR: 1.30, 95% CI (1.01-1.68)], unless when feeling of depression was added in Model 6 [OR: 1.28, 95% CI (0.99-1.66)]. CONCLUSION: Disruption in daily physical activity routine, rather than physical activity level, negatively influences sleep quality during the COVID-19 quarantine.

The same storm but not the same boat: Effects of COVID-19 stay-at-home order on mental health in individuals with overweight.

OBJECTIVE: To describe the effects of stay-at-home orders and social distancing during the coronavirus disease (COVID-19) outbreak on mental health and to compare these outcomes between individuals with normal weight and overweight. METHODS: This cross-sectional study included 1857 Brazilian adults, who were invited through social media to answer an online questionnaire from 5 May 2020 to 17 May 2020. The instrument included questions related to health behaviour, mental health (anxiety, depression, self-esteem, sadness and stress) and overall health. Overweight was defined as body mass index (BMI) ≥ 25 Kg/m2 . Multiple logistic regression was conducted to identify whether overweight is associated with mental health variables. RESULTS: Women reported increased anxiety (36.5% vs 22.2%, P < .01), depression (16.2% vs 8.8%, P < .01), low self-esteem (19.8% vs 10.6%, P < .01), sadness (17.7% vs 10.2%, P < .01), and stress (29.5% vs 19.3%, P < .01) relative to men. Women with overweight are more likely to report higher feeling of anxiety (OR 1.62, CI 95% 1.22-2.14), depression (OR 1.79, CI 95% 1.25-2.55), low self-esteem (OR 1.82, CI95% 1.28-2.58) and sadness (OR 1.51, CI 95% 1.08-2.10), adjusted for age, social isolation days, educational level, chronic diseases, smoke, alcohol intake and physical activity. CONCLUSION: Women, specially those with overweight are more vulnerable to the deleterious effects of stay-at-home orders on mental health during the COVID-19 pandemic.

Vaccination against SARS-CoV-2 and disease enhancement - knowns and unknowns.

INTRODUCTION: The world is currently fighting a COVID-19 pandemic, perhaps the most disruptive infectious disease outbreak since the 1918 Spanish influenza. Governments have taken drastic measures to curb the spread of SARS-CoV-2, and the development of safe and efficacious vaccine candidates is being accelerated. The possibility of vaccine-mediated disease enhancement with coronavirus vaccines has been flagged as a potential safety concern, and, despite the urgent need, should be thoroughly assessed as vaccines against SARS-CoV-2 are being tested. AREA COVERED: We review the in vivo evidence suggesting a theoretical risk of disease enhancement after vaccination with SARS-CoV and MERS-CoV vaccine candidates. We also identify knowledge gaps that need to be filled to maximize the chance of developing a safe vaccine and minimize the risk of encountering disease enhancement in vaccinated individuals after exposure to SARS-CoV-2. EXPERT OPINION: We compile and propose avenues to investigate the risk of vaccine-mediated disease enhancement both during pre-clinical and early clinical development. While the pressing need for a vaccine against COVID-19 (and future epidemic coronaviruses) cannot be ignored, we advocate to keep safety at the center of the debate. Protecting individuals with effective and safe vaccines should be a priority, even during extraordinary times like the COVID-19 pandemic.