Olfactory Performance in Post Mild-to-Moderate Acute Covid-19 across 2 Years

Background: Previous longitudinal studies (n=6) of objective olfaction performance post-acute COVID-19 have a maximum follow-up of 6-month and do not often test biomarkers. Although olfactory dysfunction appears to improve within two months of symptom onset, 4/6 longitudinal studies show persistent olfactory impairment. Method(s): PCR-confirmed COVID-19 patients in the prospective ADAPT cohort (Sydney, Australia) were assessed across 18 acute symptoms and hospitalization status: 40% mild, 50% moderate, 10% severe/hospitalised - none deceased). Blood samples were taken 2 (N=179), 4 (N=148) and 12-month (N=118) post-diagnosis. The NIH Odor Identification Test (OIT) and the Cogstate brief cognitive battery were performed. 58 also had an olfaction test at 24-month. The OIT raw data were transformed into demographically-corrected T-scores. OIT's attrition was completely random and only initial age (40+/-15 versus 47+/-15) differed between patients lost to follow-up and those in the study at 24-month. We tested peripheral neurobiomarkers (NFL, GFAP, S100B, GM-CSF) and immune markers (Interleukin-IL panel: 1-beta, 1Ralpha, 4, 5, 6, 8, 10, 12p40, 12p70, 13, and MCP-1, TNF-alpha and INF-gamma), analyzed as Log transformed and elevated/normal range using published references. Our previous analyses had shown no relationship with the kynurenine pathway, but an association of impaired olfaction and impaired cognition at 2-month only. Linear mixed effect regressions with time effect (months) tested olfaction trajectories (random subject effect) and their association with the biomarkers (main and time interaction). Result(s): At 2 months post-diagnosis 30% had impaired olfaction and those who had acute severe disease were more likely to be impaired (54% versus 26%, p=.009). 21%, 31% and 37% had impaired olfaction at 4, 12 and 24-months. Olfactory performance declined over time (p< .0001), which was dependent on the initial performance (Fig 1). Neurobiomarkers were within the normal range. IFN-gamma, IL-1Ralpha, IL-13 and TNF-alpha increased across time, p< .03-p< .0005. TNF-alpha and IFN-gamma showed a time covariance with poorer olfaction performance. Conclusion(s): Post-acute mild to moderate COVID-19 is associated with a declining olfactory performance up to 2-yr post-diagnosis, especially when initially impaired with the provisio of attrition although random. Olfactory performance decline may be mediated by upregulated immune parameters which are distinct from those driving cognitive changes. (Figure Presented).

Increased Prevalence of Overweight and Obesity and Incidence of Prediabetes and Type 2 Diabetes During the COVID-19 Pandemic, Active Component Service Members, U.S. Armed Forces, 2018 to 2021

This study evaluated trends in the prevalence of overweight, obesity, and diabetes among active component service members between 2018 and 2021, before and after the start of the COVID-19 pandemic. This study also investigated the incidence of prediabetes and type 2 diabetes mellitus (T2DM) diagnoses during the same period. Between 2018 and 2021, the prevalence of obesity among active component service members who completed a Periodic Health Assessment (PHA) increased from 16.1% to 18.8%. The incidence of prediabetes increased from 588.2 to 763.8 cases per 100,000 person-years (p-yrs), and the incidence of T2DM increased from 55.5 to 69.6 per 100,000 p-yrs. The largest relative increases in obesity prevalence were in the youngest (<30 years) age categories. Navy members and Hispanic service members experienced the largest absolute and relative increases in rates of new diabetes diagnoses. These findings indicate that during the COVID-19 pandemic active component service members experienced increased prevalence of obesity, prediabetes, and diabetes. Evaluation of lifestyle factors associated with these chronic diseases among service members may be useful to enhance deployment readiness and operational effectiveness.

Workers and the Post-COVID Transportation Gig Economy

The COVID-19 pandemic significantly reduced the demand for ride-hailing services but saw a sharp increase in e-commerce, grocery, and restaurant delivery services. As the economy recovers and demand increases, several issues are emerging. The tension between companies that wish to keep drivers as independent contractors, but which hope that large enough numbers of them return to the industry, and drivers who increasingly demand to be considered as employees will likely lead to more attractive labor contracts, and perhaps even unionization in the future. Prices for ride-hailing and delivery services are increasing rapidly, rendering the savings relative to the now mostly defunct taxi industry and traditional package delivery industries near zero. While that will lead to a reduction in demand, no one knows how much that reduction will be and how long it will last. This chapter addresses three overarching themes dominating analyses of these industries. The first is labor, the second safety, and the third environmental impacts. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Baseline Sequencing Surveillance of Public Clinical Testing, Hospitals, and Community Wastewater Reveals Rapid Emergence of SARS-CoV-2 Omicron Variant of Concern in Arizona, USA.

The adaptive evolution of SARS-CoV-2 variants is driven by selection for increased viral fitness in transmissibility and immune evasion. Understanding the dynamics of how an emergent variant sweeps across populations can better inform public health response preparedness for future variants. Here, we investigated the state-level genomic epidemiology of SARS-CoV-2 through baseline genomic sequencing surveillance of 27,071 public testing specimens and 1,125 hospital inpatient specimens diagnosed between November 1, 2021, and January 31, 2022, in Arizona. We found that the Omicron variant rapidly displaced Delta variant in December 2021, leading to an "Omicron surge" of COVID-19 cases in early 2022. Wastewater sequencing surveillance of 370 samples supported the synchronous sweep of Omicron in the community. Hospital inpatient COVID-19 cases of Omicron variant presented to three major hospitals 10.51 days after its detection from public clinical testing. Nonsynonymous mutations in nsp3, nsp12, and nsp13 genes were significantly associated with Omicron hospital cases compared to community cases. To model SARS-CoV-2 transmissions across the state population, we developed a scalable sequence network methodology and showed that the Omicron variant spread through intracounty and intercounty transmissions. Finally, we demonstrated that the temporal emergence of Omicron BA.1 to become the dominant variant (17.02 days) was 2.3 times faster than the prior Delta variant (40.70 days) or subsequent Omicron sublineages BA.2 (39.65 days) and BA.5 (35.38 days). Our results demonstrate the uniquely rapid sweep of Omicron BA.1. These findings highlight how integrated public health surveillance can be used to enhance preparedness and response to future variants. IMPORTANCE SARS-CoV-2 continues to evolve new variants throughout the pandemic. However, the temporal dynamics of how SARS-CoV-2 variants emerge to become the dominant circulating variant is not precisely known. Genomic sequencing surveillance offers unique insights into how SARS-CoV-2 spreads in communities and the lead-up to hospital cases during a surge. Specifically, baseline sequencing surveillance through random selection of positive diagnostic specimens provides a representative outlook of the virus lineages circulating in a geographic region. Here, we investigated the emergence of the Omicron variant of concern in Arizona by leveraging baseline genomic sequence surveillance of public clinical testing, hospitals, and community wastewater. We tracked the spread and evolution of the Omicron variant as it first emerged in the general public, and its rapid shift in hospital admissions in the state health system. This study demonstrates the timescale of public health preparedness needed to respond to an antigenic shift in SARS-CoV-2.

Stoma reversal: An already overlooked issue further compounded by the covid pandemic

Aim: Operative management of rectal cancer often requires temporary or permanent stoma formation. Delay in stoma reversal is associated with poorer functional results and an increased risk of complications. Many surgical societies, including the Royal College of Surgeons of England, produced guidance at the beginning of COVID-19 pandemic that recommended considering de-functioning stomas to mitigate risks of anastomotic complications. The study aimed to assess the impact of COVID-19 on diverting ileostomy rates, reversal rates and waiting times in elective rectal cancer surgery. Method(s): Consecutive elective anterior resections for rectal cancer were identified from the prospectively maintained database of a single colorectal MDT between January 2018 and December 2021. The database was analysed to reveal operative approach, type of stoma, waiting time from initial surgery to stoma reversal and reasons for delayed closures. March 23rd 2020 was taken as the cut-off date between pre-pandemic and pandemic patient groups. Result(s): A total of 167 patients (70 in pre-pandemic) and (97 in pandemic) were included. An increase in the proportion of diverting stomas was observed in the pandemic group (58.8%) from pre-pandemic (38.6%). A three-fold increase in the end-of- year waiting list for ileostomy reversal was noted between December 2019 (n = 17) (pre-pandemic) to December 2021 (n = 47) (pandemic). Reasons for delay in stoma reversal included ongoing oncological treatment (34%), theatre capacity (20%), colorectal clinic capacity (26%) and access to water-soluble enema (9%). Conclusion(s): The advent of the COVID-19 pandemic has been associated with increased diverting ileostomy rates among elective rectal cancer patients. A three-fold increase in the stoma reversal waiting list poses logistical challenges at different levels. This study has highlighted potential bottlenecks to develop locally tailored pathways to prioritise timely reversal and to mitigate the potential complications associated with delayed closure.

Peripartum Outcomes Following COVID-19 Vaccination in Late Pregnancy: Findings from a Population-Based Retrospective Cohort Study in Ontario, Canada

Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology

Workers and the Post-COVID Transportation Gig Economy

The COVID-19 pandemic significantly reduced the demand for ride-hailing services but saw a sharp increase in e-commerce, grocery, and restaurant delivery services. As the economy recovers and demand increases, several issues are emerging. The tension between companies that wish to keep drivers as independent contractors, but which hope that large enough numbers of them return to the industry, and drivers who increasingly demand to be considered as employees will likely lead to more attractive labor contracts, and perhaps even unionization in the future. Prices for ride-hailing and delivery services are increasing rapidly, rendering the savings relative to the now mostly defunct taxi industry and traditional package delivery industries near zero. While that will lead to a reduction in demand, no one knows how much that reduction will be and how long it will last. This chapter addresses three overarching themes dominating analyses of these industries. The first is labor, the second safety, and the third environmental impacts. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

SARS-CoV-2 Delta Variant N Gene Mutations Reduce Sensitivity to the TaqPath COVID-19 Multiplex Molecular Diagnostic Assay.

As the SARS-CoV-2 virus evolves, mutations may result in diminished sensitivity to qRT-PCR diagnostic assays. We investigated four polymorphisms circulating in the SARS-CoV-2 Delta lineage that result in N gene target failure (NGTF) on the TaqPath COVID-19 Combo Kit. These mutations were detected from the SARS-CoV-2 genome sequences that matched with the diagnostic assay results of saliva specimens. Full length N genes from the samples displaying NGTF were cloned into plasmids and assayed using three SARS-CoV-2 qRT-PCR assays. These constructs resulted in reduced sensitivity to the TaqPath COVID-19 Combo Kit compared to the controls (mean Ct differences of 3.06, 7.70, 12.46, and 14.12), but were detected equivalently on the TaqPath COVID-19 Fast PCR Combo 2.0 or CDC 2019_nCoV_N2 assays. This work highlights the importance of genomic sequencing to monitor circulating mutations and provide guidance in improving diagnostic assays.

The role of virtual clinics in the assessment of non-urgent breast referrals: A useful tool in a post pandemic era?

Introduction: During the COVID-19 pandemic virtual clinics (VC) were widely rolled out amongst all specialties, in order to maintain key services, while avoiding unnecessary face-to-face (FTF) contact. We assessed the validity/safety of using a VC to assess non-urgent referrals to the breast service. Methods: All non-urgent referrals, between May-September 2020, were assessed in a VC by a single consultant. Patients were either discharged, followed-up or upgraded to an urgent face to face (FTF) appointment depending on assessment. Outcomes assessed included patient demographics, presenting symptoms, waiting times, VC/FTF outcomes and re-attendance. The primary outcome was discharge rate from VC alone. Secondary outcomes included re-attendance within 1 year and missed cancer diagnoses. Results: 396 patients attended a VC (median age 44 years (11-91), 318 female (80%). Mean waiting time was 84.6 days (6-365 days). 178 patients (45%) were discharged after VC review and discharge was more common for patients with mastalgia (107/167 patients;64%) than other symptoms (p<0.01;χ2 test). Re-attendance within 1 year for those discharged by VC was 6.7% and was similar to those who had FTF review (6.9%). 2 patients returned within 1 year with breast cancer. Both patients had cancer in the contralateral breast and both were seen in a FTF during the first episode. Conclusion: VC was a safe method for assessing non-urgent breast referrals during the COVID-19 pandemic and may continue to be of use in a post pandemic era as part of a hybrid approach. They may be of greatest value for assessing patients with mastalgia compared to other symptoms.

Useof Video Consultation in Irish General Practice:The Views of General Practitioners

Introduction Video consultation involves the live interaction between the doctor and the patient remotely. Prior to the Covid-19 pandemic, the majority of video consultations in primary care were provided by GPs who were not the individual's own GP, which presented safety and continuity issues. This study aims to determine GPs' attitudes to the use of video consultation for their own patients. Methods This was a qualitative study involving semi-structured interviews. Participants were purposively recruited through use of a GP tutor as a key informant and guided by a sampling framework to include those with and without previous video consultation experience. Braun and Clarke thematic analysis was used. Results Participants included eight GPs, half of whom had previously worked with video consultation. Four themes emerged: impact on the consultation, the potential role, and the potential threat to current practice and technology and logistics. There were optimistic and cautious observations within all themes. Conclusion With the increased use of video consultation, Irish General Practice is in a unique position to frame the future its use. The provision of this modality to one's own patients may provide benefit while mitigating some of the pitfalls but would not entirely avoid the potential dangers of video consultation.

High Engagement in Social Distancing and Mask Wearing and Associations with Reduced COVID-19 Infection among California College Students

Background. Engaging in preventive behaviors, including face mask wearing and social distancing, has been widely recommended, and in some cases mandated, to limit the spread of the COVID-19 disease. Despite wide-scale use, there is little data available on engagement of mask wearing and social distancing in college students and associated COVID-19 infection. Methods. A school-wide online survey was conducted (2021) among university students (n=2,132) in California. Frequency of mask-wearing and social distancing (indoors or public settings) and diagnosis with COVID-19 infection were measured. Multiple logistic regression models assessed associations between i) mask-wearing and ii) social distancing and COVID-19 infection, controlling for race, age, gender, and living with people who have high-risk health conditions. Results. Fourteen percent (14.06%) reported previous COVID-19 infection. Most students reported wearing masks in public settings (77.9%) and indoors (58%). About half (49.9%) reported social distancing in public settings and 44.9% indoors. In multiple logistic regression models, wearing a mask indoors was associated with 30% lower odds of COVID-19 infection (OR= 0.70;95% CI: 0.54,0.91) but no statistically significant association was observed for wearing a mask outdoors (OR= 0.80;95% CI: 0.59,1.08). Social distancing indoors and outdoors was associated with a 34% (OR= 0.66;95% CI: 0.50,0.86) and 32% (OR= 0.68;95% CI: 0.52,0.88) decrease in the odds of infection, respectively. COVID-19 infection declined as the number of preventive behaviors a student engaged in increased. Compared to those who engaged in no preventive behavior, the odds of infection were 0.71 (95% CI: 0.46,1.11) among students engaging in one behavior, 0.70 (95% CI: 0.46,1.07) in two behaviors, 0.42 (95% CI: 0.25,0.70) in three behaviors, and 0.48 (95% CI: 0.31,0.74) among those who engaged in all four behaviors. Conclusion. Wearing face masks and social distancing were both associated with lower odds of COVID-19 infection. The more preventive behaviors students engaged in the less frequently they reported COVID-19 infection. Our findings support existing guidelines promoting mask wearing and social distancing to limit the spread of COVID-19 disease.

Uptake and Perceptions of COVID-19 Vaccines among US Pregnant Women

Background. Compared to the non-pregnant population, pregnant persons are at increased risk for severe COVID-19 related illness, including higher rates of admission to intensive care and greater mortality. Despite the potential benefits of COVID-19 vaccines for pregnant persons, current guidelines for the use of COVID-19 vaccines during pregnancy are limited, and the uptake of COVID-19 vaccines among US pregnant adults is unclear. Methods. As part of an ongoing national longitudinal cohort study, 1,372 pregnant and recently postpartum pregnant persons participated in an online baseline survey, including questions on COVID-19 vaccination status and perceptions of COVID-19 vaccines. Preliminary analyses were restricted to 1,041 individuals who were pregnant during vaccine availability (after 14 December 2020). Post-stratification survey weights were applied to ensure results are representative of the general population. Weighted percentages and odds ratios were estimated based on survey responses. Results. 39.4% (95% CI 33.7, 45.1%) of respondents received a COVID-19 vaccine during pregnancy. Predictors of vaccination included belief that COVID-19 was a serious disease (OR 2.49;95% CI 1.41, 4.11) and concerns about giving birth during the COVID-19 pandemic (OR 1.83, 95% CI 1.10, 3.04). The most common reason for receiving a COVID-19 vaccine was to protect themselves (21.2%) or their baby (39.1%). Among unvaccinated respondents, 14.9% planned to receive a vaccine during their pregnancy and 35.3% after pregnancy, 28.6% had no intention of receiving a vaccine, and the remaining 21.1% were uncertain. Among those who never planned to vaccinate, the most common reason was concern about side effects (57.2%). Percent of pregnant persons receiving at least one dose of COVID-19 vaccine, by month of delivery (postpartum participants) or estimated month of delivery (pregnant participants). Conclusion. Our results indicate that despite the lack of clear recommendations for vaccination during pregnancy, more than one-third of pregnant persons received a COVID-19 vaccine during pregnancy. Evaluation of the health effects of COVID-19 vaccination during pregnancy, including the ability to protect pregnant persons and their infants from infection, is needed.

Impact of COVID-19 on the Health-Related Quality-of-Life of Pregnant and Postpartum Persons

Objectives: To assess the impact of COVID-19 on health-related quality-of-life (HRQoL) of those who were pregnant or recently pregnant during the pandemic. Methods: Individuals who were pregnant any time since January 2020, the beginning of the pandemic, were invited to participate in an online, national US survey (EuroQol grant: 260-2020RA). Respondents were asked to self-report their experiences with COVID-19, to complete the EQ-5D-5L, and other measurements of HRQoL. To estimate the association between COVID-19 infection with the EQ-5D-5L outcomes, we used median regression for the EQ-5D utility and EQ-VAS scores, and ordinal logistic regressions for the EQ-5D-5L health items. Post-stratification weights were used to ensure representation by age, race and US census region. Results: Among pregnant or postpartum persons, the median EQ-5D-5L utility score was 0.87 and EQ-VAS was 0.80. The median EQ-5D-5L utility score increased by 0.0058 (95% CI 0.0026, 0.009) for each additional year of age of the respondent. We observed no change in EQ-5D-VAS utility measures by maternal age (ß= 0.00;95% CI -0.09, 0.09). On average, comparing Black pregnant persons to White, EQ-5D-5L utility values were 0.44 points lower, and EQ-5D-VAS scores were 0.31 points lower. Although median EQ-5D-5L utility values were similar for those with and without a diagnosis of COVID-19 (0.87 and 0.88), utility values declined by 0.022 (95% CI -0.040, -0.010) for each unit increase in perceived COVID-19 severity. Similar results were observed for the EQ-5D-VAS scores. When we evaluated EQ-5D-5L items individually, respondents diagnosed with COVID-19 reported more problems related to anxiety/depression compared with those who did not (OR 2.43;95% CI 1.35, 4.40). No other items were significantly associated with COVID-19. Conclusions: We observed lower HRQoL measures associated with severe COVID-19 infection during pregnancy. In particular, problems with anxiety and depression contributed most strongly to lowered HRQoL during pregnancy.