Thirty-Day Outcomes of Young and Middle-Aged Adults Admitted with Severe COVID-19 in Uganda: A Retrospective Cohort Study.

Background: There is scarcity of data regarding young and middle-aged adults hospitalized with severe Corona Virus Disease 2019 (COVID-19) in Africa. In this study, we describe the clinical characteristics and 30-day survival among adults aged 18 to 49 years admitted with severe COVID-19 in Uganda. Methods: We reviewed treatment records of patients admitted with severe COVID-19 across five COVID-19 treatment units (CTU) in Uganda. We included individuals aged 18 to 49 years, who had a positive test or met the clinical criteria for COVID-19. We defined severe COVID-19 as having an oxygen saturation <94%, lung infiltrates >50% on imaging and presence of a co-morbidity that required admission in the CTU. Our main outcome was the 30-day survival from the time of admission. We used a Cox proportional hazards model to determine the factors associated with 30-day survival at a 5% level of significance. Results: Of the 246 patient files reviewed, 50.8% (n = 125) were male, the mean ± (standard deviation) age was 39 ± 8 years, majority presented with cough, 85.8% (n = 211) and median C-reactive protein (interquartile range) was 48 (47.5, 178.8) mg/L. The 30-day mortality was 23.9% (59/246). At admission, anemia (hazard ratio (HR): 3.00, 95% confidence interval (CI), 1.32-6.82; p = 0.009) and altered mental state (GCS <15) (HR: 6.89, 95% CI: 1.48-32.08, p = 0.014) were significant predictors of 30-day mortality. Conclusion: There was a high 30-day mortality among young and middle-aged adults with severe COVID-19 in Uganda. Early recognition and targeted management of anemia and altered consciousness are needed to improve clinical outcomes.

URBAN AGING RESIDENTS COALITION (UARC): A HYBRID MODEL TO BRIDGE THE TECHNOLOGY GAP

The COVID-19 pandemic spotlighted technology barriers for urban Black/African American older adults that lead to chronic stress, social isolation, and inability to fully engage with the world. In partnership with an African American older adult community leader, the Urban Aging Residents Coalition was founded in May 2020 to address engaging older adults with technology. A primary goal of UARC is to prevent social isolation and promote mental wellness through education. Using a hybrid model of videoconferencing and socially-distanced meetings, volunteer health professionals and community members (e.g., Information Technology Technician, Psychologist, and Nurse) delivered education to older adults. Participants also met for computer training to build confidence by sharing technology accomplishments with others (e.g., online bill paying). UARC has 75 active members and conducted over 12 videoconferences and in-person programming. The UARC project serves as a model for community/academic partnerships to support mental wellness and technology use in urban older adults.

EXPERIENCES USING A SMARTHEALTH SYSTEM: TWO CASES OF DEMENTIA FAMILY CAREGIVERS

Family caregivers for persons with dementia often times experience stress and burden while caregiving. The COVID-19 pandemic has worsened this situation with increased physical and social isolation, further resulting in health risks in this population. Technology-based interventions have become more commonplace in today's world to address ongoing caregiver needs although gaps in technological literacy and usage still exist among many users. This case study aims to report on the implementation of an ongoing Smarthealth technology intervention for two older adult family caregivers of persons with dementia and to explore their experiences with this system. Data were collected through acoustic monitoring, survey administration, and semi-structured interviews. Intervention effects on changes in emotional states will be discussed. Study findings showed the intervention improved self-awareness of emotional care and reactions to care recipients. Findings in this study highlight the importance and challenges of real-time technology-based intervention implementation in older adult caregiving populations.

The COVID-19 Pandemic: A Global High-Tech Challenge at the Interface of Science, Politics, and Illusions

The COVID-19 Pandemic: A Global High-Tech Challenge at the Interface of Science, Politics, and Illusions discusses COVID-19 as the first pandemic in the Internet era and our current reality of continuous reports, news, and updates. Since its beginning, we were daily bombarded with news of what was happening around the world. There was no global political leadership. The United States was politically partially paralyzed. Russia and China hoped to gain diplomatic profile worldwide, but their vaccines are of limited efficacy, and trust in their clinical data is rightly low. The European Union did not order enough vaccines in time, but sued a large manufacturer for delivery delays. Now it is setting up yet another bureaucratic institution. At least the pharmaceutical or life science industry paved the way out, but is not enthusiastically praised for it. It would be too easy and superficial to blame mistakes of governments and leaders on stupidity. Idiocy exists, but we have to go deeper to understand how illusions and blind spots in today’s common perception and science, inertia, arrogance, conflicts of interest, competition of individuals, and states and institutions for public recognition have contributed to a multitude of flawed assessments and direct mistakes. Healthcare professionals and anyone interested in an in-depth understanding of humankind’s response to the COVID-19 challenge will not get around the key conclusions of this book. © 2022 Elsevier Inc. All rights reserved.

DISPARITIES IN DIABETES AND HYPERTENSION QUALITY DURING THE COVID-19 PANDEMIC

BACKGROUND: The COVID-19 pandemic changed ambulatory chronic disease care. Our goal was to assess racial, ethnic, and language disparities in diabetes (DM) and hypertension (HTN) quality during the pandemic. METHODS: Our primary outcomes were rates of DM and HTN control among patients attributed to primary care physicians. We fit linear models, with random effects to account for repeated monthly measures on patients, to estimate the absolute differences between the 2020 and 2019 rates in the same months. The models estimated and compared these monthly differences across race/ethnicity groups (ref: White, non-Hispanic), and language groups (ref: English-speaking). We adjusted for age, sex, payor, education, and income. Significance was determined from analogous logistic regression models. RESULTS: We included 32,914 patients with DM and 125,478 with HTN. Overall, performance was better in Jan-March 2020 compared to JanMarch 2019, however this differential reversed by June 2020, falling below June 2019 (Figure). Among patients with DM, Asian and Black patients had a larger decrease in control rates compared to White patients. For example, comparing September 2019 to September 2020 the absolute control rates were 12% lower for Asian patients and 14% lower for Black patients compared to 8.3% for White patients (p<0.001). Non-English-speaking patients had a larger decrease in absolute control rates compared to English-speaking patients. For HTN, Asian, Black, and Hispanic patients had larger decreases in absolute control rates compared to White patients. For example, comparing October 2019 to October 2020, control rates decreased by 13.3% for Asian patients, 15.7% for Black patients, and 13.9% for Hispanic patients compared to 10% for White patients (p<0.001). Non-English-speaking patients had a 14.4% decrease in control rates comparing September 2019 to September 2020 while there was a 10.5% decrease among English-speaking patients (p<0.001). CONCLUSIONS: DM and HTN quality disproportionately worsened among marginalized patients during the pandemic.

Replacement of the Alpha variant of SARS-CoV-2 by the Delta variant in Lebanon between April and June 2021.

The COVID-19 pandemic continues to expand globally, with case numbers rising in many areas of the world, including the Eastern Mediterranean Region. Lebanon experienced its largest wave of COVID-19 infections from January to April 2021. Limited genomic surveillance was undertaken, with just 26 SARS-CoV-2 genomes available for this period, nine of which were from travellers from Lebanon detected by other countries. Additional genome sequencing is thus needed to allow surveillance of variants in circulation. In total, 905 SARS-CoV-2 genomes were sequenced using the ARTIC protocol. The genomes were derived from SARS-CoV-2-positive samples, selected retrospectively from the sentinel COVID-19 surveillance network, to capture diversity of location, sampling time, sex, nationality and age. Although 16 PANGO lineages were circulating in Lebanon in January 2021, by February there were just four, with the Alpha variant accounting for 97 % of samples. In the following 2 months, all samples contained the Alpha variant. However, this had changed dramatically by June and July 2021, when all samples belonged to the Delta variant. This study documents a ten-fold increase in the number of SARS-CoV-2 genomes available from Lebanon. The Alpha variant, first detected in the UK, rapidly swept through Lebanon, causing the country's largest wave to date, which peaked in January 2021. The Alpha variant was introduced to Lebanon multiple times despite travel restrictions, but the source of these introductions remains uncertain. The Delta variant was detected in Gambia in travellers from Lebanon in mid-May, suggesting community transmission in Lebanon several weeks before this variant was detected in the country. Prospective sequencing in June/July 2021 showed that the Delta variant had completely replaced the Alpha variant in under 6 weeks.

Emergency medicine resident perceptions of the didactic experience during the covid-19 pandemic

Learning Objectives: The learning objective of this study was to evaluate the impact of the Covid-19 pandemic on the didactic experience of EM residents in the United States. Background: Due to the onset of Covid-19, many residency programs shifted from in-person education to online learning utilizing web-based platforms. Limited data exist on resident physicians' perceptions of the educational environment during this time. Objective: The objective of this study was to evaluate how the Covid-19 pandemic affected the didactic experience of EM residents in the United States. We hypothesized that resident physicians preferred a hybrid model of online and in-person learning. Methods: This observational study (completed in November 2020) assessed EM resident perceptions of the didactic learning environment during the Covid-19 pandemic utilizing an online survey. Participants were invited through the CORD listserv. Subjects included were EM residents and fellows in the US. There were 14 survey questions including demographics and perceptions of aspects of the didactic environment in 2020. Quantitative statistical analysis of question responses was performed. Results: 78 participants from 12 states completed the survey. 98.7% of subjects reported that some or all their in-person meetings were temporarily stopped during the Covid-19 pandemic. 98.7% of residents reported that their residencies utilized web-based meeting platforms. 77% of respondents indicated that their didactics were still being held virtually. 46% of subjects reported that live lectures provided a better learning experience than online. 15% of respondents kept their webcam on during the entire online learning experience. When envisioning July 2021, 71% of respondents answered that they would like to see their programs utilize a hybrid model of in-person and online learning. Conclusions: Most programs temporarily stopped all or some of their in-person meetings and utilized a webbased meeting platform. Many residents preferred a hybrid model of learning. Limitations included sample size. This study provided valuable data on trends in EM education during the pandemic.

Out-of-the-Box Deployment to Support Research on In-Home Care of Alzheimer's Patients

COVID-19 has caused many disruptions in conducting smart health research. Both in-lab sessions and in-home deployments had to be delayed or canceled because in-person meetings were no longer allowed. Our research project on "in-home monitoring with personalized recommendations to reduce the stress of caregivers of Alzheimer's patients" was affected. To enable continued research without any person-to-person contact, we created an out-of-the-box deployment solution. The solution is multifaceted and deals with everything from technical adjustments, deployment documentation, EMA additions, additional monitoring software, use of videos, Zoom and TeamViewer, budget changes, new logistics, and changes to IRBs. This article briefly describes the purpose and design of the original system and then articulates the necessitated changes. We also provide lessons learned and an initial evaluation of the effectiveness of the solutions after the changes. The evaluation surveys the opinions of seven people that assembled, initialized, and deployed our system in home environments. We believe that the various solutions we developed can be applied to other similar projects, and will be helpful to new projects even when personal contact returns.

Large-scale sequencing of SARS-CoV-2 genomes from one region allows detailed epidemiology and enables local outbreak management.

The COVID-19 pandemic has spread rapidly throughout the world. In the UK, the initial peak was in April 2020; in the county of Norfolk (UK) and surrounding areas, which has a stable, low-density population, over 3200 cases were reported between March and August 2020. As part of the activities of the national COVID-19 Genomics Consortium (COG-UK) we undertook whole genome sequencing of the SARS-CoV-2 genomes present in positive clinical samples from the Norfolk region. These samples were collected by four major hospitals, multiple minor hospitals, care facilities and community organizations within Norfolk and surrounding areas. We combined clinical metadata with the sequencing data from regional SARS-CoV-2 genomes to understand the origins, genetic variation, transmission and expansion (spread) of the virus within the region and provide context nationally. Data were fed back into the national effort for pandemic management, whilst simultaneously being used to assist local outbreak analyses. Overall, 1565 positive samples (172 per 100 000 population) from 1376 cases were evaluated; for 140 cases between two and six samples were available providing longitudinal data. This represented 42.6 % of all positive samples identified by hospital testing in the region and encompassed those with clinical need, and health and care workers and their families. In total, 1035 cases had genome sequences of sufficient quality to provide phylogenetic lineages. These genomes belonged to 26 distinct global lineages, indicating that there were multiple separate introductions into the region. Furthermore, 100 genetically distinct UK lineages were detected demonstrating local evolution, at a rate of ~2 SNPs per month, and multiple co-occurring lineages as the pandemic progressed. Our analysis: identified a discrete sublineage associated with six care facilities; found no evidence of reinfection in longitudinal samples; ruled out a nosocomial outbreak; identified 16 lineages in key workers which were not in patients, indicating infection control measures were effective; and found the D614G spike protein mutation which is linked to increased transmissibility dominates the samples and rapidly confirmed relatedness of cases in an outbreak at a food processing facility. The large-scale genome sequencing of SARS-CoV-2-positive samples has provided valuable additional data for public health epidemiology in the Norfolk region, and will continue to help identify and untangle hidden transmission chains as the pandemic evolves.

Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, Update 2020.

This assessment by the Environmental Effects Assessment Panel (EEAP) of the United Nations Environment Programme (UNEP) provides the latest scientific update since our most recent comprehensive assessment (Photochemical and Photobiological Sciences, 2019, 18, 595-828). The interactive effects between the stratospheric ozone layer, solar ultraviolet (UV) radiation, and climate change are presented within the framework of the Montreal Protocol and the United Nations Sustainable Development Goals. We address how these global environmental changes affect the atmosphere and air quality; human health; terrestrial and aquatic ecosystems; biogeochemical cycles; and materials used in outdoor construction, solar energy technologies, and fabrics. In many cases, there is a growing influence from changes in seasonality and extreme events due to climate change. Additionally, we assess the transmission and environmental effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the COVID-19 pandemic, in the context of linkages with solar UV radiation and the Montreal Protocol.

Large scale sequencing of SARS-CoV-2 genomes from one region allows detailed epidemiology and enables local outbreak management (preprint)

The COVID-19 pandemic has spread rapidly throughout the world. In the UK, the initial peak was in April 2020; in the county of Norfolk (UK) and surrounding areas, which has a stable, low-density population, over 3,200 cases were reported between March and August 2020. As part of the activities of the national COVID-19 Genomics Consortium (COG-UK) we undertook whole genome sequencing of the SARS-CoV-2 genomes present in positive clinical samples from the Norfolk region. These samples were collected by four major hospitals, multiple minor hospitals, care facilities and community organisations within Norfolk and surrounding areas. We combined clinical metadata with the sequencing data from regional SARS-CoV-2 genomes to understand the origins, genetic variation, transmission and expansion (spread) of the virus within the region and provide context nationally. Data were fed back into the national effort for pandemic management, whilst simultaneously being used to assist local outbreak analyses. Overall, 1,565 positive samples (172 per 100,000 population) from 1,376 cases were evaluated; for 140 cases between two and six samples were available providing longitudinal data. This represented 42.6% of all positive samples identified by hospital testing in the region and encompassed those with clinical need, and health and care workers and their families. 1,035 cases had genome sequences of sufficient quality to provide phylogenetic lineages. These genomes belonged to 26 distinct global lineages, indicating that there were multiple separate introductions into the region. Furthermore, 100 genetically-distinct UK lineages were detected demonstrating local evolution, at a rate of ~2 SNPs per month, and multiple co-occurring lineages as the pandemic progressed. Our analysis: identified a sublineage associated with 6 care facilities; found no evidence of reinfection in longitudinal samples; ruled out a nosocomial outbreak; identified 16 lineages in key workers which were not in patients indicating infection control measures were effective; found the D614G spike protein mutation which is linked to increased transmissibility dominates the samples and rapidly confirmed relatedness of cases in an outbreak at a food processing facility. The large-scale genome sequencing of SARS-CoV-2-positive samples has provided valuable additional data for public health epidemiology in the Norfolk region, and will continue to help identify and untangle hidden transmission chains as the pandemic evolves.