Mild COVID-19 clinical course among paediatric patients with primary immunodeficiency

Background: The clinical course of coronavirus disease-2019 (COVID-19) varies from those who are asymptomatic, experience mild symptoms such as fever, cough, and dyspnea, to more severe outcomes including acute respiratory distress, pneumonia, renal failure, and death. Early reports suggested severe outcomes in patients with primary immunodeficiency (PID), particularly those with type 1 interferon signalling defects. This prompted a rigid approach to social distancing to protect this patient population, particularly children. To date, real-world data describing the course and outcome of COVID-19 in paediatric PID patients remains scarce. Method(s): In this retrospective case series, we describe the clinical course of 36 paediatric patients with underlying primary immunodeficiency (PID) followed by SickKids Hospital (Toronto, Canada) who were symptomatic and tested positive for SARS-CoV-2 infection between October 2020 to November 2022. Result(s): Our cohort consisted of patients with combined immunodeficiency (66.7%), antibody deficiency (22.2%), neutrophil dysfunction (8.3%), and immune dysregulation (2.8%). The median age was 7.5 years (range: 8 months - 17 years), with 21 male and 15 female patients. Three (8.3%) patients were post-hematopoietic stem cell transplant (HSCT) and 12 (33%) patients were on immunoglobulin replacement. Nine (25%) patients had underlying lung problems including bronchiectasis (1), interstitial lung disease on home oxygen therapy (1), and underlying asthma (7). Most patients had mild clinical course and were managed at home. The most common symptoms were fever (80%), cough (75%) and other upper respiratory tract symptoms (72%). Nineteen (52.7%) patients experienced other symptoms which included headache, lethargy, or gastrointestinal upset. At the time of the infection, 13 patients (36.1%) had received 2 doses of a SARS-CoV-2 vaccine, 5 patients (13.9%) had received 1 dose, and 18 (50%) were not vaccinated. None of the patients received antiviral or monoclonal antibody as prophylaxis or treatment. Only 1 patient required hospital admission out of precaution given the close proximity to HSCT. All patients recovered without complications. Conclusion(s): The paediatric patients with PID followed by our centre experienced mild to moderate COVID-19 symptoms and recovered fully without complications. These findings support the return of much needed social interactions among children, which were impacted severely during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc.

Mild COVID-19 outcomes in adults with inborn errors of immunity: a single-center experience

Currently, 640 million cases of coronavirus disease 2019 (COVID-19) and 6.6 million deaths have been reported world-wide. Risk factors for severe COVID-19 are known, including those with compromised immunity. Among patients with inborn errors of immunity (IEI), early reports of severe outcomes lead to strict masking and social distancing measures. While this resulted in relatively low infection rates among those with IEI, real-world data describing the clinical course of COVID-19 in this patient population have remained limited. We performed a retrospective study of adult IEI patients followed by our center in which a positive test (rapid antigen or PCR) for COVID-19 was determined between November 2021-November 2022. Medical charts were reviewed, and patient interviews conducted. All patients provided informed consent. Twenty-nine patients were enrolled (22 females, 7 males), aged between 18-69 years (median: 20-29 years). The cohort included those with antibody deficiencies (41.37%), combined immunodeficiencies (34.48%;HIES, CARD11, STAT1-GOF), immune dysregulation disorders (20.69%;LRBA deficiency, AIRE deficiency) and phagocyte defect (3.45%;CGD). The duration of symptoms ranged between 3 days-4 weeks (median: < 1 week). Upper respiratory symptoms (including sore throat, congestion) were reported in 97% while fever was present in 41% of patients. Prior to infection, 14 (48%) patients had underlying asthma or bronchiectasis - 2 subsequently experienced shortness of breath and were treated with inhalers or Sotrovimab, respectively. No treatment was required in 65.5% of cases. The remaining received Paxlovid (10.3%), Sotrovimab (13.79%), or antibiotics (10.3%). Of the 2 patients with STAT1-GOF, one tested positive during a repeat episode of febrile neutropenia which required hospitalization. No other patients were hospitalized or needed ICU admission. No deaths were recorded. In light of these favourable outcomes, patients with IEI can gradually and safely return to normal activities.Copyright © 2023 Elsevier Inc.

COVID-19 and Social Media Use by Professional Sport Organisations

In Chapter 15, the authors analyse the use of social media by athletes and sport organisations during the pandemic. Ironically, while social media as a digital platform have typically been pilloried by multiple actors and social commentators, the format has provided a positive outlet for many athletes who faced the prospect of being in lockdown for weeks, if not months. This chapter considers how athletes and sport organisations engaged with their fans during the initial period of the COVID-19 pandemic. © 2023 selection and editorial matter, Stephen Frawley and Nico Schulenkorf;individual chapters, the contributors.

Engaging AYAs by Meeting Them Where They Are: Development of an Annual AYA Cancer Summit

Background/Purpose: Adolescents and Young Adults (AYA) with cancer represent a small but increasing number of the overall cancer population in the US, representing about 5% of those diagnosed. Given the impact of treatment on quality of life, especially fertility, programmatic efforts to educate patients on ways to mitigate these effects are paramount. However, reaching this population in a large academic medical center can be elusive given the diversity of cancers diagnosed within this population and the many competing personal and developmental demands patients face. The recent COVID-19 pandemic also challenges efforts to build a cohesive AYA program. Method(s): We present efforts to host an annual in-person patientcentric summit for 60 AYA patients and 60 caregivers in the year 2022. The summit included a community partner fair. Agenda design was based upon patient feedback from an online summit in 2021 requesting more direct engagement and topics specifically focused on coping with side effects from treatment. Recruitment efforts included targeted social media marketing, phone campaigning and direct contact at patient medical appointments. Agenda topics focused on exercise, nutrition, onco-fertility, caregiver burnout, and rebuilding social connections. An incentivized exit survey was provided for feedback on the current summit and topic ideas for future programming. Result(s): Over 250 patients were contacted directly via phone or in person. Patients and caregivers registered for all 120 slots prior to the summit. A total of 75 (49 patients and 26 caregivers) participated in the summit. There were 10 local and national community partners at the fair. Fifty-seven exit surveys were completed with 86%-95% of respondents indicating they learned a good amount or a great deal from the presentations. Conclusions and Implications: Recruitment of AYAs for educational events requires significant front-end effort. However, patients appreciate the information provided and program leadership gain invaluable information about the current needs of AYA patients.

Case series of COVID-19 outcomes in adult patients with inborn errors of immunity

Background: Si nce the onset of the COVID-19 pandemi c, a mai n chal l enge for cl i ni ci ans and publ i c heal th deci si on-makers has revol ved around ri sk strati fi cati on i n vul nerable popul ati ons, i n parti cul ar i ndi vi dual s wi th i nborn errors of i mmuni ty (I EI ). However, avai l abl e report s of t he cl i ni cal course of COVID-19 in patients with IEI show wide variability, from a complete lack of symptoms to severe and compli-cated disease. Objective(s): To present the clinical features and outcomes of SARS-CoV-2 infection in adult patients with IEI. Method(s): We performed a retrospective chart review documenting patient characteristics and clinical course of SARS-CoV-2 infection between December 2021 and July 2022. Result(s): Ten adult patients with IEI followed in our center were diagnosed with COVID-19, as determined by RT-PCR or rapid antigen testing. IEI in this cohort included those with humoral and combined immunodeficien-cies, as well as phagocytic defects. An underlying lung comorbidity was identified in 3 patients. Symptoms were mostly mild and self-limiting, and no severe outcomes, complications, or mortality were noted in this study. Conclusion(s): We suggest that patients affected by a wide range of both humoral and combined IEI may demonstrate resilience, while highlighting the possible protective effects of vaccination and immunoglobulin replacement in this population. Statement of Novelty: We report on the mild COVID-19 clinical course of 10 adults with IEI. Copyright © The Authors.

ULTRA-RAPID REAL-TIME MICROFLUIDIC POLYMERASE CHAIN REACTION INSTRUMENT FOR CLINICAL AND FORENSIC APPLICATIONS

The SARS-CoV-2 pandemic has elevated the development of novel diagnostic solutions, including rapid nucleic acid amplification tests (NAATs), to a global priority to meet the high demand for accurate, timely viral detection and diagnosis. However, ubiquitously implemented NAATs, such as polymerase chain reaction (PCR), consume hours of testing. We report a field-forward instrument capable of ultra-fast real-time PCR for amplification-based nucleic acid detection in a custom-designed microfluidic chip. Prudent selection and unconventional positioning of thermal cyclers relative to the microfluidic chip and a fluorescent detector permit ultra-fast simultaneous amplification and detection, with 40 cycles complete in under 10 minutes. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

IS IT SAFE TO PROVIDE 28 DAY POST-EXPOSURE PROPHYLAXIS (PEP) PACKS IN SEXUAL HEALTH SERVICES, EMERGENCY DEPARTMENTS AND SEXUAL ASSAULT REFERRAL CENTRES?

Introduction Since the beginning of COVID lockdown, we have provided 28 day PEP packs from sexual health clinics, emergency departments and sexual assault referral centres to minimise number of patient contacts. This study is to look at the provision of PEP since the new initiative. Methods Patients who attended our hospital emergency department, sexual assault referral centre, and sexual health clinics between March 2020 and October 2021 were randomly selected. Retrospective patient records were reviewed and the BHIVA 2015 PEP standards were used. Results 434 patients and 468 PEP prescriptions were included. 384 (88%) were male, in whom 337 (87.8%) were MSM. 166 (38.2%) were from our emergency department. 401 (85.7%) were after sexual exposure, 56 (20.0%) were occupational exposure. 413 (88.2%) prescriptions met criteria for initiation, 43 (9.2%) did not and 3 (0.6%) had insufficient information. 448 (95.7%) had baseline blood tests. 28 (6%) did not attend sexual health clinic for follow up. 255 (54.5%) had repeat HIV test after 8-12 weeks of exposure. 213 (45.5%) did not have repeat test. STI screening was performed in 368 (78%) attendances and 106 infections were identified. Discussion The majority of PEP was prescribed appropriately and baseline testing was performed in most cases. Out study demonstrates the safety of 28-day PEP pack being issued in settings other than sexual health clinics. Post-PEP HIV testing remains poor, which is consistent with other national audits. This highlights the need for focussed work to improve followup attendance.

Early career researchers benefit from inclusive, diverse and international collaborations: Changing how academic institutions utilize the seminar series.

Efforts to make research environments more inclusive and diverse are beneficial for the next generation of Great Lakes researchers. The global COVID-19 pandemic introduced circumstances that forced graduate programs and academic institutions to re-evaluate and promptly pivot research traditions, such as weekly seminar series, which are critical training grounds and networking opportunities for early career researchers (ECRs). While several studies have established that academics with funded grants and robust networks were better able to weather the abrupt changes in research and closures of institutions, ECRs did not. In response, both existing and novel partnerships provided a resilient network to support ECRs at an essential stage of their career development. Considering these challenges, we sought to re-frame the seminar series as a virtual collaboration for ECRs. Two interdisciplinary graduate programs, located in different countries (Windsor, Canada, and Detroit, USA) invested in a year-long partnership to deliver a virtual-only seminar series that intentionally promoted: the co-creation of protocols and co-led roles, the amplification of justice, equity, diversity and inclusion throughout all aspects of organization and representation, engagement and amplification through social media, the integration of social, scientific and cultural research disciplines, all of which collectively showcased the capacity of our ECRs to lead, organize and communicate. This approach has great potential for application across different communities to learn through collaboration and sharing, and to empower the next generation to find new ways of working together.

Medical Student Education During the COVID-19 Pandemic: Initial Experiences Implementing a Virtual Interventional Radiology Elective Course.

RATIONALE AND OBJECTIVES: In response to the COVID-19 pandemic reducing medical student presence on clinical services and in classrooms, academic institutions are utilizing a virtual format to continue medical student education. We describe a successful initial experience implementing a virtual elective in interventional radiology (IR) and provide the course framework, student feedback, and potential improvements. MATERIALS AND METHODS: A 2-week virtual IR elective curriculum was created utilizing a combination of synchronous and asynchronous learning and the "flipped" classroom educational model. Students virtually participated in daily IR resident education conferences, resident-led case review sessions, and dedicated lectures. Asynchronous prelearning material consisted of text and video correlating to lecture topics. Anonymous precourse and postcourse surveys were sent to all participating students (n = 10). RESULTS: Ten students (100%) completed precourse and seven (70%) completed postcourse surveys. Enrolled students were considering residencies in surgery (50%), internal medicine (40%), interventional radiology (30%), and/or diagnostic radiology (30%). Students' understanding of what IRs do and the procedures they perform (p < 0.001), when to consult IR for assistance in patient management (p = 0.005), and the number of IR procedures students could recall (p = 0.015) improved after the course. Case-review sessions and virtual lectures ranked as having the highest education value. Students recommended additional small-group case workshops. CONCLUSION: This successful virtual IR elective provides a framework for others to continue IR medical student education during the pandemic and grow the specialty's presence within an increasingly virtual medical school curriculum. The described model may be modified to improve IR education beyond the COVID-19 era.

Development and Pilot-testing of a Hepatitis C Reinfection Prevention Intervention for Patients in Treatment for Hepatitis C Infection (preprint)

Background: With annual rates of hepatitis C virus (HCV) reinfection among persons who inject drugs ranging from 5% to 22%, the need for behavioral interventions to prevent reinfection following successful treatment is clear. Methods: This report aims to describe the conception and development of an intervention to prevent HCV reinfection and present preliminary results from its pilot testing at an opioid treatment program offering on-site primary medical care, including treatment for HCV infection. We developed a two-session intervention combining a teachable moment followed by a session based on the Information-Motivation-Behavioral Skills (IMB) Model to reinforce learning. The teachable moment occurs in less than ten minutes during the routine blood draw to measure viral load during HCV treatment. The reinforcing IMB session builds knowledge, motivation, and self-efficacy in practicing safer injection skills. Formative exploratory work for the intervention involved a literature review, planning meetings with implementation staff, and development of study materials. Intervention staff were trained and the intervention was pilot tested. Measured outcomes included feasibility and acceptability of the intervention to patients and implementers, study recruitment and retention, and preliminary changes in knowledge, motivation, self-efficacy, and HCV reinfection risk behaviors over the study time period. Results: The study protocol and intervention content are both described, along with the preliminary results of implementation and psychosocial outcomes among 17 patients undergoing direct-acting antiviral treatment for HCV. Baseline data revealed gaps in HCV prevention knowledge that could lead to reinfection. We also report lessons learned related to implementation of such an intervention with this population in integrated care settings. After some minor adjustments, we found high levels of feasibility and acceptability for the intervention at the implementing organization. Intervention implementation was interrupted due to COVID-19 restrictions. Conclusions: It is possible to implement an intervention in an opioid treatment program to improve HCV prevention knowledge with the potential to prevent reinfection. Intervention staff must be attentive to participant needs regarding time and monetary constraints to maximize acceptability. Given the impact of the COVID-19 pandemic, future research should explore the possibility of offering the intervention via phone or video chat.

Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine.

On March 16, 2020, Ukraine's Ministry of Health issued nonspecific interim guidance to continue enrolling patients in opioid agonist therapies (OAT) and transition existing patients to take-home dosing to reduce community COVID-19 transmission. Though the number of OAT patients increased modestly, the proportion receiving take-home dosing increased from 57.5% to 82.2%, which translates on average to 963,952 fewer clinic interactions annually (range: 728,652-1,016,895) and potentially 80,329 (range: 60,721-84,741) fewer hours of in-person clinical encounters. During the transition, narcologists (addiction specialists) expressed concerns about overdoses, the guidance contradicting existing legislation, and patient dropout, either from incarceration or inadequate public transportation. Though clinicians did observe some overdoses, short-term overall mortality remained similar to the previous year. As the country relaxes the interim guidance, we do not know to what extent governmental guidance or clinical practice will change to adopt the new guidance permanently or revert to pre-guidance regulations. Some future considerations that have come from COVID-19 are should dosing schedules continue to be flexible, should clinicians adopt telehealth, and should there be more overdose education and naloxone distribution? OAT delivery has improved and become more efficient, but clinicians should plan long-term should COVID-19 return in the near future. If the new efficiencies are maintained, it will free the workforce to further scale up OAT.

Fake news travels fast: exploring misinformation circulated around Wu Lei's coronavirus case. (Special Issue: Sport and the coronavirus crisis.)

This commentary analyzes how misinformation related to a coronavirus case of a star soccer player (i.e., Wu Lei) was spread widely on Chinese digital media and accepted by sports fans as the truth. The paper first examines the mechanisms by exploring how misinformation emerged and was disseminated. Then, the paper explores how social media and the fast-growing self-media in China exacerbate tendencies toward misinformation during the news production process, which poses a new threat to legacy media and journalists' profession. The paper concludes by discussing new challenges faced by Chinese sports journalists in the new digital era after COVID-19.