Disproportionate policy dynamics in crisis and uncertainty: an international comparative analysis of policy responses to COVID-19

Differences in policy responses have enabled some nations to successfully mitigate COVID-19 cases and deaths while others continue to struggle. In their efforts to contain the virus, nations have pursued disparate policy responses with policy stringency ranging from policy over-reactions to under-reactions. As nations look towards recovery, a retroactive evaluation of the relationship between policy responses and outcomes can provide much-needed insight on disparities in pandemic-related outcomes. Using time series data for 2020, we employ pooled panel linear regression to analyze the relationship between policy choices and COVID-19 outcomes. This study uses stringency measures of government policy responses across three dimensions—containment, economic, and health policies—to assess the impact of these policies on COVID-19 cases and deaths. Our results indicate that increased income support and debt relief policies are associated with a reduction in the rate of COVID-19 deaths that lasts up to four weeks, while broad policy interventions are associated with a short-term reduction in the rate of deaths. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Drivers of Digital Pathology Adoption for Clinical Practice: An Experience from a Single Large Academic Institution

Background: Digital pathology has enormous potential to make routine pathology practice more efficient and accurate, however, full adoption has been slow. We aimed to identify driving factors that encourage pathologists to adopt digital pathology for their daily practice at our institution. Design: We have collected data on four indicators of pathologist adoption since the implementation of digital pathology: (1) number of pathologists receiving training and certification for primary diagnosis using digital whole slide images (WSI);(2) average daily number of users logged in imaging managing system (IMS);(3) average daily number of primary diagnosis slides scanned;and (4) average daily number of slides scanned for immediate pathologist use (including consultation, urgent cases, etc.) Since adoption of digital workflow was voluntary and slides were only scanned for pathologists who have indicated to use WSIs for routine practice, these are accurate indicators of pathologists' transition from glass slides to digital workflow. These data were correlated with potential events during the study period. Results: The data of four indicators were summarized in the table. We observed two spikes: the first one was from July to September 2019 and the second was from March to May 2020 (Figure 1). The first spike correlates with our pathology laboratory information system (LIS) transition from Sunquest Copath to Epic Beaker, which enables single-click access to WSIs in IMS from case working drafts. Previously, pathologists had to switch from pathology LIS to IMS and type in case numbers in order to access WSIs. The second spike correlates with the beginning of COVID-19 pandemic when many academic activities transitioned from live to remote using digital platforms. The need to work remotely, conduct education and consultation at distance, and minimize interaction with others appears to have driven many fence-sitting pathologists to adopt digital pathology. CMS waiver to loosen regulatory requirements during this pandemic has hastened pathologists' decision to switch to digital pathology for primary diagnosis. Conclusions: Our data suggests that ease of use and the ability to work remotely are the most powerful drivers of digital pathology adoption. (Table Presented).

IMMEDIATE AND DELAYED REACTIONS AFTER PEANUT INGESTION: A DIAGNOSTIC CHALLENGE

Introduction: Food protein-induced enterocolitis syndrome (FPIES) is a distinct entity from IgE-mediated food allergy. We present a case in which a patient has a history consistent with both diagnoses to a single food allergen. Case Description: An exclusively breast-fed 5-month-old female initially presented with repetitive emesis 2 hours after consumption of egg, which was accompanied by a delayed rash. Given overlap of symptoms, testing was performed as a diagnostic aid for distinguishing between FPIES and IgE mediated food allergy. Egg white IgE was 0.43 ku/L, and peanut IgE was 0.26 ku/L with completely negative components. After counseling and shared decision making, the caregiver was motivated to introduce small amounts of peanut at home during COVID as a preventative intervention for the development of IgE mediated allergy. After peanut ingestion, the infant first had delayed emesis. At a later date, the caregiver gave a reduced dose of peanut and the patient had an immediate reaction of hives and facial edema requiring epinephrine. Discussion: FPIES and IgE-mediated allergy can be differentiated by history with attention to timing and accompanying symptoms. It is known that patients with FPIES can develop IgE antibodies to trigger foods (atypical FPIES), signifying a likelihood of a more protracted FPIES course and transition to acute reactions. In our patient however, peanut ingestion resulted in distinct episodes with both FPIES and IgE-mediated symptoms, perhaps signifying a further need for understanding of the relationship between the two disorders.

EXERCISE INDUCED ANAPHYLAXIS IN AN ADOLESCENT MALE

Introduction: Exercise induced anaphylaxis (EIA) is a rare diagnosis accounting for less than 2% of anaphylaxis cases. Here, we present a patient with multiple episodes of anaphylaxis shortly after exercising with no clear associated triggers. Case Description: A 16-year-old male presented with three separate episodes of anaphylaxis requiring epinephrine, all within thirty minutes of exercise. He did not have recurrence of symptoms with cessation of exercising behaviors. The patient could not link episodes with antecedent food ingestions, and previous food panel testing was only weakly positive to foods he was tolerating without issue. He was started on cetirizine with a working diagnosis of EIA, and workup was initiated for differentials including food dependent exercise induced anaphylaxis (FDEIA), alpha-gal allergy, and mast cell disorders. Due to COVID 19, a formal diagnostic exercise challenge has been delayed. Discussion: Though not well understood, EIA results in mast cell degranulation and anaphylaxis. One hypothesis is that physical activity and dehydration affect plasma osmolarity, leading to mast cell and basophil degranulation. Other mechanisms suggested are acid-base disturbances with gastrin and endogenous opioid release, which act directly on mast cells. Antihistamines are the first-line treatment, while biologics such as omalizumab have also been used. The hallmark symptom is onset shortly after starting exercise. While not common, protocols for fasting exercise challenges have been proposed. Here, we present a probable case in a 16-year-old, illustrating the importance of further understanding for diagnosis and management of EIA.